SUD Whack-A-Mole –

September 9, 2019 – The epidemic arose in the 1990s in areas that had experienced economic decline, a brain drain and population loss over decades. Many factors combined to create a monstrous situation in which small towns were flooded with prescription opioids: the preponderance of injury-prone hard labour jobs, requirements that physicians routinely ask patients about pain, aggressive marketing by the pharmaceutical industry, greed and extensive job losses from the collapse of key rural industries such as coal mining.

By the time Congress moved to address the opioid epidemic, the pattern of drug use had started to shift. Once, those using multiple drugs combined opioids with alcohol and other drugs, such as anti-anxiety agents that act on the central nervous system. Where I work in central Appalachia (West Virginia, southern Ohio, eastern Kentucky and northeastern Tennessee), opioids are being rapidly supplanted or exacerbated by cheap, readily available, high-potency methamphetamine. When opioids are used, they are being increasingly combined with stimulants such as cocaine — which, like methamphetamine, is thought to help to counteract the depressant effect of opioids. Federal grants come tagged for combating opioids and cannot be repurposed to deal with the rising incidence of methamphetamine misuse. The narrow focus on opioids means we cannot keep up with the drug du jour cycle: we will just keep playing whack-a-mole.

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