Drug addiction: 5 things we can learn from Cory Monteith

Drug addiction: 5 things we can learn from Cory Monteith

Hollywood stars, like Glee’s Cory Monteith, aren’t the only Americans struggling with addiction that kills. Monteith, who died of a heroin and alcohol overdose, exemplifies the public health tragedy that is opioid overdose deaths in America. The fact is, there is no greater public health issue.

From as far back as 2008, we have been dying more from poisoning – almost all poisonings are drug overdoses – than we die from car accidents, or any other type of injury. Every community in America – including yours – is being hit hard by prescription drug abuse and opioid overdose deaths. Just how hard? Check out these numbers and graphics from the CDC, available for us all to use.

Drug addiction: 5 things we can learn from Cory Monteith

Most opiate abusers get them from family and friends. To give you an idea of the scope of the problem, an  article from Medscape, as part of an announcement of a new drug for treating opioid dependence, noted: “Americans constitute 4.6% of the world’s population, but consume approximately 80% of the world’s opioid supply.”

That’s a pretty mind-blowing number. But for many of us, when numbers get too big, it’s hard to get our minds around them. Sometimes it takes a story – the talent, and the sweetness, and the struggles to quit – of a person like Monteith, for one death to jerk overwhelming numbers into sharp, human focus. On the exact same day that the coroner announced the cause of Monteith’s death, I got an email from Westley Clark, the Director of the Center for Substance Abuse Treatment, telling me about a new risk of overdose from fentanyl-laced opiates and asking me if I was doing as much as I could to prevent our increasing numbers of overdose deaths.*

As physicians, as providers, as journalists, and as people who just flat out care about the health of those we love and our communities, Monteith’s death is a moment for us all to look around and better understand how this public health crisis can be confronted.

Here are five issues that Monteith’s story may illustrate for your community:

1. Rehab is hard to getYou’d think, with the staggering numbers of overdose deaths we have, there would be a treatment program on every street corner in the U.S. But exactly how many rehab programs are in your area? How many people can each program see in a year? How does this compare to how many people are dying? How long is the wait time to get in and how much does it cost? Do you have to be a celebrity to afford it? If you compare the populations of people in your community (ages and incomes) to this information, what are the rates of treatment versus the rates of death and addiction?

2. Rehab has its own risks. If someone relapses after being abstinent, his or her chances of dying are high, particularly in the first year afterward. One of the main reasons is because a person’s tolerance for the exact same dose of drug has dropped dramatically since he/she last used it. If you succumb to cravings and take that same dose, or even a bit less, you could stop breathing. Rehab can also introduce people to a new group of fellow users. It’s an often discussed, but rarely-written-about risk of going to rehab, particularly when someone has made a social transition away from their old group of contacts who used drugs. What are the rates of overdose death after rehab in your community? Does it vary, based on the program? How does that rate compare to not getting rehab at all?

3. Just talking about substance abuse may not work that well for many kinds of drug addiction.

Drug addiction: 5 things we can learn from Cory Monteith

There is a surprising lack of research about the effectiveness of “talk-based,” or psychosocial rehab. Available studies don’t show impressive results. If someone is like Monteith and started drug use at a young age (or had their first drug arrest young), their opiate dependence is likely to be even harder to treat than usual. Methadone and buprenorphine are both more studied than psychosocial rehab and show reduced rates of overdose deaths. But how hard are those to get in your area? Check out this map of the relatively small numbers of physicians and treatment centers who are licensed to prescribe buprenorphine (left). How does it compare to the CDC’s map of overdose deaths for your area (below)? How many methadone clinics are in your area? What is the wait time to get in? Are their gender differences in success or participation rates? How much would it cost to get buprenorphine if you didn’t have insurance?

4. Overdose prevention preparation works.

Drug addiction: 5 things we can learn from Cory Monteith

Not talking to someone leaving a program about how to prevent overdose death is like refusing to discuss CPR with someone leaving the cardiac care unit. Having a relapse plan is an important part of sustained recovery. People leaving rehab should have access to naloxone (an antidote for opiate overdose), and some basic teaching about how to prevent overdose death: never use alone (not even in a hotel room), don’t mix substances (like heroin and alcohol). Keeping yourself alive allows you to get back into recovery. Are there any overdose prevention programs in your area?

5. There is a journey through addiction. Monteith apparently spent his adolescence on the streets. Undoubtedly, there are kids in your area who are struggling through the same journey – kids who may not survive long enough to make to rehab. Who are they? Who is helping them? If you’re looking for powerful stories, sometimes they are as close as the sidewalk.

*Dr. Clark sent the message to me, specifically, because I am one of a relatively small proportion of physicians (roughly 10,000 nationwide) who have the highly-regulated training and ability and special dispensation to prescribe something called buprenorphine. 

Obligatory conflict of interest notice: I am a salaried employee for one of the nation’s largest departments of public health. My salary does not vary based on either who I see or what I treat. I do not profit in any direct way from the provision, or not, of treatment for opioid dependence. These views expressed here are my own, and are in no way part of the department of public health.

Jan Gurley is an internal medicine physician who blogs at Doc Gurley.

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  • marie-noel salem

    Sounds like the next big public health project… Mind-boggling numbers!

    • Guest

      Yes, let’s pour billions more into a “public health project” to stop people from abusing drugs… we can call it “Just Say No”

      … after all, the CURRENT “War On Drugs” we’ve been pouring taxpayers’ money into over the last 25 years is working so well!

  • http://www.dpsinfo.com LaurieMann

    Individuals need to have some personal responsibility. If you are getting over surgery or an injury and you have opiates, keep them hidden. When you no longer need them, destroy them, don’t leave them in the house.

    • SarahJ89

      Destroying meds that never should have been prescribed is not solution. Part of why we did not fill the two unneeded prescriptions is because have frogs with legs growing out of their heads nowadays from the medications that have been flushed down the toilet.

      • http://www.dpsinfo.com LaurieMann

        When I’ve had leftover pain meds from surgery, I’ve mashed them up in mixed them in the garbage. Maybe a little safer than flushing them down the toilet. But definitely safer than leaving them around when I no longer needed them.

  • Anthony D

    That taking drugs is a choice and not a disease!!!!!!!

  • SarahJ89

    One big factor I see is overprescribing/inconsistent prescribing. My husband and I had two medical events last year. We ended up with a shocking amount of vicodin and oxycontin at our disposal from three prescriptions which were written by doctors who had no knowledge of us and who never discussed the possibility of addiction.

    We only filled one prescription and that only partially. We still have two pills left from that. Between the two of us we were prescribed 70 pills. We used 10 to get through two surgeries and a week of walking around in a loose splint with an unset broken arm. The effects of the pills were so unpleasant it was easier to live with the pain, however excruciating. The pain was surprisingly debilitating to cognition (I would never have put up with a week’s wait to have that arm set had I been in my right mind) but the effect on cognition from the pain killers was even worse.

    In the end we had two scrips for a total of 50 highly addictive pills. Our neighbour is a prescription drug addict. We did not sell the pills to her, but we could have done so very easily and for quite a lot of money.

    Doctors’ blithe prescribing practices are definitely part of the problem.

    • Tamara

      “We did not sell the pills to her, but we could have done so very easily and for quite a lot of money.”

      / / / /

      And hopefully, if you had done, you would have ended up in prison for drug dealing. And if your neighbor had OD’ed and come to harm with the drugs you illegally sold her, I would hope you’d be brought up on manslaughter if not murder charges.

      The doctors are not the problem. The problem is people like you, who would even THINK of illegally diverting that which your doctor has prescribed to YOU to try to help YOU.

      Good grief. If you’re entertaining thoughts of becoming an illegal drug dealer, THAT IS NOT YOUR DOCTOR’S FAULT.

      What next, will you hold your local car yard responsible for your drunk driving?

      • Stacey Friebus

        The point is that they were overprescribed in the first place. It was responsible to use them sparingly and not fill them all. The neighbor could have easily robbed them had they had them filled.

        • SarahJ89

          Thank you Stacey, for seeing my point which Tamara totally missed.

          Tamara, the last time I looked thinking wasn’t a crime. Did you miss the part where we didn’t even FILL the prescriptions? You obviously are heavily invested in blame.

          For your information, the reason my neighbour is a prescription addict is because she injured her shoulder. She lacked health insurance so it was never treated. She was in pain and took addictive painkillers prescribed by doctors who didn’t bother to treat the shoulder. The nerve of her to get addicted.

          It must be nice to live in your tidy little world. Life for the rest of us is a bit messier. And yes, overprescribing doctors who write prescriptions for strangers with an unknown history instead of making a follow up appointment are part of the problem. Anyone who has so much prolonged pain that they need 20 or 30 vicodin after surgery should be seen, not unquestioningly medicated. These ridiculously over done prescriptions we received are obviously standard. Instead of grappling with that fact, you chose to indulge your moral outrage.

          • Guest

            Addiction and psychological dependence are two different issues. Anyone who takes opioid analgesics long term is going to develop a physical dependency — that’s to be expected,and it can be managed. Addiction is a psychological disorder, usually only occurring in those who have underlying psych issues.

            Most people whose pain is treated with opioid analgesics do not become addicts. Don’t abuse the medications you are prescribed, and you won’t become an addict. It’s not helpful to imply that doctors are responsible for a drug addict’s pathological behavior any more than it is to imply that a car salesman or a bartender is responsible for a drunk driver’s speeding death.

  • Pete

    Addiction to illegal drugs is not a disease you catch like the flu. It is a deliberate choice.

    You do it because you want to escape or to be cool or to feel wild & crazy.

    You want to float on Cloud 9 ….. and then when you crash, it is expected that society will put you back together again.

    But in case it has escaped your attention, our healthcare system is going broke — if it is not there already — treating people with ‘legitimate’ diseases, not the least of which are cancer, heart disease, stroke, MS, Alzheimer, etc. etc.

  • IknowmorethanU

    Buprenorphine (Suboxone) works!! Finding the Programs w/ the Doctors to prescribe it is the hard part! Each doctor licensed to prescribe Suboxone can only take 100 patients each to enroll in the programs, which isnt nearly enough considering how many addicts want help via the programs!! Also, it is very, very expensive without insurance considering there isnt a generic form of the medicine yet! Also, yes using drugs is a choice, but addiction is a DISEASE that needs medication just like any other disease such as Heart disease etc.!!!

  • http://warmsocks.wordpress.com/ WarmSocks

    “Americans constitute 4.6% of the world’s population, but consume approximately 80% of the world’s opioid supply.”
    Wow! That is a sad, sad statistic.

    Unfortunately, it wouldn’t matter if there was a rehab facility on every corner. Many people don’t want rehab. They don’t even believe they have a problem.
    One anecdote: my SIL battles with kidney stones — wait, that’s not exactly true. She has kidney stones but refuses to do battle. She won’t drink water or make any dietary changes. Astonishingly enough, she claims that it is the doctor’s job to fix her and she shouldn’t have to do anything. This problem has been going on for years. When she walks into the ER they know she’s there for her IV painkillers and a prescription for pain pills. One month she was there 15 times. She’s also been known to go to urgent care one day, then to ER the next day for another script — without bothering to fill the prescription she already has. However, she has not been to see her internist or urologist in over a year. BUT she does not believe she has a drug problem because she doesn’t fit her preconceived notion of a homeless, smelly drug addict. She believes that since she has a job, home, car, nice clothes, and a physical reason for her pain, that her drug seeking is legitimate. Apparently it’s learned behavior. When she gets together with her mother and sisters, they have a drama party to see who’s in the worst pain. They share their prescription narcotics – thinking it’s not illegal if they’re giving them to family instead of selling them to strangers on the street corner.

    People are ruining their lives with prescription drugs. Confront the problem. Please.

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