Contemporary Social IssuesDrug Abuse & Diversion:Enablers Vs. Unworthy

Sonya BoninInstructor: Emily Britt

GNED-2057Thursday, April 3rd, 2014

Drug Abuse in Statistics in Canada

• 47,000 Canadian people die from prescription drug abuse annually (TCC, 2013).

• 1 million Canadians are addicted to prescription medications (TCC, 2013).

• Substance abuse has cost our health care system $8 billion (TTC, 2013).

...Voids the “Norms”?

Prescriptions drug abuse voids the norms of what a functioning society expects of an individual, creating negative sanctions known as medicalization. Medicalization is further seen as a general social process of nonmedical problems being transformed into medical problems (Poitras,2012).

…Voids the “Norms”

The harms related to prescription drug abuse:1) a community issue 2) a family issue 3) a healthcare issue

Community Issue

Prescription drug abuse becomes a community issue as it directly relates to the structural-functionalist perspective theory. If members of the community are not working together in harmony to maintain a state of balance and social equilibrium for the whole, it directly effects everyone around. Prime example of this was found during an aggressive marketing scheme and misrepresentation of the pain killer, OxyCotin which lead to doctors, pharmacists and the general public to understand and have confidence in the fact that this particular drug was not as addictive and less subject to abuse, compared to other medications used for moderate to severe pain (Poitras,2012). One of the ways misrepresentation was accomplished was through a Purdue Pharma sales representative who claimed “less than one percent” risk of addiction, nonetheless did not state that this so called scientific evidence in reality was only based on acute pain, not long term chronic pain, which is actually where Oxycontin dependence arises from (Poitras, 2012). Consequently generating “commercial triumph and public health tragedy…” (Poitras, 2012). This anomie created great social disorganization and lead many down the wrong path and beliefs.

Family IssuePrescription drug abuse and family issues can also relate to the structural-functionalist perspective theory. When an individual is abusing prescription drugs it literally takes over their life, they become disconnected from the family and therefore lack of emotional care arises. Increased domestic violence and partner abuse are also related to prescription drug abuse of Benzodiazepines , which are anti-anxiety medication and are more commonly known as Valium, Ativan, and Klonopin (Graedon, 2011). Other family issues relate to finances as an individual whom has a dependence on a prescription drug will often use their prescription before they are able to fill the “repeat” at the pharmacy, often leading the addicted family member to the street, in search of their drug of choice. OxyContin which has become a very popular abused prescription drug can go for as much as $80 per 80mg pill (Hennessy, 2013).

Health Care Issue

Prescription drug abuse and health care directly relates to the Conflict theory, the battle of power is between the client or misuser and the doctor/pharmacist, not only with the fact that the doctor had given a highly addictive drug that intensely needs to be monitored but the lack thereof resources for the addicted client. The numbers of increased use of a methadone maintenance treatment programs has went from 7,800 people in 2001 to 35,228 in 2011 (CCSA, 2013 ). Some of these resources are cover ups like methadone, resulting in conflict in whether the addiction is truly being dealt with, therefore not allowing social change for the abuser.

High Social Status The “enablers” have the power and benefit from hierarchical social arrangements, such as high income and the social status of being a doctor, pharmacist, or multi billion dollar company such as Purdue. Relating to the conflict theory the bourgeoisie control resources, these resources are program/education, treatment and the access of the drugs themselves leaving the “unworthy” or drug abusers with little control and a massive dependence not only on the substance but on the “enablers” themselves. This is also a prime example of economic medicalization which is seen as a general social process of nonmedical problems being transformed into medical problems due to the main priority being business profits for larger statuses.

The Enablers• Oxycodone prescriptions (known by brand names

Oxycontin & Percocet) have increased 850% in 10 years (TCC, 2013).

• In 1996, OxyCotin was a $44 million business with 316,000 prescriptions provided. In 2002, this increased dramatically to a $3 billion business and over 14 million prescriptions provided (Poitras,2012).

Business Ethics According to Michael Josephson “Business ethics” can loosely defined as:

1. HONESTY. Be honest in all communications and actions. 2. INTEGRITY. Maintain personal integrity. 3. PROMISE-KEEPING. Keep promises and fulfill commitments. 4. LOYALTY. Be loyal within the framework of other ethical principles. 5. CARING. Demonstrate compassion and a genuine concern for the well-being of others. 6. RESPECT FOR OTHERS. Treat everyone with respect. 7. LAW ABIDING. Obey the law. 8. ACCOUNTABILITY. Be accountable.

The Worthy

• A Study of 1,095 overdose deaths in Ontario, 56.1% of patients had been given an opioid prescription within four weeks before death (CCSA, 2013).

• 37% of addicts admitted to a addictions treatment centre in Toronto stated receiving opioids from physician prescriptions, 26% from both a prescription and “the street,” and 21% from the street (CCSA, 2013).

Medical EthicsMedical ethics state “individual self-interest is secondary to the well-being of the patients” (Poitras, 2012).

Further there are four basic concepts for medical ethics stated by Jane Runzheimer, MD in the article Basic Principles of Medical Ethics.

1. Autonomy: People have the right to control what happens to their bodies.

2. Beneficence: All healthcare providers must strive to improve their patient’s health, to do the most good for the patient in every situation..

3. Nonmaleficence: “First, do no harm” is the bedrock of medical ethics

4. Justice: The fourth principle demands that you should try to be as fair as possible when offering treatments to patients and allocating scarce medical resources. You should be able to justify your actions in every situation.

Solution is Balance

1. Program/ Education2. Treatment3. The access4. Profits

1. Why? What? When?2. Too Long/short

Too much/Too little3. Doctor Stacking Vs. One

Doctor4. Profits Vs.

Medical Value of Treatment

Program & Education

The structural-functionalist perspective theory needs to be put into place and other members of society such as social workers, addiction counsellors and community workers, and practitioners in various settings need further education in the areas of “addiction, mental wellness, co-morbidities, concurrent disorders, pain management, trauma-informed-care, and primary and secondary prevention, as well as populations at risk of harms associated with prescription drugs”(CSSA, 2013). Basically addressing the educational needs required by healthcare practitioners, primarily prescribers and dispensers for proper medical ethics (CCSA, 2013). Without working together to create a functioning society the balance that is required in the structural functionalist perspective will not be achieved.

Treatment

The treatment has to have balance as well and needs to avoid the conflict theory of one hierarchy over another. Treatment needs to assist the client in fulfilling the needs of the clients disability, for example pain management (CCSA, 2013). Treatment needs to be appropriate for the situation, for example the prescriber needs to recommend a suitable dosage, not always jump to the highest level of dosage. They also need to look at what type of pain the client is dealing with. Is it chronic long-term pain or acute pain? Can this be managed with other applications such as physio therapy ? Often, the “band aid” solution is given causing further issues such as drug dependency instead of dealing with what is causing the disability. These “band aid” solutions are known as medicalization and are directly related to the conflict theory. The solution is education of what type of pain classifies what type of drugs and the dosage level that is required.

The access

Client profiles linked provincially or nationally to all pharmacies are the solution to double-doctoring for the purpose of abuse. Along with identification of priority issues that require additional focus for that individual, for example does the client have a previous drug abuse history (CCSA, 2013)? Is the client suffering from acute or chronic pain? Just as a pharmacist will briefly explain how the medication is taken, they also need to make sure the client is aware of the risks associated with the drug, what type of program the client requires and what type of pain the client is dealing with in order to see the red flags such as finishing prescription too quickly, increased dosage amount or mixing other forms of pain relievers for the use of getting high. The solution is working together as a community to prevent future problems which only cost our health system more in the end.

Profits

Lastly, the solution to prescription drug abuse in Canada relates to the pharmaceutical companies. These companies need to follow not only business ethics to produce morally right profits but also follow medical ethics. When OxyCotin is used correctly it is an efficient way of managing long-term chronic pain. The profits need to switch from dollar signs to Medical Value of Treatment. Purdue Pharmaceutical company made an astronomical amount of profit in 2002, and the profits are still high in 2014 (Poitras,2012). Even if Purdue remarketed their drug, there are hundreds of thousands of people dealing with legitimate chronic pain that would benefit from the use of OxyCotin. The amount of prescriptions written and how much OxyCotin is produced in one year should not be the first priority of these companies. Increased quality of life should be the first priority of any pharmaceutical company, pharmacist, and doctor. Economic medicalization should not be at the expense of others and their lives.

The Bigger Picture:A video relating to Prescription Drug Abuse in Canada

• http://youtu.be/tDkn2Xzrs4U

Reference Bishop, C. (2013). First do no harm: responding to Canada's prescription drug crisis. National Advisory Council on Prescription Drug Misuse, Canadian Centre on Substance Abuse. Retrieved on January 15th, 2014 from http://www.ccsa.ca/Resource%20Library/Canada-Strategy-Prescription-Drug-Misuse-Report-en.pdf

Graedon, J & T. ( July 18th, 2011) The People’s Pharmacy. Drugs That Trigger Violent Behavior. Retrieved on March 28th, 2014 from http://www.peoplespharmacy.com/2011/07/18/drugs-that-trigger-violent-behavior/

Hennessy, A. (April 13,2013) Vice. OxyContin in Ontario: Wildly Addictive and Barely Regulated. Retrieved on March 28th, 2014 from http://www.vice.com/en_ca/read/oxycontin-in-ontario-wildly-addictive-and-barely-regulated

Josephson, M. (December 17th, 2010) Business Ethics and Leadership. 12 Ethical Principles for Business Executives.Retrieved on March 28th, 2014 from http://josephsoninstitute.org/business/blog/2010/12/12-ethical-principles-for-business-executives/

Poitras, G. (2012). OxyContin, prescription opioid abuse and economic medicalization. Medicolegal & Bioethics, 231-43. doi:10.2147/MB.S32040

Runzheime, J. & Larsen L. (n.d) Medical Ethics For Dummies Cheat Sheet. Basic Principles of Medical EthicsRetrieved on April 2nd, 2014 from http://www.dummies.com/how-to/content/basic-principles-of-medical-ethics.html

Teen Challenge Canada. (2013) Canadian Drug Crisis: Drug Abuse is Closer to Home Then You Think!Retrieved on March 28th, 2014 from http://www.teenchallenge.ca/get-help/canadian-drug-crisis