Doctors have a long and illustrious history of addicting people to narcotics.  In the 1800s this was largely because they didn’t know what else to do, they had no idea what was wrong with anyone, and they didn’t have any drugs that worked.  Apothecaries, pharmacists, and doctors made proprietary concoctions in which opium was always the active ingredient.

And it worked, right?  Morphine works for anxiety, works for pain, works for “fluxes.”  What else could really be wrong with people anyway?  This profligate use of narcotics had it’s expected effect.  Thomas Crothers, in 1902, wrote a book called Morphinism and Narcomanias from Other Drugs.

“Morphinism,” Crothers explained,  “is a condition following the prolonged use of morphine by needle or mouth.  Women, especially, are affected by it.  Capriciousness, irritability, selfishness, and excitability are the natural characteristics of women who are morphinists.  Morphinomania is the condition of persons in which the impulse to use morphine is dominating.  Such a person is often a psychopath from heredity and has a defective neurotic organization.  Morphinomania is a moral disorder.  Even if no immediate deleterious effect is in evidence, the will, and moral forces suffer.”

Something had to be done about these amoral, mostly female, degenerates, clearly.  In the 1860s states started passing laws that said that the potions being made at least had to have an ingredient label.  The Pure Food and Drugs Act of 1906 was the beginning of the FDA, so named in 1930, but even then narcotics were available, as long as they were labeled.  But it helped.  In an effort to regulate narcotics, the Controlled Substance Act was signed into law in 1970, creating the schedule system we know today.

Other early interventions basically amounted to warning labels.  In 2005 The DEA, in an effort to increase detox and treatment, allowed practitioners who were not formally in the drug treatment business to use other scheduled drugs to treat addiction.  In 2007 the FDA got a new tool, Risk Evaluation and Mitigation Strategies (REMS), that allowed them to put restrictions on certain substances.   In 2009, the FDA asked for recommendations on restricting prescribing which were met with opposition from drug companies and physicians’ lobbying groups.

 

Last year, the FDA recommended changing hydrocodone-containing drugs to Schedule II (highly addictive) and limiting refills and prescribing practices.  Still the epidemic goes on.

Dr. Thomas Frieden, director of the Centers for Disease Control, made the following comment about prescription drug abuse: “This is an epidemic that was caused largely by inappropriate prescribing, and it can be fixed to a significant extent by improving prescribing.”

I used to take umbrage at this kind of remark.  After all, doctors cannot be responsible for what people put in their mouths.

Then I read about Florida.  Did you know that doctors in Florida bought 89 percent of the oxycodone sold in the entire country in 2010? 98 of the 100 highest prescribers of narcotics practiced in Florida. The pain clinics lined the streets.  No wonder trust in physicians is at an all-time low.  There is absolutely no excuse for the behavior of these physicians.

Here’s what Florida did, starting in 2010.  They made pain clinics register with the state.  They indicted “pill mill” owners and, in once case, accused a doctor of murder.  Doctors’ licenses got suspended.  A prescription drug monitoring system was put in place, privately funded since Florida Republicans blocked the measure in the state legislature.  And it worked.  Prescription drug overdose deaths are down 23 percent.  Doctors’ purchases of oxycodone fell by 97 percent.

What is the problem here?  A few physicians violating the Hippocratic and every other oath I can think of?  Oh, yes.  Doctors and pill mill owners should absolutely be prosecuted to the full extent of the law.  But, as I pointed out above, addiction is an old disease.  Some of the Florida patients who can’t get prescription narcotics anymore will go to heroin or cocaine.  Some will get morphine instead.  Some will seek rehab treatment.

The larger issue, however, is addiction itself.  The social, genetic, behavioral, and neurochemical drives for drug use are powerful, persistent, and ancient.  We can choose to criminalize drug use, declare it a disease and treat it, ignore it, or feed it.  What we do with it, as a society, will be one of the things that define us for future generations and civilizations.

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.