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No one is immune from addiction!

Published : Monday, 14 October, 2019 at 12:00 AM  Count : 213

Nazarul Islam

Nazarul Islam

Imagine what could happen if the deadliest germs got released from the 'secure' premises of biology labs--to reach our homes, via contaminant agents or household groceries. In terms of human costs, this impact would be deadly and similar in effect, to a meteor hitting the dark freeze of Siberia, or the crater valley being created in Mexico, by a rocky space 'visitor'.

When our research doctors and scientists make their errors- perhaps, collateral damage is the outcome; colossal, and fraught with casualties. Or, simply imagine a scenario, where thousands of high rise residences would collapse en masse, in the face of earthquake of magnitude 7.5 on Richter scale.

These metaphors may appear to be few dramatic examples,  that have remained stuck in my mind--and point toward one apt way, that describes our pathological marketing system. This direction allows companies to push dangerously addictive drugs to the public, and to our doctors. It could describe both the mistakes of opioid makers and the emerging problem of nicotine addiction, now exploding through the global practice of 'vaping'.

Society ultimately, has come to terms with consumption of narcotics, and has sought refuge within the domains of practices, adopted by our indigenous, health community. Way back in the 1990s, drug makers had encouraged the term 'opioids', to be substituted by the more scary term 'narcotics', after the producers had aggressively commenced marketing a new set of painkillers. Opioids were once reserved for people with terminal conditions, such as cancer. However, an influential 1986 paper started a fashionable trend which had focused opioid--and, projected its use as a 'humane' way to treat other painful conditions.

In the milieu that followed--by the year 2014, doctors in the United States had written a staggering total of 245 million prescriptions for opioids. Meanwhile, the teen smoking rates had plummeted, and as a sequel, vaping among teens has been soaring. Nearly 21 per cent of high school students surveyed in 2018, have admitted to vaping, up from 11 per cent in 2017.

Medical community's error in both cases comes down to register a failure--of respecting addiction, as a disease. Our Doctors were required to be trained, to recognize and comprehend and diagnose 'addiction'. Along with the insurance companies, regulators and others players, they failed to balance the risks of addiction, with the benefits of alleviating pain, or helping a patient quit patronage of nicotine, available in all its forms!

The problems with opioids have remained obvious, but now, we are only beginning to learn about the risks of vaping. As with opioids, some in the health industry have initially hailed the devices used for vaping--electronic cigarettes--as something quite beneficial, since these were likely to cut drastically, the risk of lung cancer--in people with incurable nicotine addiction. These addicts could satisfy their drug cravings without the cancer-causing tar, which otherwise, they would likely receive from regular cigarettes.

The obvious downside has been for the non-addicts, starting an electronic cigarette habit had been the primary cause of addiction, and that in turn had placed users at the risk of other problems. First, there had existed, the unknown long-term risks. Nobody really knew what might happen to people, after they had 'vaped' for three decades. And now, there exists a rare but imminent threat: statistics reveal that over 500 people have been treated for an acute lung disease, from which at least three hundred have died so far, in the United States.

This is a small number compared to the 480,000 annual deaths associated with tobacco smoking, but some young people are now reverting back, from vaping to smoking, arguing that the risk of lung cancer-decades into the future, is preferable to even a tiny risk of dying of a weird new disease, before their next birthday.

The big question is, how may the medical community respond to all this, today? One step in the right direction is to develop, standardize, and test electronic cigarettes as a prescription 'medical device', and advise a ban on the marketing that promotes them as a multi-flavoured form of recreation. Methadone is known to contain uses for helping heroin addicts, for example, but we would be horrified, if companies started to market it as a product, that offered something 'fun and cool' in value, particularly, if these were aimed to be marketed for those users, aged eighteen or less.

In the UK, the medical community has acknowledged that e-cigarettes could benefit addicts, and various sorts of clinical trials are underway to document harm-reducing potential. To do that in the US, there arises a need for a standardized device.

Nora Volkow, an expert on the neuroscience of addiction and the head of the National Institute on Drug Abuse, had explained in an interview: 'It's impossible to test the great variety of devices available now, some of which can deliver extreme nicotine doses, equivalent to an entire pack of cigarettes'.
The flavours and potential to smoke cannabis add to these complications--and there's some evidence that this new acute lung disease is tied to cannabis, even if not all patients admit, that was what they were vaping.

"Smoking and vaping may not be known for giving people the intense high associated with cocaine or opioids, yet the power to addict is anything but mild', Volkow had opined."She has observed how the this drug affects the brain functions of laboratory animals, and explained that nicotine gets into and out of the brain rapidly, altering neurological circuits involved in rewards and, in essence, training the brain to get to repeat this activity. This drug has been known to alter the neurological, reward circuits, which affect the way the brain responds to other forms of pleasure.

Both nicotine and opioids cause two separate neurological effects: dependence and addiction. Dependence is a disruption of people's body chemistry, leading to withdrawal symptoms if they stop. Opioid patients can develop extreme nausea and vomiting from withdrawal, while nicotine users tend to get irritable and fatigued. When people are addicted, however, the brain undergoes long-term changes and they can crave a drug even years after quitting. That's good reason to stay away from nicotine, but also good reason for the medical industry to help those who are already afflicted.

With opioids, the benefits were clear, while the risks were underplayed. Today, companies like Purdue Pharma and Johnson & Johnson have been asked to pay heavily for their role in that crisis. With vaping, while reports on the sudden deaths have led to categorical calls for a ban, Volkow sees a different road forward. 'If you analyze what's responsible for the deaths and study how you can potentially use the devices in a way that's beneficial (to nicotine addicts)--then my perspective is that, we should look into it.'

In both cases, some of the 'casualties' of the past, might have be alive today, had doctors better understood addiction as a disease--one that medicine can help treat, but in some cases has helped spread, beyond control.

Finally, let us endeavour to understand the underlying, finer concepts of the widely misunderstood term 'addiction'. We don't choose to be addicted; what we choose to do is deny our pain. Remember, that just because you hit bottom doesn't mean you have to stay there. And, beyond any doubt there is not a drug on our planet,that can make your life meaningful!

The writer is former educator based on Chicago

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