Misinformation and unknowns
fuel new dependencies
Few people had heard of East Liverpool, Ohio until an image went viral last September, showing two adults passed out in the front seat of an SUV, with a 4-year-old boy in the back. Posted by the local police department on social media, the photo came to symbolize the face of opioid addiction in America.
But the problem goes far beyond small-town America. Today, drug overdoses kill more people than gun homicides and car crashes combined. Together with other unintentional injuries, they rank as the fourth leading cause of death (behind heart disease, cancer and respiratory disease).
In 2016 alone, nearly as many Americans lost their lives to substance abuse as died in the entirety of the Vietnam War. In 2015, there were more drug-related fatalities than deaths from HIV/AIDS at that disease’s 1995 peak. With opioids accounting for more than 60 percent of all overdose fatalities, it’s clear that we are in the grip of nothing less than a national epidemic that affects every part of the country.
“More than 70 percent of our patients come from suburban communities, and I see the largest epidemic with suburban children,” said Phillip Milgram, medical director of a drug treatment facility in San Diego. “This is no longer a problem that only street dealers face. Now the problem is with your fifth-grade child. This is an issue that has to be brought out into the open.”
Opioids just the beginning
In late March, the White House issued an executive order calling for creation of a commission to investigate ways of combating drug addiction, especially opiates. While the United States comprises five percent of the world’s population, it now accounts for a staggering 80 percent of global prescription opioid consumption.
Other popular substances are raising questions as well, precisely because their long-term health impact is not yet known. Public health officials are voicing particular concern over growing marijuana use, with more and more states having legalized the drug in one form or another.
“The common denominator is this idea of highly addictive substances as medicinal, whether you’re using opioids for chronic pain, marijuana for medical conditions or e-cigarettes to quit smoking,” said Anna Lembke, chief of addiction medicine at Stanford University School of Medicine. “That’s the story being told, and I think it’s a dangerous one, because these kinds of narratives have a powerful impact on how consumers perceive risk.”
Marijuana’s troubling unknowns
Information is often mixed when it comes to the long-term safety and efficacy of marijuana.
While some studies suggest cannabis is effective for treatment of chronic pain or nausea following chemotherapy, other studies say its effectiveness for other medical problems—such as anxiety and epilepsy—is still unclear.
“There has not been enough research to show whether there are safe—or not safe—options for marijuana use,” said Erica Peters, director of marijuana research within the Battelle Public Health Center for Substance Use Research.
In the two decades since California first legalized marijuana for medical use, 28 other states and the District of Columbia have followed suit. In 2012, Colorado joined Washington State in allowing marijuana for recreational use. A total of eight states and the District of Columbia now have legalized recreational marijuana use.
Rehabilitation professionals, meanwhile, say new strains of marijuana in a largely unregulated industry are complicating their therapeutic efforts.
“I see the casualties of these substances every day,” said Bruce Cameron, a drug treatment counselor in the Dallas area.
“New strains are so potent now, and bud from indoor ‘grows’ shows an increased psychological withdrawal for smokers,” Cameron said. “Dabs and oil are the worst form of this and intensify this effect. Research needs to show the unpredictable, and selective, effects of this hallucinogen.”
Troubling questions remain about marijuana’s long-term impact on:
- * Youth, older adults and pregnant and breastfeeding women, especially those using it daily or almost daily
- * Cancer, respiratory and heart conditions, motor vehicle crashes, learning, memory and attention problems and mental illness
- * Secondhand smoke exposure
- * Other drug use, such as tobacco and alcohol
New products, new challenges
Not only is the information mixed on the health impact of marijuana, but growth of the $1.5 billion a year e-cigarette industry also is threatening decades of progress in shrinking cigarette use—particularly among young people. While older users report using e-cigarettes as a cessation device, the use of e-cigarettes and other nicotine products by under-18-year-olds has jumped significantly, driven by curiosity and a desire to avoid indoor smoking restrictions.
E-cigarettes have soared in popularity. One in five adult smokers—and 24 percent of high school students—have tried these alternative products.
Hundreds of e-cigarette brands come in thousands of flavors, with more coming to market each month.
Are their chemical ingredients—metals, formaldehyde and diacetyl—linked to asthma, strokes, heart disease, diabetes and cancer? No definitive science has yet answered that critical question.
“Unfortunately, it’s like changing seats on the Titanic,” said Alan Cavaiola, a psychologist who heads the addiction studies program at Monmouth University in New Jersey, referring to the prevalence of risk despite the medium or mode. “The marketing appears to be directed at kids—with all the flavors being offered, more young people are becoming smokers.”
Among all age groups, there’s a common assumption that e-cigarettes are safer than traditional cigarettes. Researchers are only now beginning to understand their long-term health consequences. And while e-cigarettes don’t contain tobacco, the nicotine in them is a critical concern in connection with young people, who may be more vulnerable to its addictive impact.
Seeds of an epidemic
the turning points in opioid use
Civil War veterans treated with morphine were already hooked on opioids in the latter half of the 19th century.
Commercial heroin production began as the perceived wonder drug was used as a cough suppressant and pain reliever.
World War I veterans returning from overseas were treated with opiates to help relieve pain, even for minor ailments.
Heroin became illegal in the United States
Doctors struggling to treat severely injured World War II soldiers used opioids to manage pain in lieu of surgery.
Soldiers returning from Vietnam created a surge in heroin use.
1980s + 1990s
Physicians faced complaints they were undertreating pain.
More than 8,200 people died from opioid overdose in the U.S.
A patient suit found a California doctor guilty of recklessness and abuse for not prescribing sufficient pain medication.
The government began cracking down on pharmacists and doctors for over-prescribing opioid pain killers, thus pushing users to illegal heroin.
U.S. deaths from opioid overdose (over 33,000) nearly equaled car crash fatalities, while those from heroin (12,989) outnumbered gun homicides (11,208).
A survey in Utah found roughly 80 percent of heroin users started with prescription drugs.
Uniform, validated research needed
As the world’s largest independent research-and-development nonprofit, Battelle is studying the impact of marijuana, tobacco and nicotine products, including e-cigarettes.
“There is a strong connection between marijuana use and tobacco use—almost 70 percent of adults who use marijuana also use tobacco,” said Peters. “[But] because marijuana and tobacco use are connected, it is hard to disentangle what negative health effects can be attributed to marijuana use alone.” Amid such unknowns, there is an essential need for research along accelerated timelines that can keep pace with marijuana and e-cigarettes’ rapid proliferation into the marketplace.
Such research, experts say, can’t come too soon. That’s the lesson of the opioid epidemic.
“No one is immune,” said Lembke of Stanford. “You can grow up in a wonderful, loving family, you can be socioeconomically privileged [or] poor, but the bottom line is that anybody can become addicted.”