Drug Problem in RI

Article
Posted Mar 8, 2016 at 2:00 AM Providence Journal

By Michael Fine

We are missing the boat about drug overdose and alcohol poisoning deaths. We lost 239 Rhode Islanders to drug overdoses in 2014, and the available evidence suggests the number will be 4 to 5 percent higher in 2015. As the ever-climbing number of deaths suggests, we have not yet found the solution to the problem of overdose and alcohol poisoning in Rhode Island, a problem with many causes.

Somehow we have yet to understand that the major cause of drug overdose and alcohol poisoning death isn’t which drug Rhode Islanders are using or how we use those drugs. The problem is that too many of us are using drugs, and that we have allowed a culture of drug and alcohol use to become acceptable in our state. We are not going to be able to reduce the number of Rhode Islanders who die of drug and alcohol poisoning until we reduce the number of Rhode Islanders using in the first place.

Drug and alcohol use and our attitudes about that use are the problem. But the role of family and community as social support, the lack of a coherent approach to the treatment of pain, and the absence of an organized health care system also play a role.

Rhode Islanders used more drugs and alcohol per capita than people from almost any other state in 2013. Survey data suggests that we were the state with the largest number of people reporting illicit drug use in 2013, and the third highest in 2014. We were third in the nation for alcohol poisonings in 2013. Fourth in the nation for benzodiazepine use. Third highest in the nation for binge drinking. Fourth highest in the nation for non-medical use of pain relievers and cocaine use in 2013. The evidence is clear that almost 50 percent more of us per capita report illicit and marijuana drug use than the national average, and ten percent more of us use alcohol to excess.

No one will die of drug and alcohol overdoses if no one is using.

Treatment and Narcan are important tools to help stop people from dying. Better control of opiate prescribing — and the prescribing of other drugs — is important, but let’s not fool ourselves: people will use heroin, cocaine, alcohol, benzodiazepines, marijuana and stimulants even when prescription opiates are tightly controlled. We have to reduce inappropriate access to prescription opiates and provide treatment on demand. We have to provide access to Narcan and change our culture. Until we can say with certainty that the use of all drugs and alcohol is declining, we have no right to expect that fewer people will die of overdoses.

Drug overdose death is the symptom. Drug and alcohol use is the disease.

That said, recently published evidence suggests the work we did together as a community in 2013 and 2014 was effective in reducing drug and alcohol use, so we may want to consider thinking about ways of changing our culture so that we reduce drug and alcohol use, over-use, drug overdose death and alcohol poisoning.

But changing behavior is difficult, and creating a sensible drug and alcohol policy means balancing many competing interests: the interests of those who can use casually without consequence against those of us who are likely to become addicted with casual use; the interests of those of us who make our livings selling these substances (and treating the addictions that result) against the interests of those of us whose lives will be upended by using and those who can and want to use casually; and the interests of those of us who influence the policy process against those of us who have to bear the costs and burdens that our policy choices create.

It’s time we admitted that what we are doing now has failed. Rhode Island’s drug and alcohol use is much more intense than that of other places in the United States. Too many Rhode Islanders are dying from substance-use disorder each day, week and month. The human and financial cost of this use and the disorder that sometimes results is now difficult to bear. We can keep on pretending that substance use is someone else’s problem. Or we can own our problem, and change.

Michael Fine, M.D., an occasional contributor, was director of the Rhode Island Department of Health from 2011 to 2015. He is a family physician.