Why Does a Crackdown on One Drug Lead to a Rise In Another?
The abuse of opioid pain medication increased substantially in the past two decades, and the government and pharmaceutical companies took action. The Federal Drug Administration (FDA) shared data in 2013 on how to make opioids more tamperproof, and the Drug Enforcement Agency (DEA) moved hydrocodone (a common opioid ingredient in brand name painkillers) to a more restrictive drug class (Schedule II) in 2014, and many pharmaceutical companies were already making changes before that. For decades the government has not shied away from cracking down on drugs, including prescription medication, but clinical studies and statistics have shown that a crackdown on one drug often leads to a rise in use of another.
Prescription Medication as a Gateway Drug
In an effort to combat abuse, the makers of OxyContin switched formulations in 2010 to include anti-abuse deterrents, and per The New England Journal of Medicine in 2012, larges numbers of opioid addicts stopping use the drug. However, the study also highlighted the paradox. The addicts did stop or decrease OxyContin use, but they also initiated or increased their use of other opiate drugs. Similarly Forbes published a study in 2014 that asked why heroin use was on the rise while the use of many other drugs were in (an albeit slow) decline. The conclusion was that legal pressure on opioid prescriptions increased cost and decreased availability, and heroin was the less-expensive, more available alternative.
Most prescription drugs with abuse potential have an illicit counterpart. There are several examples including the following:
- Heroin and opioid painkillers are both synthesized from opium poppy plants.
- Prescription stimulants (e.g., Adderall and Ritalin) and cocaine both increase dopamine levels and have pharmacokinetic similarities especially when used intravenously.
- Benzodiazepines like Xanax (alprazolam) and Klonopin (clonazepam) and illicit downers like GHB all sedate the central nervous system (CNS).
Simply put prescription medications can be a gateway drug to illicit substances. A 2009 report by the Substance Abuse and Mental Health Services Administration (SAMHA) found that 29% of college students who used Adderall recreationally also used cocaine compared to 3.6% of their college classmates who did not use Adderall. Other studies found that Adderall users were 8 times more likely to try cocaine. The government has cracked down on prescription drug abuse, and electronic medical databases decreased doctor shopping and overprescribing, but the result has been a shift back to illicit drugs.
Addiction: Crime or Health Issue
To be clear the problem is not prescription drugs or the crackdowns but rather the idea that punishments and decreased availability offer the best solution to the country’s drug problem. Consider the ultimate law against substance use, Prohibition, in which alcohol was banned from 1920 to 1933. As the Cato Institute explained in 1991, alcohol was still available, though in a more dangerous setting, and the usage rates for opium, marijuana and cocaine all increased dramatically. In response to a crackdown, addicts are more likely to switch drugs or find a related substance than simply stop using.
Drawing on the expertise of more than 80 researchers, the American Society of Addiction Medicine (ASAM) published a long-form definition of addiction in 2011 that includes several applicable observations including the following:
- Addiction produces powerful memories that when triggered by external cues produce profound biological and behavioral responses.
- Addiction produces cognitive changes that manifest as obsessive preoccupation with the drug and inaccurate beliefs that problems are unrelated to the addiction.
- Addiction alters evaluations of the benefits, consequences and detriments of continued substance use.
- Addiction spurs emotional changes that increase sensitivity to stress and amplify the symptoms of mental health disorders like anxiety.
Addiction is a brain-reward disease that alters normal functioning and drives addicts to continue using regardless of the costs or consequences. For this reason addiction and drug use like of clonazepam should be viewed as health issues rather than criminal acts, and rehabilitation treatment is far more effective in reducing substance abuse than crackdowns and punishments.
Professional Addiction Treatment
If a person has a disease, loved ones encourage treatment, and addiction is no different. Rehabilitation centers offers the most effective treatment methods available, and while treatment plans are customized for each patient, potential services can include the following:
- Supervised detox that minimizes drug withdrawal symptoms
- Integrated therapies for co-occurring mental health and personality disorders
- Education for patients and loved ones on the neurobiological nature of addiction
- Collaborative behavioral therapies that target maladaptive thought patterns
- Anger and stress management therapies to improve emotional responses
- Motivational therapies that help patients find personal motivations to change
- Strategies to avoid or counter memory cues that trigger drug cravings
The benefits of treatment are now recognized at all levels of government. The Affordable Care Act (ACA) made addiction treatment benefits one of its 10 essential benefits for the insurance marketplace, and nonviolent drug offenders are often offered alternative sentencing options involving treatment. Addiction is a health issue first and foremost, and getting people help is arguably more effective than crackdowns.
If you have questions about addiction or treatment to drugs like clonazepam, please speak with one of our admissions coordinators. We are available 24 hours a day to answer questions and make recommendations, and we can even check health insurance plans for treatment coverage. Our helpline is toll-free, so please call now.