“Abuse of opioid painkillers and heroin has been spreading throughout the U.S. population, from inner-city youths, jobless rural residents and high school students to wealthy suburbanites, young professionals and pop stars,” according to Peter Katel‘s recent CQ article, “Opioid Crisis: Can recent reforms curb the epidemic?” He continues, “More adults use prescription painkillers than cigarettes, smokeless tobacco or cigars combined, according to a federal Substance Abuse and Mental Health Services Administration report released in September.”

The Opioid Epidemic 

The problem with the abuse of painkillers and heroin is that an overdose can be lethal. People who use opioids are at risk if they are carelessly prescribed opioids, or if they are non-adherent in taking the medication as directed, because painkillers act chemically on the part of the brain that controls respiration. A person who overdoses on painkillers may stop breathing.

Now that the opioid epidemic has spread to the suburbs and more affluent communities, the public is taking it seriously and demanding action. Their voices are being heard. Laws and policies are being implemented in an attempt to curb the problem.

For example, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) into law in July of 2016. “The law — the first major legislation in 40 years dealing with addiction — calls for spending more than $180 million annually to address the opioid problem. Authorities are also trying to stop ‘doctor shopping,’ in which patients go from doctor to doctor to obtain prescriptions for painkillers. To curb the practice, some states are strengthening electronic databases known as Prescription Drug Monitoring Programs, with California the latest of 30 states to require physicians to check the database before prescribing opioids or other restricted drugs,” Katel explains.

Some experts see these steps as progress in curbing opioid abuse. But others — such as David Courtwright, an opioid addiction historian who is a University of North Florida in Jacksonville professor— worry that, however well-intentioned these action are, they won’t do much to curb the epidemic. “We’ve got massive importation of Mexican heroin, and more recently Mexican heroin spiked with fentanyl.”

In the CQ article, I am quoted as saying, “We have defaulted to using opioids. It is quick, easy, cheap and wrong in many instances.” And, yes, I do believe that overprescribing of opioids is one piece of the puzzle. But, I agree with Courtwright when he says that the widespread availability of street drugs is an even bigger problem.

Another opioid historian, Eric C. Schneider of the University of Pennsylvania, says “historical patterns indicate that the opioid wave will weaken largely on its own.”

I hope he’s correct. Like Schneider, I see a brighter future for people in pain as new, safer treatments become available.

The Disease of Addiction 

I also largely agree with Dr. Robert DuPont of Rockville, MD when he says that the disease of addiction, and heroin use, will always be a problem. Dr. Dupont, who served as the first director of the National Institute on Drug Abuse in 1973, believes that even though addiction is a disease, the stigma associated with it is warranted. “Yes, you’ve got a disease, but I don’t think an alcoholic is not responsible for his drinking when he runs over a 5-year-old. Stigma is bad when applied to recovery but positive when it’s applied to drug use. I don’t want to have a tolerance for that.”

Regardless of the type of addiction, people have some agency in the expression of their disease, at least in the beginning. This is true whether it is obesity, gambling or drugs. A recent study suggests 4 personality traits that are associated with increased risk of addiction.

Addiction is complicated. It requires far more than just exposure to an addictive substance. It begins with something that invites the use of an addictive substance. Genetics and environment are the major factors that lead to addictions. Everyone is at risk, but as the New York Times article points out, children with specific personality traits are more vulnerable.

The principle seed of addiction is the desire to seek a psychoactive effect from a substance. Addiction is often associated with mental health disorders or the personality traits suggested by Maia Szalavitz. Reducing the supply of prescription opioids may decrease the number of people who move from prescription opioids to heroin, but it will also force people seeking the psychoactive effect of opioids to move to other drugs or to start with heroin as was the case in the 60s.

Availability of Illegal Drugs 

The availability of illegal drugs seems endless and so does the curse of addiction. The opioid epidemic will probably end when alternatives to opioids for pain become more available and more affordable than opioids.

The disease of addiction will always be part of human behavior. People who are seeking a psychoactive experience will migrate to another substance, if they’re not able to find opioids. Perhaps they’ll use alcohol.

There is an end in sight for the opioid epidemic, even if there will never be an end to addiction.

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD