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Drug decisions should involve more thought about potential harm

By KATHY MILES

Boyle ASAP

“Do No Harm.” There is probably no code of ethics for any profession in America that doesn’t include this as a foundational concept.

Medical professionals — and those in the other helping professions — are guided to do everything possible to avoid harm, even as they work to provide assistance and improvement for the people they serve.

Unfortunately, decisions to avoid harm are often not simple and clear. 

The history of treatment for substance use disorders, and public policy related to substance use, have glaring examples of harm being done, in the name of helping.  An old Swedish approach to alcoholism treatment included soaking everything eaten by people suffering from alcohol use disorder with alcohol.

In the 1880s, Dr. J.B. Bentley recommended the ingestion of large quantities of cocaine as treatment for both alcohol and morphine addiction. Early in the 20th century, bromide sleep treatments were given to people in withdrawal from narcotics, in spite of high death rates during the procedures. And, in the late 1950s, methamphetamine, the drug that is ravaging our part of the country right now, was used by some physicians as a replacement for alcohol and heroin in people with addictions to those substances.

Almost everyone knows that our current opioid crisis has been fueled by some very flawed decisions related to the use of painkillers. In 2001, the Food and Drug Administration responded to heavy pressure from Big Pharma companies, like Purdue Pharma, and chronic pain patients, by approving the expansion of Oxycontin from short-term to long-term use. We have to hope that the FDA thought they were making a helpful decision; but the addiction, untimely deaths, and suffering we have seen since, have proven it was not. 

Across America today, decisions are being considered and made regarding recreational marijuana, medical marijuana, Kratom, CBD products and new pharmaceuticals.

In late 2018, the FDA approved a new and extremely potent opioid, Dsuvia. The approval came in spite of the strong disagreement of Dr. Raeford Brown, University of Kentucky anesthesiologist and chair of the committee who voted to approve. Approval of the drug was also opposed by the consumer advocacy group, Public Citizen. Reasons to approve were characterized by the goal to better help patients in severe pain.

It would be good to see solid ethical principles applied by policy makers, elected officials and all of us citizens, as we consider a variety of decisions about substance use. Doing no harm should be part of our decisions.

Crystal balls aren’t the answer, and hindsight is usually better than predicting future outcomes. But considering all relevant information methodically, with an eye on who produced the information, how it was generated, and what we have learned from past decisions, would be a start. Considering only the short-term financial benefits of a decision is not ethical. We have plenty of history to show that quick gain may yield a long stretch of pain and cost.

A recent University of Minnesota study has looked at the effects so far of legalizing recreational marijuana in the states of Colorado and Washington. In both, researchers found that underage use of marijuana and driving under the influence cases increased measurably. Most people would consider these harmful effects. But, on the other hand, many citizens of those states would also list helpful, or at least pleasant, effects for themselves. 

One of the complicating factors in ethical decision-making about substance use is the difference between youth and adult brains on substances. So, even though a change in policy may be about adults only, effects on kids should be considered by decision makers.  The children and youth don’t typically have a voice themselves.

We want to see policy makers have serious and educated discussions about these kinds of decisions.  We are encouraged when we see significant listening and attention given to the relevant research that is available. We’d like to see ethical guidelines really inform decisions, rather than be framed words hung on a wall. We’d like to see less harming in the name of helping, when it comes to legal and illegal substance use in this country.

Kathy L. Miles is coordinator for the Boyle County Agency for Substance Abuse Policy Inc.