Drug abuse has existed since the dawn of time (or at least since the first person ground a leaf into powder.) Just about any substance can be misused or abused. Many drugs lend themselves to misuse/abuse due to their mood altering effects. However in recent years antibiotics have become misused as well. As a culture we are not entirely comfortable with discussing prescription or over-the-counter (OTC) drug abuse. We know what drug abusers (a.k.a. junkies) look like; we’ve seen them in movies and magazine features. Surely the (pill taking) carpooling mom next door can’t be abusing drugs; look at her! Those honor students doing homework in the media room can’t be abusing A.D.H.D. medication; look at how well they’re doing! What adds a heavy opaque veil to the detection is that these drugs come from doctors. Doctors know a thing or two about the human body and what is good for us, no? In theory, yes.
Detecting drug abuse during a 3-5 minute office visit is not easy. There are those who live with people day in and day out and still have no knowledge of drug misuse/abuse. This is by no means to suggest that doctors shouldn’t prevent and detect misuse/abuse. Quite the contrary. We need to incentivize the doctors to limit prescription writing (kind of the way drug companies give incentives to write the prescriptions.) Primary doctors need to spend time asking pointed and probing questions and not merely relying upon questionnaires to make diagnoses for mood altering drugs. Doctors must know the signs of dependency and always err on the side of lower dosage. Doctors know the signs of mental illness and should be on alert for signs of self-medicating behavior. Doctors should refer patients to a mental health practitioner if there are any doubts about stability. The mental health practitioner and referring doctor must decide in concert what medication (if any) is best for the patient.
Pharmacies are already set up to detect prescription abuse. But there are gaps and it’s not considered abuse to fill legitimate prescriptions. We need to start with source (or ‘dealer’ as he/she is known on the street.) Doctors are not looking to get people ‘hooked’, not consciously anyway. For the most part they want their patients to be healthy and happy. They certainly don’t want to see their patients in pain, physical or psychic. Pain medication is tricky business and that’s why there are specialists and pain clinics. Managing pain and pain amelioration can’t happen in a 3-5 minute general practitioner’s office visit. General practice is not the place for treating a cognitive, behavioral or mood issue either. Psychologists and psychiatrists are trained to diagnose learning disorders, and behavior and mood disorders. Relying on general practitioners to treat all aspects of the human condition is quaint and ridiculously. No one person can possibly be up to date on all the medical developments of the 21st century.
We’ve become rather blasé about medicine; ironically as it’s become space age in its sophistication. But we are wrong to do so. Often times, dangerously wrong. Drugs are drugs; whether they come in a childproof bottle or a tiny ziploc bag. They can be life saving or ending, and should be treated as such.