An acquaintance of mine buried her daughter yesterday. She died on her 20th birthday of an opioid overdose. She had been in recovery for many months, but had suffered repeated relapses. Her introduction to opioids wasn’t through some backstreet pusher. Her physician gave her a prescription. I’m taking this one particularly hard. I am grateful, however, that Congress seems to be taking this problem seriously. I only wish I could say the same for the Food & Drug Administration.

While only accounting for about 5 percent of the population, the U.S. now consumes 99 percent of the world’s Vicodin and 84 percent of its Oxycontin.

According to the Centers for Disease Control, 12 million people reported using prescription painkillers non-medically in 2010 (meaning without a prescription or only for the feeling), the most recent year for which there is data. Since 1999, the number has led to an over 400 percent increase in female deaths and 265 percent increase in male deaths involving opiates. In 2008, the CDC reported 14,800 deaths from prescription painkillers. Two years later that number had increased to 16,651. Opioid overdose deaths in America are now greater than heroin and cocaine combined.

But prescription opioids are only the beginning of the problem. While the high is similar to that of heroin, pain pills are roughly six times the price. But with opioids status as the second-most addictive substance to tobacco, those who get hooked on prescriptions are likely to search for another way to get high. Which may explain why the number of heroin users nearly doubled from 373,000 people in 2007 to 620,000 in 2011.

After the dirty work of explaining to Sen. Feinstein and cohorts what the drug landscape in America is, Dr. Andrew Kolodny, chief medical officer of nonprofit drug rehabilitation organization Phoenix House, was the first to take the reins. “This epidemic was caused by the medical community,” he said, looking at Feinstein. “We [doctors] were responding to a campaign that encouraged long-term use. Minimized risk and maximized comfort,” he said. Instead of lessons about the dangerous, addictive, and deadly qualities of prescription opioids, he got lessons on relieving pain. The result was the over-prescription and over-consumption of prescription opioids that still exists today—or at least that’s how he sees it. “Most patients with chronic pain on long-term opioids… we’re probably harming them,” he says.

But doctors aren’t the only ones at fault, Kolodny says, even if they are the original purveyors of the drugs. “The CDC is calling for reduced prescribing, especially for chronic pain. But the FDA continues to approve dangerous opioids and continues to allow marketing of opioids for chronic problems like low back pain.” It’s a move that he says turned medicine cabinets into death traps. Without a complete overhaul of the opiate world, he worries it will continue. “Overdose deaths will remain at historically high levels, heroin will continue flooding into our neighborhoods, our families will continue to suffer.”

Somewhere around eight percent of the population is genetically predisposed to react to opioids differently from the rest of us, just as around eight percent of the population reacts differently to alcohol. These are people who have what can be considered a brain disease that only really kicks in when they are exposed to certain substances. Our culture encourages substance abuse, but most kids grow out of it sometime in their twenties. But some kids become addicts and lose the ability to control their use. If you give these kids a prescription for vicodin, there is a very good chance that they won’t stop taking opiods until they are dead. Along the way, they will be transformed into pathological liars and thieves who no longer resemble their former selves except in the most superficial ways. Many people describe it as “losing their soul.”

They can regain their soul by getting treatment and staying sober, but they won’t be happy and content as sober people. They won’t “feel” right. Sometimes, with the help of a 12-step program, miracles do occur and addicts learn to feel normal even when living a sober life, but it takes a real commitment to the program. This can take a lot of time and involve many relapses and overdoses. Overdoses are usually fatal unless there is very prompt medical treatment using a drug called Narcan. For my friend’s daughter, this time, there was no prompt medical treatment.

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