Although the drugs of choice and rates of use may differ around the world, substance abuse is a global problem that all countries must confront. Societies have multiple goals when addressing the issue, such as maintaining a healthy workforce and reducing crime.
In many places, the problem currently demanding the most attention is that of drug overdose. This is especially true in the United States, home to four percent of the world’s population and 27 percent of the drug-related fatalities.1 These are most often linked to opioid drugs like prescription painkillers and heroin. Drug overdoses are the leading cause of death for people under 50 in the US, and the opioid epidemic has been labeled the deadliest drug crisis in American history.2
Limiting Access to Drugs
Governments often begin tackling the drug problem by attempting to reduce the supply and making drugs harder to obtain. In the US, prescription painkillers may be easier to find legally than they are in many other countries because of the nature of the healthcare system. People addicted to opioids sometimes engage in “doctor-shopping,” going from one to another seeking medication. This is more difficult to do in European countries and others with universal healthcare systems where patient records are integrated.
Limiting access to drugs can be helpful, but it isn’t enough on its own to solve the problem. It doesn’t address the issue of people who’ve already become addicted or the needs of chronic pain patients. Often, limiting the supply of one drug simply leads to increased usage of another. It’s very common for people who’ve become addicted to prescription painkillers to switch to heroin. They may also substitute one prescription product for another.
Treating Drug Abuse as a Medical Issue
Governments often feel a tension between treating drug abuse as a criminal or medical issue, since they must decide how to allocate limited funds. The country that has perhaps gone the furthest in treating the issue as a medical concern is Portugal. Having faced one of the historically worst drug epidemics in the 1990s, they addressed the issue in 2001 by decriminalizing all drugs. Dealers are still sent to prison, but users caught with less than a 10-day supply receive mandatory medical treatment. Some countries, including the United States, have drug courts that divert a percentage of offenders from incarceration, but in Portugal there are no judges or courtrooms involved. The result is that Portugal’s drug-related death rate is now five times lower than the European Union average.3
Treating addiction successfully often involves a multi-pronged approach, using both psychological and pharmacological tools. Medications used to treat opioid addiction include methadone and buprenorphine. These drugs are themselves opioids, but are considered to have a lower abuse potential than the more commonly abused drugs in the class. The medications also stay in the system longer than most opioids, reducing the frequent cravings associated with addiction.
Medication-assisted treatment appears to be a significant tool in combatting the opioid overdose crisis. An analysis of seven countries that successfully reduced overdose deaths found the commonality to be good access to opioid substitution therapy.4 In five of the countries, patients receive their medications in doctor’s offices or pharmacies, as opposed to the specialized clinics that dispense methadone in the United States. The countries that require clinic dosing have enough of them that it poses no hardship, which is not the case in many areas of the US. In six of the most successful countries, the therapy is essentially free and there are no wait times. In the United States, buprenorphine is available for at-home use, but the price is prohibitive for many patients.
An Emergency Treatment Option
As opposed to methadone and buprenorphine, which are useful for long-term addiction treatment, naloxone is a medication for emergency use. It can block or reverse the effects of opioids, and when administered to a patient during an overdose, it can often prevent death. Scotland was the first country with a national program to distribute naloxone, and found that within a high-risk population, deaths decreased from 9.8 percent to 4.7 percent after the program was initiated.5 Many U.S. jurisdictions have passed laws making naloxone easier to obtain, but availability differs from state to state.
Addiction is a serious but treatable disease.
1 “America leads the world in drug overdose deaths — by a lot.” Vox.com, June 28, 2017.
2 Katz, Josh. “Short Answers to Hard Questions About the Opioid Crisis.” The New York Times, August 3, 2017.
3 Frayer, Lauren. “In Portugal, Drug Use Is Treated As A Medical Issue, Not A Crime.” National Public Radio, April 18, 2017.
4 Anderson, Kenneth and April Smith. “7 Countries That Beat an Overdose Crisis.” Altnernet.org, May 19, 2017.
5 Miles, Tom. “WHO recommends naloxone to prevent 20,000 overdose deaths in U.S.” Reuters.com, November 4, 2014.
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