As I start my new position for the opioid crisis as one of 10 public health officer – epidemiologists for Canada, stationed in Newfoundland & Labrador, I am exposed to the world of drug addiction that once fascinated me during my undergraduate degree at the University of Toronto. There, I looked at the neural underpinnings associated with a drugs ability to “hijack” the brain and eventually assume control of an addicts executive functioning abilities, namely an inability to make sound decision in the face of immediate gratification. I studied clinical addiction in rodents, who were given the option to lever press for water & food pellets versus cocaine. In almost all instances, rodents in testing scenarios chose to self-administer cocaine over food and water until they died. Studies like this, illustrated to me that drugs of abuse are capable of assuming complete control of all individuals who take them leading to a destruction of their lives. Therefore, prohibition of its use and penalization seemed logical measures of control.
My position on this topic has changed dramatically since following my move to Labrador several years following my undergrad. Labrador was the first instance in my life, where I knew individuals who abused drugs either in the past or were presently abusing them. The narrative of drug abuse became human and I began to question the moral stance I took on drugs which simplistically put was that “drugs are bad, therefore only bad people would use them.”
Let’s sidetrack and go to the history of drug use. From the earliest records, drugs have been for a variety of reasons, which include spiritual enlightenment and transcendence, relaxation with the advent of wine as well as medical practices. In its essence, drugs were created to heal people in a medical setting for physical ailments or to help them experience a part of life that was evidently important (and I’d argue recreational drug use is also an important life experience for some and maybe not others). Time and time again, drugs went through various bans and prohibitions all which were ineffective in preventing people from its use. For example, Tabaco use was banned following its introduction to Europe by Christopher Columbus and the same has been true for alcohol in many areas of the world. Yet, people still use it and now both have become normalized and accepted in many societies. The ban on other more addictive and potent drugs seem to be well accepted around the world, but they continue to be used vastly. The lack of a centralized system for monitoring its creation and consumptions has resulted in two things: one, we don’t know how much is being used and by how many people & two, because of a lack of monitoring/control the drugs are being created with extremely toxic substances that result in overdose related deaths and other medical complications. If a legalized control system was in place with limitations on dispensation, education for users of drug interactions and dose recommendations, this would:
- Reduce overdose related death as drug dispensing would be controlled
- Clean drugs may result in a reduction in healthcare costs associated with bi-products in street drugs
- The government would be able to profit from sales, monitor rates of consumption and identify the proportion of drug use among adults
- Reduce the stigma associated with drug addiction, lending to an increase in people seeking support for their addiction
- Reduce costs associated with criminalized petty drug use (police force, courts, lawyer fees etc)
Despite the radical change in dialogue regarding de-stigmatization of mental health in the medical world, there is a great deal of stigma toward those who are addicted to drugs. We see drug addicts as failed individuals in our societies and they are shamed, penalized, reprimanded and given a track record that prevents them opportunities that are available to others. An important note to keep in mind is that, not all people who abuse drugs, become addicts. The pathway from drug use/abuse to full blown addictions is very dependent on the individual and their predispositions, personal anecdotes for using the drug and duration and extent of use. The exact reason why some people turn to drugs versus others varies, but something that since captured my attention was one specific subset of drug users. The one’s who use drugs to numb trauma/pain and those who use to feel loved.
The brain is hardwired to gravitate toward acceptance, love and companionship; and these areas are the reward centres of the brain which drugs act on. This is why humans are so vastly different from other species, we are inherently social and depend greatly on others for support, a sense of belonging and acceptance. It’s the reason why the concept of family is so deeply rooted in all human societies which is not seen in the animal kingdom nearly to the same degree. And it’s also why solitary confinement is the worst possible punishment we give to individuals who have crossed social boundaries like committing first-degree murder. Individuals who use drugs to initially numb trauma or those who have experienced neglect and social isolation, may be desperately trying to fulfill the very human need to feel love, acceptance and to forget the memories that prevent them from feeling “normal.” The underlying issues the individual is facing may be the trigger that causes their addiction, as they must rely on drugs.
The stigma surrounding drug addiction needs to be re-examined and the use of coercion, penalization and legal labels that follow addicts for the rest of their lives should be removed. Drug addiction shouldn’t be a legal issue, I don’t think police officers are trained to react with empathy and understanding of the social, economic, personal and neurobiological underpinnings associated with drug addiction. Let’s penalize the suppliers and enforce control measures that prevent smuggled substances that destroy lives. But the funding used to arrest petty drug use should come to a halt. Instead, that funding should go directly to specialized mental health worker, counsellors and therapists who treat addicts with empathy and respect.
On a much larger scale, we as a society must stop the need to judge or belittle the living conditions, circumstances and decisions of other people whose shoes we do not walk in. Listening to the stories of those who have suffered systemically, like our Indigenous communities, or those who face social, economic and cultural struggles that are not apparent will allow us all to see the truths that are often forgotten or unheard. The only way to move forward is to know the realities of the past and everyone has a past.