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	 Currently, our latest statistics show that in 2016 there were over 64,000 deaths due to overdose of drugs. That translates into 180 people dying
in the United States every day by overdosing. More than two-thirds of the overdose deaths were caused by opioids. But numbers by themselves
do not always hit home. Comparing these numbers may shed some empathy to the human lives lost. I am reminded that 58,000 American
soldiers died in the Vietnam War. I am also struck by the fact that there are 180 passenger seats in a typical 737 airplane. We need to ask ourselves
if we would tolerate a 737 airplane crashing with no survivors every day. Maybe we need an anti-drug movement similar to the anti-war movement
of the 1960s.

We All have Our Parts To Play

Of course patients need to take responsibility for their actions if these lead to addiction. Pharmaceutical companies need to be held responsible
when their products and their actions result in initiating an addiction in patients. In 2007 Purdue Pharmaceutical paid over $600 million in fines
for deceptive marketing of OxyContin. Physicians and other medical providers need to take steps to ensure that their prescribing habits do not
unduly put patients at risk of addiction. Pennsylvania now has a Prescription Drug
Monitoring Program to help providers monitor themselves and their colleagues'
The scourge of opioid addiction has
prescribing patterns. Insurance companies need to monitor their approvals and
denials of medications that increase or decrease the risk of addiction. And finally,
the general public needs to take steps to make certain that when an appropriate,
but dangerous, product is prescribed, careful handling and disposing of leftover
medication is done in a way to ensure it does not fall into hands of people who
may misuse and become addicted. Programs such as drug take backs allow people
to properly, without any questions asked, dispose of unused medications.

along a time line that spans from
Abraham Lincoln to Bill Gates.

	 The catalyst for addiction came in many forms and for many reasons. But none
of those who suffered from the disease willfully volunteered to be subjected to its
evils, in the same way you and I would not willfully volunteer to be subjected to
cancer or sickle cell anemia. Addiction may not be new but the fact that this is a disease in many ways is. Like it or not, we all now have a role
in combating addiction and one tangible way we all can contribute to its suppression is illuminating the stigma of "the addict."

The Harrison Narcotic Tax Act of 1914 is often cited as the beginning of the

change from treating addiction as a disease to treating it in the courts. It states,
"An Act to provide for the registration of, with collectors of internal revenue,
and to impose a special tax on all persons who produce, import, manufacture,
compound, deal in, dispense, sell, distribute, or give away opium or coca leaves,
their salts, derivatives, or preparations, and for other purposes." Although the
Act permitted physicians to prescribe or dispense opioids as long as they
kept the required records, the Treasury interpreted the act as a prohibition on
physicians' prescribing opioids to persons with addictions to maintain their
addictions. The Treasury was the agency responsible for enforcing the Harrison
Act as well as prohibition laws. The Treasury's position appeared to be that
addiction was not a disease and the person with an addiction, therefore, was
not a patient. It followed that any physician prescribing or dispensing opioids
to this type of individual was not doing so in the "course of his professional
practice" (White 1998). In 1919, the United States Supreme Court upheld the
Treasury's interpretation. Until the 1960s this interpretation and enforcement
of the Harrison Act effectively eliminated any legitimate role for the general
medical profession in medication-assisted treatment for Americans who had
a drug addiction (White 1998). Moving the treatment of addiction from the
hands of physicians to those of law enforcement perpetuated and worsened
the stigmatization of this disease.


the response // summer/fall 2018


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White W L. Slaying the Dragon: The History of Addiction Treatment
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Systems/Lighthouse Institute, 1998.
Nyswander M. The Drug Addict as a Patient. New York: Grune
and Stratton, 1956.
Dole V P. Addictive behavior. Scientific American. 1980;
Dole V P. Implications of methadone maintenance for theories of
narcotic addiction. JAMA. 1988;260(20):3025-3029.
Courtwright D T, Joseph H, Des Jarlais D. Addicts Who Survived:
An Oral History of Narcotic Use in America, 1923-1965. Knoxville,
TN: University of Tennessee Press, 1989.
Joseph H, Dole V P. Methadone patients on probation and parole.
Federal Probation June 1970, pp. 42-48.
Courtwright D T. Dark Paradise: A History of Opiate Addiction.
Cambridge, MA: Harvard University Press, 1982, expanded
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Institute of Medicine. Federal Regulation of Methadone Treatment.
Washington, DC: National Academy Press, 1995.

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