Pubdate: Mon, 25 Jan 2016
Source: Baltimore Sun (MD)
Copyright: 2016 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Nate Hughes
Note: Nate Hughes is an alumnus of the Johns Hopkins Bloomberg School 
of Public Health in Baltimore

FORMER DRUG REP: DID I CONTRIBUTE TO TODAY'S OPIOD EPIDEMIC?

Thirteen years ago, I started a pharmaceutical sales career for Wyeth 
Pharmaceuticals, peddling samples out of my bag near the lush 
beautiful beaches of Newport and Laguna beaches in California. I 
threw ornate dinners for local psychiatrists to boost the sales of 
Effexor XR for depression and anxiety, even though it was clear that 
the physicians I sold to - the "pain docs"- prescribed Effexor 
off-label for pain. Almost a decade later, I parked my sporty 
Infiniti company car in Beverly Hills and traded my $200,000-plus 
salary, which I was then receiving from a boutique firm called 
Medicis, for a used epidemiology textbook at the Johns Hopkins 
Bloomberg School of Public Health in Baltimore, where I started a 
Master of Public Health program in 2011. What I did not realize at 
the time was that my own actions in closing a drug sale, without any 
bioethical considerations of what I was doing, helped contribute to 
the over-prescription of powerful psychotropic drugs much like that 
of OxyContin, a powerful painkiller.

While the pharmaceutical industry is typically looked to as the 
public's life raft when health epidemics arise, it is one of the 
major culprits of the addiction epidemic.

Prescription drug-induced mortalities have surpassed car crash 
fatalities for the first time, as primary-care physicians 
overprescribe opiates and patients abuse them. I was made aware of 
this new American epidemic almost two years ago when I attended a 
town hall at my alma mater on "prescription drug abuse." It was 
hosted by former President Bill Clinton, who told a story of two 
young men he had known who died as a result of opioid painkillers.

It's not just the prescription drugs that are the problems, though. 
Opiates are also the gateway for street heroin; in fact, three 
quarters of heroin addicts started their addictions with pain pills. 
According to NPR, between 2007 and 2013, there has been a 150 percent 
increase in heroin use in the U.S. At the same town hall conference 
at Hopkins, former Congressman Patrick Kennedy fiercely tried to 
explain the plight of the stigmatized and institutionalized addicts, 
thrown into a "revolving door" of antiquated rehabs and relapse, and 
urged attendees to heed a call by the FDA to treat addiction as a 
chronic disease much like type II diabetes, not an acute flare-up 
condition to be addressed in a 30-day rehab.

The Hopkins town hall made me realize that I had come full circle.

I left the pharmaceutical rep business to search for meaningful ways 
to ameliorate the nation's health.

I now understand that science can change cultural perceptions of 
illness in line with some of the 20th-century French philosopher 
Maurice Merleau-Ponty's writings on the phenomenology of perception. 
That is, pharmaceutical innovation, medical breakthroughs and 
publicity change our perception of stigmatized patients: Highly 
active antiretroviral therapy (HAART) changed the life span and view 
of HIV patients in the 1990s (as did celebrity infection admissions - 
think Magic Johnson and, more recently Charlie Sheen), Prozac changed 
the perennial stigma of depressed and anxious patients with new hope 
in the 1980s, and even Viagra somewhat removed a stigma of growing 
older in society with diminishing sexual desires.

Many if not most of us know someone close to us struggling from 
addiction, wrapped up in the criminal justice system, kicked out of 
school, and stigmatized from our communities - from Donald Trump's 
older brother, to the homeless veterans who struggle with substance 
abuse in our city streets, to the Lumbee Native American tribe of 
North Carolina, to the lower-income African-Americans who relapse 
back and forth in between prisons and unemployment, and finally to 
the "vanishing population" of the white male middle-class.

But it doesn't have to be that way. The time has come for a new 
approach, a new modality, and a new cultural acceptance so that 
addicts can reintegrate into our society as one of us, not one of "them."
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MAP posted-by: Jay Bergstrom