From: rpattree2@gmail.com   
      
   Addicts Will Always Find a Way to Get High   
   site-iconblogs.psychcentral.com/addiction-recovery/2014/06/addic   
   s-will-always-find-a-way-to-get-high/   
   David Sack, M.D.   
      
   By David Sack, M.D.   
      
   When the makers of OxyContin reformulated the drug to minimize abuse in 2010,   
   the sudden unattractiveness of one of the most widely abused painkillers   
   prompted a dramatic surge in heroin abuse. Onlookers expected OxyContin to   
   lose its huge following, but    
   few expected such a widespread shift to heroin. Yet studies show that's   
   exactly what happened.   
      
   From 2010 to 2012, researchers from Washington University and Nova   
   Southeastern University surveyed over 2,500 people seeking treatment for   
   opiate addiction at 150 treatment centers throughout the country. They further   
   interviewed 103 people who filled    
   out anonymous surveys in an effort to assess how their drug habits had changed   
   over time.   
      
   Much to their relief, the reformulation achieved an important goal: OxyContin   
   went from being the primary drug of abuse for 36 percent of participants to   
   just 13 percent less than two years later. But participants didn't stop using   
   drugs. As Oxy abuse    
   fell, participants switched to other opioids. Use of potent painkillers   
   fentanyl and hydromorphone rose from 20 percent to 32 percent, and the number   
   of people abusing heroin in the past month doubled. Every single one of the   
   103 patients interviewed    
   said they would replace OxyContin with something else.   
      
   Addressing Demand, Not Supply   
      
   To those of us in the field of addiction treatment, the switch to heroin and   
   other prescription painkillers came as no surprise. That's because, as I've   
   described in previous posts, treating addiction is like a game of Whac-a-Mole.   
   Take away one drug,    
   another pops up in its place.   
      
   Changing supply does little to change demand when it comes to drugs of abuse.   
   Why? Because addiction is a chronic brain disease that changes the function of   
   the brain, and because people often use drugs to cope with painful emotions.   
   Neither of these    
   problems is cured by making drugs less available.   
      
   Few drug abusers are "sold" on just one drug. Most are opportunists who,   
   driven by the changes that occur in the brain, will use whatever drug they can   
   get their hands on to feel better. Heroin is a seemingly attractive option   
   because it is cheaper and    
   more readily available than OxyContin and other prescription painkillers.   
      
   One Step Forward, Two Steps Back   
      
   Unfortunately, heroin is also extremely dangerous for the individual and a   
   much greater overall risk to public health than OxyContin. Users have to take   
   it more frequently, rarely know the purity of what they're taking (which   
   increases the risk of    
   overdose), and often end up engaging in high-risks behaviors like needle   
   sharing and criminal activity to fund their habit. What's more, they're out of   
   touch with the medical system. Instead of dealing with doctors, they're   
   scoring from street dealers.   
      
   Since some OxyContin users have switched to other prescription painkillers,   
   experts are calling for additional slow-release formulations that can't be   
   abused. Of course, true to the nature of addiction, users would simply turn to   
   heroin and other opiates.   
    We saw this happen when an abuse-resistant form of Opana (oxymorphone) was   
   released, which predictably prompted a switch to other opioids rather than a   
   cessation of drug use. If addicts run out of prescription drugs, they'll turn   
   to heroin or other    
   illicit substances. If they run out of illegal drugs, they'll find someone   
   synthesizing bath salts, synthetic marijuana or some other manufactured high.   
      
   Similar to drug reformulations are efforts to create an addiction vaccine.   
   After nearly 40 years of research, scientists are getting closer to a vaccine   
   against a number of addictive substances including heroin, meth, cocaine and   
   nicotine. For some    
   motivated people, vaccines may be an adequate deterrent from continued drug   
   abuse. But for most addicts, even if these vaccines prove effective in   
   blocking the pleasurable effects of certain drugs, they will not prevent users   
   from circumventing the    
   vaccine by taking extremely high doses, failing to comply with vaccination   
   schedules, or switching to other drugs or compulsive behaviors. While vaccines   
   rightly approach addiction as a medical disease, they simply cannot address   
   the mental, behavioral    
   and spiritual issues that led to addiction in the first place.   
      
   Getting Back to What Works   
      
   People aren't going to stop using drugs because we change the formulation.   
   They aren't going to quit because we create harsher drug laws. Even a vaccine   
   won't put an end to drug abuse. What will make drug abuse a thing of the past?   
   The same solutions    
   that apply to other chronic illnesses: prevention and long-term treatment that   
   addresses the underlying issues that fuel the need to self-medicate with drugs.   
      
   Instead of criminalizing addiction, encouraging doctors to stop providing care   
   to people who may be addicted to prescription drugs, and focusing the majority   
   of our research and resources on finding new formulations, vaccines and pills   
   to defeat people's    
   attempts to get high, we need to address the much deeper issues at work in   
   addiction.   
      
   David Sack, M.D., is board certified in psychiatry, addiction psychiatry and   
   addiction medicine. Dr. Sack currently serves as CEO of Elements Behavioral   
   Health, a network of addiction treatment centers that includes Promises   
   Treatment Centers, The Ranch,    
   Sexual Recovery Institute, The Recovery Place, Right Step, Promises Austin,   
   Lucida, Journey, Sundance, and Clarity Way.   
      
       
      
      
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       Last reviewed: 9 Jun 2014   
      
   APA Reference    
   Anonymous. (2014). Addicts Will Always Find a Way to Get High. Psych Central.   
   Retrieved on June 10, 2014, from http://blogs.psychcentral.com/a   
   diction-recovery/2014/06/addicts-will-always-find-a-way-to-get-high/   
      
       
      
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