President Trump declared a National Public Health Emergency this week; in his statement from the Whitehouse he was not talking about HIV or Hepatitis C nor was he referring to the increased incidence of gun violence in the country. The President’s statements focused on a very different Public Health problem, he was talking about America’s high incidence of opioid related deaths mostly from overdose.
This declaration has been met with various pronouncements including some statements from politicians and some individuals within the minority communities on the fact that the labeling of this problem as a public health emergency was only because the majority of deaths in this crisis happened to be white Americans. I would say though that, I agree with Mr. Trump on this issue; this is a public health emergency irrespective of the color of the skins of the cases. To those who say this problem is a white only problem I beg to differ, 90% of the cases are whites but we must not lose site of the fact that 77% of our population are Whites so if 90% of the deaths are whites there is still a relatively significant contribution from minorities.
This is not a time to politicize issues especially when we are dealing with lives especially the lives of young Americans. A 2015 Kaiser Family Foundation representation of vital registration data revealed that 1 in 4 of all overdose deaths involving opioids was among younger’s Americans ages 25 – 34 years. This problem was so bad it actually affected overall gains in life expectancy among white Americans. Although there were more overdose deaths among men than women the increase appears to be accelerating faster in females compared to males. American Association of Addiction Medicine Reports suggest that from 1999 – 2010 overdose deaths from prescription opioids among women have increased by about 400% compared to 237% among men.
The question that we need to address now though is; why are we having such a rapid increase in the number of addictions to opioids and other addictive drugs today? Whilst we may not have any good data to support this claim it is well known that close and supportive family and other forms of social relationships have a positive impact on addiction as well as response to painful stimuli both physical and psychological. Over the past 10 years our dependence on technological gadgets including social media outlets have significantly reduced close interpersonal interactions. Whilst there is a whole list of other factors driving this epidemic it is my belief that our gradual decline in significant social interactions may be negatively impacting some of the other drivers. This theory is based on a an experiment by Bruce Alexander who used rats to prove that social isolation does negatively impact ones risk of addiction and rats in a socially enriched environment where more resistant to addiction.
If this theory is true then what must Mr. Trump and our public health authorities focus on in our efforts to reduce risk of addiction to opiates in our communities? To achieve good control we must not focus so much on the supply as we have always done in the past at great cost but on the demand. In the 1980s and 1990s we fought a very costly war on drugs mostly in our inner city neighborhoods and supply sources in South and Central America and today I cannot clearly say who won that war. In this current problem we must address the disenchantment and social isolation that is driving our young people to ingest and inject chemicals into their body’s to make them feel better. Our bodies have always depended on its own abilities to produce similar effects from chemicals called endorphins that are produced endogenously by the activities that we engage in. Anyone who enjoys good physical exercise and other playful interactions with others regularly can attest to the life enhancing effects of these activities. The difference between the good feelings that are self is that their benefits usually last longer than the high from any opioid and also tend to be much safer. We are also wired to enable us to actually relive those joyous moments and reap some of the feel good benefits again.
So Mr. Trump if you want to address this epidemic and make any big impact please forget about your wall and do not go the same way that all your predecessors who attempted to address this problem have gone. To make any headway on this problem we must look at our best we can enrich the life’s of the individuals in the communities mist affected either by addressing the high rates of unemployment or even our over dependence on electronic devices to the detriment of better interpersonal relationships. Another important element of addressing this epidemic is improvement in our mental health infrastructure which unfortunately is very sparse to almost non-existent in our rural communities who are disproportionately affected by this epidemic. I addressed this in an early blog post. I would like to state a major disclaimer, I do not have any good data to support this but when all we have done so far has failed then looking for solutions supported by good research data can be considered frivolous. So Mr. President I would quote you on this “What do we have to lose?”
Image credit – CNN
By Dr. Leonard Sowah an Internal Medicine Physician in Baltimore, Maryland