Addiction's Grip On The Brain: "It's A Matter Of Their Biology"
Today, we meet Darryl Inaba. He’s a Doctor of Clinical Pharmacy and co-author of “Uppers, Downers, All Arounders,” a book on addiction and the brain that’s widely used as a training text. He says while the belated recognition of prescription opioid addiction is reducing the number of new addicts, not enough is being done to help those already hooked.
Inaba understands the push for what’s known in the medical field as “compassionate pain management.” But he says he realized some years ago that the movement to provide patients with adequate pain relief had backfired.
Darryl Inaba: "My God, doctors are over-prescribing these things, they’re addicting people. They’re creating junkies out of law-abiding, decent people who now have to find their opiates on the street."
Inaba says a contributing factor was the pharmaceutical industry’s successful efforts to persuade federal regulators to allow opioid drugs such as OxyContin and Vicodin to be made in doses many times stronger. For example, he says, "We have Vicodin, hydrocodone, which is classically in only 5 milligrams. Now it’s 80 milligrams and 120, so there was a whole promotion that these could be safely used and not addicting."
It didn’t turn out that way. During the 2000s, communities across the US saw spiraling rates of addiction to prescription painkillers – and of deaths from overdose of those drugs. Between 2000 and 2012, nearly 4,200 Oregonians died from overdoses. And while OD deaths peaked several years ago, the death rate in 2012 was still four times higher than at the beginning of the decade.
Darryl Inaba says natural opiates such as heroin – and their synthetic opioid cousins – are so powerfully addictive because they mimic the body’s own pain-killing and stress-fighting chemicals.
Darryl Inaba: "And when they do so, your brain mistakes that it has enough balance of those chemicals and it turns off its own chemicals."
When that happens, Inaba says, "Your brain becomes imbalanced in chemicals, so that you need to keep taking the opiates just to function as a human being."
Over the past several years, efforts to dry up that flood of pills have led to fewer people dying from prescription drug overdoses. Most doctors aren’t writing prescriptions as freely, and insurance companies are limiting how long they’ll pay for them.
But making it harder to obtain these legal opioids hasn’t helped the patients who are already addicted. And they often turn to heroin, which can be easier to get – and cheaper – than prescription pain pills.
While overdose deaths from opioid painkillers have started to decline, heroin O-Ds continue to rise.
Inaba says efforts to fight the opioid addiction epidemic haven’t translated into enough support for treatment programs such as the ARC in Medford, where Inaba is Director of Clinical and Behavioral Health Services.
Darryl Inaba: "At the Addictions Recovery Center we have a three to four month waiting list to get into residential treatment and a lot of men on that waiting list are suffering from tremendous opiate addiction. What that means is that many are going to die before they get in, many are going to get incarcerated before they get in and many are just going to give up and they’ll continue to use."
Inaba says it’s time to re-think a common social judgment that says addicts are weak-willed, losers who caused their own problems and don’t deserve public help. "Society has to realize that it’s not a matter of choice for these people. It’s a matter of their biology," maintains Inaba.
He says creating more opportunities for addicts to get help is not only the compassionate thing to do, it makes economic sense, too.
Darryl Inaba: "It costs us what? Maybe $40,000 or $50,000 dollars a year to keep somebody in jail? If we gave that person $5,000 of outpatient treatment wed’ get much better outcomes and they fare much better and society fares much better and there’s less criminal recidivism."
For Inaba, the bottom line is that addicts aren’t some anonymous “other” whose suffering we can ignore.
Darryl Inaba: "They’re your children. They’re your spouse. They’re your doctor. They’re your minister. They’re your judge. Addiction crosses all lines because of its biology, not because of what the choices are."
Next, in the final part of our series, we’ll talk to a recovering addict about how she got hooked, what addiction did to her life, and her struggle to get clean.