Drug and Substance Abuse

Dr. Marc Siegel: Treat opioid abusers, don't jail them

Marc Siegel

Last week, Attorney General Jeff Sessions announced his intention to seek harsher penalties for criminal activity involving opioids. On the surface this would seem logical, as a large extent of the opioid epidemic involves criminal activity. But, unfortunately, there is no evidence that stiffer penalties will stem the tide of abuse and overdose. In fact, a National Institutes of Health study published in the Journal of the American Medical Association in 2009 concluded that treating the addiction that led to the criminal behavior not only improved public health, but also reduced criminality.

Treatment involves effective medication such as Suboxone (naloxone and buprenorphine) or methadone, but it can help only with the physical addiction. The disease goes much deeper. Lasting cures are tied to 12-step rehabilitation programs, peer-to-peer counseling and having something to live for. Alicia Reddy, the registered nurse known as the Addiction Angel of Staten Island, tells the story of one addict who couldn’t kick his heroin habit until his 7-month-old daughter required recurrent operations for her malformed bowels. Being there for her gave him something to live for, and this change in focus enabled him to rise to a cure.

Clearly, heroin abuse is steeped in a criminal culture. But the abuse itself is a disease. It can stop your breathing or give you a life-threatening infection, a truth that was brought home last week when the Centers for Disease Control and Prevention reported that hepatitis C infections tripled from 2010 to 2015, and that injection drug use, including heroin, was a primary cause.

Since four out of five cases of heroin abuse begin with prescription opioids, physicians — especially primary care doctors like myself — have to make sure we know what we are treating. Back pain, for example, is often muscular, and may not require prescription opioid painkillers in the first place. It may respond well to heat or muscle relaxants or ibuprofen or chiropractic or acupuncture. Medical marijuana has uses for pain that need to be further explored. New drugs that target non-opiate receptors in the brain and avoid the addiction centers are in the pipeline.

Doctors need more education, beginning in medical school, on properly diagnosing and treating pain. It’s one thing to prescribe Percocet or Vicodin or codeine after an operation or procedure or for cancer pain. It’s another to knee-jerk a prescription for muscle pain. A program such as I Stop in NY State, which requires physicians to record their prescriptions of DEA-controlled drugs on a state website, helps to limit over-prescriptions that lead to addiction.

Our war veterans, more than half of whom the VA says are afflicted by chronic pain, elicit our compassion and help us see opioid addiction as a disease, not a crime. The Center for Ethics and Rule of Law reported that the number of veterans addicted to opioids rose 55 percent, to 68,000, between 2010 and 2015.

“Far too many war-wounded succumbed not just to the bullets of the enemy, but to the opiates intended to ease their suffering,” said Bill Morgan, the White House chiropractor for 16 years and a military veteran himself who worked at Bethesda Naval and Walter Reed Military Medical Centers during the darkest days of the wars in Iraq and Afghanistan.

“Nothing is more tragic than nursing a wounded soldier back from near death for over two years, only to lose him to an opiate overdose. No soldier should ever survive the wounds of combat only to die from the medications prescribed by their well-intentioned countrymen.” 

Morgan provides chiropractic treatment as an alternative, as a way to wean patients from their addiction or to prevent it in the first place. Referring to opioids, he said, “Nothing is easier for a doctor than to give a medicine with no therapeutic value which take away the patient’s complaints.”

The solution to opioid addiction isn’t locking up the addicts. It’s getting them effective treatment. Clamping down on the dealers and suppliers and tightening the border to thwart Fentanyl and heroin trafficking are one thing, but clamping down on the abusers themselves is another.

They are victims. They generally belong in treatment centers, not in jail.

Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He has been a medical analyst and reporter for Fox News since 2008.