DRUG ABUSE

Running head: DRUG ABUSE

Drug Abuse
A Special Look into the Recent Opiate Trend
Shena Poma
SW 3710
Wayne State University

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Abstract
The objective for this research is to discover the truth about drug abuse on a global and national
level. This paper focuses heavily on one of the recent dangerous trends within the drug culture,
opiate abuse. The history of opiates dates back to centuries ago, and the development of opiate
use becoming increasingly popular recently is discussed in detail. The policies created to reverse
this social issue are constantly expanding as we learn even more about the disease of addiction.
America is not alone when it comes to skyrocketing rates of drug use. However, other countries
have taken a different approach to relieving this problem. Some of the other methods are quite
controversial, but that bravery proved to be worth it in the end. According to the statistics, some
of the countries have incorporated treatment methods and policies that seem to be more effective
than ours, and others have failed miserably in the resolution for this social issue. Drugs,
especially opiates, are flooding the schools, stealing our kid's motivation, and cutting people's
lives too short.

Defining the Issue

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3
The purpose of this paper is to dissect one of societys largest current social issues. This
specific issue has a dramatic ripple effect into each and every aspect imaginable. The social issue
I am referring to is drug abuse, specifically opiate drug abuse. Throughout this paper I will
examine the life of an opiate abuser, as well as the statistics, policies, and history regarding this
social issue. I will start exploring the details that fall under this category, but first I must define
the issue. According to The American Pain Society and The American Academy of Pain
Medicine,
Addiction is a neurobiological disease that has genetic, psychosocial, and environmental
factors. It is characterized by one or more of the following behaviors: 1. Poor control
over drug use 2. Compulsive drug use 3. Continued use of a drug despite physical, mental
and/or social harm 4. A craving for the drug (2009, p.101).
The Current Impact of Opiate Substance Abuse
As of 2004, nearly eight percent of the United States population ages twelve years old or
older (19.7 million people) are using illicit drugs, and almost one quarter of the population
confessed to binge drinking (Substance Abuse and Mental Health Services Administration
[SAMHSA], 2005 para.1). According to Avila and Murray (2011), The United States makes up
only 4.6 percent of the world's population, but consumes 80 percent of its opioids -- and 99
percent of the world's hydrocodone, the opiate that is in Vicodin (para.2)
Demographics
Substance abuse is a disease that does not discriminate. It is difficult to pinpoint the exact
demographics of this issue because it still holds a negative connotation, and users hide their
abuse in order to not lose their jobs, disappoint loved ones, be imprisoned, or admit it to

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themselves. Once you admit it to yourself, it becomes more real, and much more difficult to

justify continuing to use. The common method used to produce the most accurate results when
determining the demographics of chemically dependent individuals is to keep track of the
individuals seeking treatment. Obviously this method is never going to be exact, but it allows us
to make general assumptions. Some of the statistics researchers have gathered came as quite a
shock to me. It proved to me even more how dangerous this epidemic of opioid prescription pills
has really become, and how this prescription pill movement has truly affected each and every
aspect of our nation.
The Substance Abuse and Mental Health Services Administration (SAMHSA), stated that
as of 2011, over 22.5 million people ages twelve or older, had used an illegal substance at least
once in the last month (SAMHSA, 2011 para. 1). The survey that SAMSHA administers is called
the National Survey on Drug Use and Health (NSDUH), and it includes using a traditional
survey method in combination of looking over the treatment centers records. The 2011 survey
concluded,
Among those who used pain relievers non medically in the past 12 months, 54.2 percent
got the drug they most recently used from a friend or relative for free. Another 18.1
percent reported they got the drug from one doctor. Only 3.9 percent got pain relievers
from a drug dealer or other stranger, and 0.3 percent bought them on the Internet. Among
those who reported getting the pain relievers from a friend or relative for free, 81.6
percent reported in a follow-up question that the friend or relative had obtained the drugs
from just one doctor (NSDUH, 2011, p.2).
The rise in opiate prescription pills has consequently influenced the rate of heroin use,
which has, and continues, to skyrocket. At the end of 2011, the amount of people who admittedly

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used heroin within that year was nearly 620,000 people, which has more than doubled since

2007. According to National Institute of Drug Abuse,

In 2008 the demographics of treatment for substance abuse included about 60 percent of
admissions were White, 21 percent were African-American, and 14 percent were
Hispanic or Latino. Another 2.3 percent were American Indian or Alaska Native, and 1
percent were Asian/Pacific Islander. The age range with the highest proportion of
treatment admissions was the 2529 group at 14.8 percent, followed by those 2024 at
14.4 percent and those 4044 at 12.6 percent. The age range with the highest proportion
of treatment admissions was the 2529 group at 14.8 percent, followed by those 2024 at
14.4 percent and those 4044 at 12.6 percent (Bose, 2011 p.3-4).
The National Institute of Drug Abuse also included the percentage of drug and alcohol
choice for those in treatment. The drug that drove majority of these individuals to seek
professional help was opiates, either heroin or prescription pills, at twenty percent (Bose, 2011
para.5).
Historical Overview
According to David Courtwright, professor and chair of the Department of History,
University of North Florida, and member of the Committee for the Substance Abuse Coverage
Study, the nineteenth century did not acquire any serious laws regarding narcotics. There were
several variations of derivatives from opium which were handed out freely without even a
second thought. Some states discouraged the sale of narcotics, or the smoking of opium, but
these were loosely enforced. Opiates were as easily accessible as a carton of milk, and
pharmacists would even deliver vials of morphine to homes much like you would order a pizza
now-a-days. There were a limited amount of medication to ease the patients symptoms, and

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medications that were derived from opium were abundant and powerful. Opiates were able to

subside almost all imaginable symptoms, and to top it off, it produced a euphoric high that
temporarily created a false sense of happiness. Physicians felt that they had the miracle cure, and
an opiate prescription was prescribed for almost any patient complaint. By the time they realized
how serious medications infused with opium really were, there were nearly 300,000 opiates
addicts towards the end of the nineteenth century. Courtwright estimates that currently there are
over 500,000 opiate addicts in America, with majority of them being heroin addicts
(Courtwright, 1992, p.2). Towards the end of the nineteenth century into the early twentieth
century, a common thought was that using opiates was classier than drinking alcohol, making it
much more socially acceptable. The opiate medication provided a way of feeling a buzz that was
seen as more controllable than drinking which leads to drunkenness, irresponsible decision
making, and inability to control themselves. David Courtwright stated that Surveys taken in the
late nineteenth century consistently showed that two-thirds of those addicted to medicinal
opiates, such as laudanum or morphine sulfate, were female (1992, p.3). The Civil War (18611865) was the start of opiate use being a social concern in the nation (Joseph, Stancliff, and
Langrod, 2000 para.3).
Although most medical professionals in the late 1800s ignored addiction, there were
several revolutionary physicians who saw the dangers of opium, and the dramtic increase in the
population of opiate users. They saw how these drugs affected people from all over the globe,
especially in America. These physicians started to specialized in addiction, and as they built up
experience, theories began to be developed to explain addiction. During the 1870s-1880s, the
theory of addiction being a neurological disorder, which still has not been perfected over 100
years later, was first openly discussed within the medical field. The notion that alcoholism and
addiction were related also came about during this time period. It was thought that both were

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nervous disorders, which that referred to as inebriety, hence the current term inebriated

(Courtwright, 1992, p.4).

The following decades, from 1923-1965, was commonly referred to as the classic era of
narcotic control (Courtwright, 1992 p.1). By this time the government had immersed
themselves into societal issues, such as narcotic abuse. The government demanded that the law
enforcement was strict with addicts, and that crimes involving drugs were to be harshly
punished. Unfortunately, during this time there were very little resources, or treatment options
for those who were struggling with addiction. Over time people noticed that punishing addicts
did not lower the recidivism rates, however, they discovered that treating addiction was found to
be the most successful method for preventing relapse.
A major key player in the anti-drug movement was none other than the fortieth American
president, Ronald Wilson Reagan, and his wife, the first lady, Nancy. After witnessing more than
enough suffering due to this social issue of such great magnitude, the couple prepared a speech
that would revolutionize the war on drugs, by starting with a simple motto:Just Say No. The
national speech took place on September 14th 1986, Reagan stated,
Now you can see why drug abuse concerns every one of usall the American family.
Drugs steal away so much. They take and take, until finally every time a drug goes into a
child, something else is forced outlike love and hope and trust and confidence. Drugs
take away the dream from every child's heart and replace it with a nightmare, and it's
time we in America stand up and replace those dreams (Miller Center, 2013 para.11).
Reagan dedicated much of his speech focusing on the future of our nation, the young people. He
addressed the youth by saying,

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And finally, to young people watching or listening, I have a very personal message for
you: There's a big, wonderful world out there for you. It belongs to you. It's exciting and
stimulating and rewarding. Don't cheat yourselves out of this promise. Our country needs
you, but it needs you to be clear-eyed and clear-minded. I recently read one teenager's
story. She's now determined to stay clean but was once strung out on several drugs. What
she remembered most clearly about her recovery was that during the time she was on
drugs everything appeared to her in shades of black and gray and after her treatment she
was able to see colors again. So, to my young friends out there: Life can be great, but not
when you can't see it. So, open your eyes to life: to see it in the vivid colors that God
gave us as a precious gift to His children, to enjoy life to the fullest, and to make it count.
Say yes to your life. And when it comes to drugs and alcohol just say no (Miller Center,
2013 para.13-14).
After the president sparked the publics interest in the social issue, he proposed six
initiatives to attain the goal of a drug-free nation. The initiatives he discussed in the speech
included a drug-free workplace and school system, protect the public, make treatment available
for addicts, expand international cooperation in treating drug trafficking as a threat to national
security, strengthen law enforcement activities, and expand public awareness and prevention
(Miller Center, 2013 para.17). He insisted that everyone get involved in this crusade, and work
towards removing the negative stigma attached to drug addiction. Reagan asks the public to
extend their hands to others suffering from addiction, rather than turning their backs on them.
Although the war on drugs has reached a whole new level of epidemic proportions, his
dedication to work endlessly to protect the nation from the adverse effects that is guaranteed to
follow drug abuse was inspiring and provided America will a sturdy foundation and helpful
stepping stones to future endeavors in curtailing this social issue.

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Policies & Services to Address the Problem

The policies that have been passed to relieve the current substance abuse issue are
continuously changing as the drug culture undergoes constant changes. The history of narcotic
policies is a great example of trail-and-error.
The 911 Good Samaritan Law was developed to protect "good Samaritans" who present
pure intentions from possibly being sued or charged with negligence if an error occurs while
attempting to aid or rescue a stranger in an apparent emergency (Good Samaritan Doctrine, 2008
para.1). The purpose of this law is to encourage bystanders to provide emergency assistance if
necessary by removing the ability to hold them liable if an accident occurs during assistance. A
recent addition to the Good Samaritan Law is those who witness and assist someone
experiencing a drug overdose will be guaranteed to not be criminally charged with anything
related, such as possession of narcotics (Drug Policy Alliance, 2013, para. 1).
A second policy that has been set forth to lower the ability to access prescription pills is
Prescription-Take-Back days. There are several pre-determined dates that are respected across
the nation where people can take old unused prescriptions to designated locations to ensure the
leftover pills are not able to be taken and spread within the school systems or on the streets. The
locations are typically police or fire departments where the collection is closely monitored and
responsibly disposed of at the end of the day. The authorities promise that a "no questions asked"
policy will be used during the visit, and that they have no intention of jailing the participants.
The Prescription-Take-Back days are solely enacted to increase the safety of our society by
working to decrease the amount of unused prescription pills available for others to abuse.
Another example of a dedicated day set aside to promote drug awareness is the International
Overdose Awareness Day (August 31st). The focus of this day is to educate people on the proper

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steps to take when attempting to revive someone who is overdosing on drugs.

10

One of the most effective methods to reversing an opiate overdose is to quickly

administer an antidote for opiates called naloxone. According to an article found on Huffinton
Post under the addiction category, "Studies have shown it can cut overdose death rates by 50
percent, yet only 11 states have enacted laws giving legal protection to those who administer the
drug(Wing,2013 para.7).
The recent uproar of elevating drug abuse rates, especially opiate based narcotics, have
motivated scientists to develop numerous types of maintenance drugs. Methadone is a synthetic
narcotic that was introduced to the public in the 1960's to assist opioid dependent addicts with
the withdrawal process or reduce the likelihood of recidivism. This medication generally entails
the patient visiting a Methadone Maintenance Program (MMP), which is a designated clinic
where a medical professional can monitor the patient and manipulate the dosage based on current
factors. It has helped many addicts to improve their lives by allowing them to be employable
productive members of society again. It has been successful in many cases, however, methadone
dependency can be nearly as brutal as heroin. The withdrawal is severe and the duration is much
longer than other opiates. The development of methadone was only the first of many stepping
stones to the current maintenance drugs and programs available today. The next maintenance
drug to be introduced to the public is buprenorphine, or its brand name Suboxone .
Buprenorphine is a partial agonist that blocks the natural opioid receptor in the brain (National
Institute on Drug Abuse, 2005 para.4). The Drug Addiction Treatment Act of 2000 (Title XXXV,
Section 3502) provides guidelines and restrictions for physicians who are able to prescribe
Suboxone. The physician must met certain educational criteria, and fill out a waiver. The
physician is only allowed to treat no more than thirty patients at a time during the first year.

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Once that year is finished they are given the option to fill out a second waiver to expand the

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number of patients they are legally allowed to treat at a time to one hundred (NIDA, 2005
para.4).
The drug policy that has created a stir globally within the last decade is the heroin
assisted treatment (HAT) and heroin maintenance treatment (HMT). These programs provide
patients with pharmaceutical heroin, otherwise known as diacetylmorphine, to individuals whose
treatment track record is anything but successful (Ralston, 2013 para.8). Once they are accepted,
the addict will visit the clinic up to three times a day where they are professional injected with
tested heroin and observed. The patient is instructed to attend multiple types of therapeutic
services available to them by the clinic, and refusal to do so will be likely to end in termination
of services from the entire clinic. These services are helpful in the recovery of the patient and
their mental health. To many people this many sound like absolute ludacris, but once you look at
the countries who have already incorporated this way of treatment and the positive results it has
produced, the idea starts to make a bit more sense. Meghan Ralston had this to say about the
reality of the HAT and HMT programs,
These programs are predicated on the knowledge that some people, despite numerous
efforts, cannot or will not stop using heroin and that their continued use in unsupervised
settings creates costs related to arrests and incarceration, increased healthcare expenses,
supporting the illicit drug trade, overdose, and loss of employment and housing
(Ralston, 2013 para.5).
The laws regarding the development and explanation of the tool, Prescription Drug
Monitoring Programs (PDMPs) are critical in the reduction of doctor shopping. Doctor
shopping describes the action of an individual who visits multiple physicians to manipulate

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receiving several prescriptions without detection. This act is one of the several reasons the

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prescription pill epidemic has reached such enormity. According to the Office of National Drug
Control Policy, currently the PDMP policies have been passed in 35 states, and 11 states are in
the process of authorizing the creation of this tool (2011, para. 7). The ONDCP is hopeful that
eventually all of the states will pass policies to enact the PDMP, which will make the tool even
more effective.
The past beliefs about substance abuse treatment was that an abstinent only model should
be used for a patient's recovery. The twelve step programs such as AA and NA are adamant about
not needing medication to quit using drugs. However, the relapse rates for these programs are
exceedingly high, which suggests that this method is flawed. The fact of the matter is that
everyone's treatment plan should not be the same because methods that work for one addict may
not work for another. The approach should be individualized to best fit the individual to
minimize the likelihood of relapse.
Global Perspective
America is not the only country that is facing an overwhelming amount of drug abuse
rates. However, the differences within the countries lie behind the reaction and treatment of the
national issue. One of the countries that has encountered a major drug issue mainly because of
their location is Iran.
According to Devito, the director for the Iran180 outreach,
Iran does face a daunting drug problem. Being a neighbor to the world's largest poppy
growers in Afghanistan does not help, as Iran sees much of the world's heroin supply
travel through its territory. However, Iran isn't simply a transit point. By most estimates

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the country has one of the highest rates of heroin and opium addiction in the world
(Devito, 2012 para.2).
Iran implemented some of the same of the same progressive drug prevention and treatment
programs as many other countries, such as methadone clinics and needle-exchange programs.
However, there is one policy unparticular that sets Iran apart from other countries in their drug
prevention efforts, the draconian measure. In 2010 Iran passed this policy which lowered the
amount of narcotics an offender must be caught with to be sentenced to death. In 2011, one year
later, the Iranian authorities executed more than 600 people, and of those deaths, more than
eighty percent were drug related offenses (Schleifer, 2013 para.3)
The second country with a different perspective on how to handle the current drug issue
is Switzerland. The policy they developed was one that created a global controversy and a
national heated debate, which didn't stop them from implementing the heroin assisted treatment
(HAT) programs. Switzerland was the first to pioneer the heroin clinic in 1994, which allowed
the addicts to have a safe place to be prescribed and inject pure grade heroin (Ribeaud, 2004
p.163-194). Many people claimed that handing heroin addicts heroin for treatment is absurd, but
decades later the statistics show it has been a very successful program. The approach Switzerland
took is referred to as a harm reduction approach. According to the Beckley Foundation, Upon
admission to the HAT, 73% of the addicts were unemployed and 69% were funding their habit
via an illegal income. After 18 months of treatment, the figures dropped dramatically, to 45%
and 11%, respectively (Beckley Foundation, 2013 para.1). The Report of the Global
Commission on Drug Policy stated that,
In Switzerland, the government responded to the burgeoning HIV epidemic among
injection drug users in the 1980s by implementing innovative policies that provided clean

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14
syringes, supervised injecting facilities, easily accessible methadone therapy, heroin
prescription and antiretroviral treatment. This strategy has led to a marked reduction in
the number of new HIV infections linked to drug injection, from an estimated 68 percent
in 1985 to about 15 percent in 1997 and about 5 percent in 2009 (Report of Global
Commission on Drug Policy, 2012 p.8).
The third country that took a different approach to this social issue is Russia. The
treatment methods and resources available for addicts in Russia is limited and harsh. Majority of
the industrialized nations now treat addiction as any other disease, and they have several
resources for struggling addicts to receive treatment. These countries typically handle the disease
of addiction with compassion and empathy, and they are open to change the policies if the
current approach is not working. However, Russia is not one of those countries. Russia still
remains cold to this issue. The treatment model is one that has only one option for addicts:
prison.
According to Andrey Rylkov Foundation, nearly one in three people in Russia's prison
system are there for drug related offenses (Ivan, 2012 para. 2). Although there has been
intensive evidence based research based on long term maintenance treatment such as methadone
being effective, it is still illegal in a few countries, one being Russia (G.C.O.D., 2012 p. 10) The
three treatment centers provided by Russia are the only hope for the two million registered
alcoholics and almost two million intravenous drug users in Russia (NZ Drug Foundation, 2009
para. 17). The women who are either pregnant or have children at home, risk the chance of
losing all custodial rights if they seek help from a Russia treatment center (Andrey Rylkov
Foundation, 2012 para.2). Authorities Test College aged students for narcotics, and if they fail
the drug test they will be forced to register as a drug addict. When you are registered as a drug

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addict, you are likely to be expelled from school, shunned from the community, and have an

15

extremely difficult time finding employment. These policies implant fear into the addicts, and
receiving treatment may seem like more of an unpleasant option that continuing to use.
Unfortunately, Russia's population of drug users are still among the highest across the globe, and
the statistics confirm that Russia's way of dealing with this social issue is ineffective and
harmful.
Impact of Social Perception
The public still holds onto the negative stigma that was leeched onto all mental health
issues, especially substance abuse. The hold on this view has eased up a bit over the last few
decades, but addiction still makes people uncomfortable. The common thought that drug addicts
are all old men who are bums living under a bridge in the ghetto, could not be farther from the
truth. The new face of addiction is young white suburban kids who most likely received good
grades and played sports. Although research has proved that addiction is a disease, the media still
occasionally portrays an addict as someone with weak will power and choosing to do drugs. I am
a recovering heroin addict, with a little over three years sober. My father is like millions of other
Americans in the sense that he is uneducated in addiction, and therefore, holds a negative
connotation of this issue and believes things about addicts and addiction that are not true. Drug
awareness is key in breaking the stigma. I am involved in the non-profit organization called
Families against Narcotics (F.A.N.) where I am granted the opportunity to travel to schools,
hospitals, and conferences to share my story and educate the public on addiction.
The negative stigma placed beside this issue resulted in a lack of action in the past to
correct it. The result of that is what we are seeing now, a growing epidemic that shows no sign of
stopping in the near future. The last few decades have made headway in the policies and

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programs set up to handle the substance abuse issue, but we are still far from the finish line. The
overwhelming amount of people affected by this social issue have led to the development of new
policies, programs, and treatment methods.
My Beliefs about Opiate Abuse
I place much of the blame for this social issue on the large pharmaceutical companies.
The overabundance of unnecessary prescriptions that are constantly being written, especially for
opiates, is preposterous. Our society has become so dependent on pills to instantly fix any
problem they may be experiencing, that it is not surprising that this issue has affected so many
people. The younger generation see their parents and grandmother take pills when they feel pain
or cannot sleep, so when it comes time that they are offered pills from a classmate the shock
value of these drugs has been dulled. Children imitate the adults they are surrounded with, and
many adults underestimate a child's ability to pick up on behaviors. No to mention, the
accessibility of narcotics has become so easy. The school systems around the nation are now
filled with teenagers exchanging the prescription pills they found in the medicine cabinet at
home. I was addicted to opiate prescription pills throughout majority of my high school years,
and I was never unable to find someone at school carrying pills to sell to other students. It has
been brought to my attention that the drug issue within the schools has become much worse
since I graduated six years ago.
I believe that America should observe the treatment models used in other countries to see
which are effective or not, and build policies and programs around those results. It appears to me
that harm reduction works the best so far, and hopefully America will jump on board with that
approach soon. When you receive treatment from an accredited rehabilitation center in our
nation, you are programmed to achieve complete abstinence from all substances. Abstinence is

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great, but it is unrealistic for many addicts. It is time for America to step away from the

17

traditional methods of viewing and treating drug addiction, and be more accepting towards
change.
Values and Ethics
The National Association of Social Work (NASW) Code of Ethics includes a variety of
values and codes in which professional social workers are expected to adhere. The code that
comes to mind when discussing this social issue is 4.02 Discrimination. The Discrimination code
mentions a list of characteristics that professional social workers are mandated to not
discriminate an individual for possessing. One of the factors encompassed in that list is mental
disabilities (NASW, 2013 para.3). The disease of addiction is now professionally recognized as
being a mental disorder, and as a social worker you are to treat clients with substance abuse
issues as any other client or human being.
The second code that ties into the treatment of clients with substance abuse other than the
Discrimination code is the 2.01 Respect code. This code discusses the importance of treating
clients with a variety of characteristics and medical or social issues, such as mental disabilities,
with respect and providing everyone with equal services (NASW, 2013, para.2).
Conclusion
In summary, drug abuse is a social issue that has spiraled out of control. Drug abuse is
nothing new to our nation, or other nations around the globe, but the issue continues to become
increasingly concerning. Other countries have tried new methods of treatment for substance
abuse, with some of them proving to be effective. America is holding onto a traditional abstience
model for treatment, which can be unrealistic for some addicts, and has an extremely high rate of

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relapse. It is time for America to undergo major changes when it comes to drug policies and
programs. Like they say in AA, We shall look for progress, not for perfection (the Twelve
Steps and Twelve Traditions, 1952, p.91).
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