So I figured we could do with a little history lesson, so for the next few posts I’m going to talk about the different laws that changed the landscape of opiate addiction treatment. First, a timeline for reference. Here’s what the United States has been doing legally concerning drugs and regulation over the past 100+ years:

• Pre-1890: Local city or state laws and regulations only. Opium was the first target in 1875, made illegal in opium dens in San Francisco. In 1890, the federal government taxed morphine and opium. And laws just got tighter and tighter from there.
• 1906: Pure Food and Drug Act - Here’s where we started regulating quality and prescription drugs were apart of that.
• 1909: Smoking Opium Exclusion Act – Clearly, no more opium for anyone except in the form of opium-based prescriptions. Big landmark: this was the first law that banned the nonmedical use of a substance.
• 1914: The Harrison Act - Hmm. An incongruency: even though it was illegal to use opium, those who were involved in any way with selling it had to register with the government and pay taxes on their sales.
• 1919: Not a law so much as a ratification: the Supreme Court upheld a decision that doctors could no longer prescribe needles or other paraphernalia to opiate addicts. And thus the need for needle exchange was born.
• 1922: Narcotic Drug Import and Export Act – All narcotics are now regulated… or at least their sale and production, possession and consumption.
• 1924: Heroin Act – Heroin joins opium on the illegality list.
• 1927: Bureau of Prohibition – This organization was started to stop drug trafficking through bootleggers and organized crime as they cross state laws, becoming too much for local law enforcement to handle.
• 1932: Uniform State Narcotic Act – The feds get state lawmakers to create laws equivalent to the federal Narcotic Drug Import and Export Act.
• 1938: Food, Drug, and Cosmetic Act – Lots of regulation concerning prescription drugs, including the requirement of proof that a drug works for a particular ailment before it can be marketed as a treatment.
• 1951: Boggs Act – Criminal penalties and mandatory minimum prison sentences for importing and exporting drugs established.
• 1956: Narcotics Control Act – Mandatory minimum prison sentences for other existing drug laws.
• 1965: Drug Abuse Control Amendment – With psychoactive drugs comes the requirement of approval of all drug research by the FDA.
• 1970: Controlled Substance Act - This law is a big one and regulates both the manufacture and distribution of everything from narcotics to prescription drugs to psychoactive drugs to the chemicals used to make drugs. The five-schedule system is created based on medicinal value of the substance, its potential for abuse and addiction, and how harmful it can be if abused. Schedule I drugs are the worst with no medicinal value to speak of and a high danger factor (i.e., heroin). Each level is decreasingly less dangerous, with Schedule V covering the least dangerous drugs of all. 

Too. Many. Laws.
Must. Take. Break.

Check out a History of Opiate Laws in the United States, Part II in a couple days!

It looks like the Drug Enforcement Administration has a new idea that they want to run by you: what if we allowed controlled substances to be prescribed electronically? It’s a little more than just an idea at this point, actually. It’s a proposed rule, which means that it will require a public comment period before it can be passed and certainly before it is implemented.

What Online Painkiller Prescriptions Would Look Like

Well, it’s a little unclear and that’s part of what the public comment period is for: to bring up possible problems and complications and then address them. Security requirements will more than likely be a part of that, to make sure that those who procure online prescriptions are actually who they say they are and in need of said medications. In short, that no one is stealing drugs or “diverting” them as they say for illegal purposes.

Controlled substances make up an estimated 10 percent and 13 percent of all prescription medications in the United States. Included in this proposed rule for online prescriptions would be Schedule IV medications (Xanax, Ambien, Lunesta), Schedule V medications (Lyrica), and even Schedule II medications that many struggle with (OxyContin, et al).

Online Painkiller Prescriptions Might Just Happen

The feeling I get from what I’ve read is that this is something that is being pushed for by a number of different groups, including Medicare. The DEA is hoping for it go through and would in fact conjoin the rule with a Medicare bill with the hope of encouraging physicians to adopt the practice. According to the Wall Street Journal, these might “finally lead to widespread adoption” of online prescriptions of controlled substances because many doctors “have been reluctant to purchase the technology because of concerns including cost and DEA restrictions.” In fact, according to Kaiser Daily Health Policy Report and Medical News Today, “fewer than 10 percent of U.S. physicians currently use e-prescribing.”

Do You See A Potential Problem with Online Painkiller Prescriptions?

Call me paranoid, but it seems like it’s already too easy to get prescription opiate painkillers. The online pharmacies that are currently in existence, even if illegally or internationally, are a huge part of the problem with ill-gotten prescription meds. Isn’t anyone concerned about hackers? If people can snag your credit card information, break into your bank accounts, find out your Social Security number and use it against you, then doesn’t it stand to reason that medical records including prescriptions if maintained in an online database could become subject to the same abuse?

This could all begin as early as next week. So what do you think? Is the convenience of online automation of prescriptions worth the possible abuse that could arise? Are you for it? Against it?

When I was using drugs, the idea that I might be an addict was a source of great shame. I wasn’t ashamed that I used drugs; that wasn’t my problem at all. No, I was ashamed that I’d lost control of my use, that I couldn’t quit when I wanted to, that I couldn’t handle the withdrawals.

I also didn’t want to be like “them”, you know: addicts, junkies. I wasn’t that sick, was I?

My use was out of control for a long time before I got help. I thought about getting help - but I didn’t want to say to my family: I am addicted to pain pills, and I need treatment. No way did I want my friends, or my job to find out. What would they think of me? How could I face everyone?

I feared the stigma of having “addict” all over my medical records too. Many of us know how doctors treat patients who are “drug seeking,” and I imagined it would be a hundred times worse if I was an admitted addict.

So I suffered, and I suffered some more. Finally, the suffering was worse than the shame (but only very slightly) and I decided to call for help.

What Was It Like?

Amazing. And scary, but not shameful. In fact, the health care professionals I’ve worked with throughout my addiction recovery - from doctors to therapists to research coordinators - have been some of the most respectful, kind and empathetic people I’ve ever known. It was among these people that I first began to really understand that my addiction is a medical problem, not a moral problem.

By the time I decided to get help, I knew I wanted to try Suboxone treatment. This meant I needed a diagnosis of “opioid dependency,” which required meeting with a doctor. My doctor was an addiction specialist, and he was so non-judgmental that it was a relief just to talk to him.

The first appointment was just me answering a lot of questions about my drug use. That was the scary part, but it was also really eye-opening. The questions were like:

• What kinds of drugs are you using?
• How much?
• How often?
• Do you ever drive when you’re high? (That was a big slap upside the head for me, I’m sad to say.)
• Do you do anything illegal to get your drugs?
• Do you hide your use from others?
• Does your drug use effect your job? Your social life?

By the end of that interview it was abundantly clear to me that I was addicted to pain pills. It was also clear that I wasn’t being judged for my problem, no one was going to slap a scarlet A on my chest and expose my faults to the world. I was among people who both wanted to help me and had the means to do so. I made an appointment to come back in a couple of days for my first dose of Suboxone.

When I arrived for my “induction” (that’s what they call it when you start Suboxone treatment) I was in moderate withdrawals as I hadn’t used in about 30 hours. I felt pretty crappy indeed, but hopeful too.

My doctor told me how to put the pill under my tongue and let it dissolve. I started with half of an 8mg pill, and went to sit by myself in the lounge and read a magazine. The taste was bitter and I wasn’t used to holding anything under my tongue like that, but my word…that first dose of Suboxone was a revelation.

Within 20 minutes my nose stopped running, my legs weren’t aching, no yawning, no coughing, no stomach cramps. It was like this huge wave of relief washed through my body. By the time I took the other half of my dose and walked out of the doctor’s office, I felt normal.

All day long, I felt normal - by which I mean good. I felt like myself, a feeling I hadn’t experienced in a long while. I had no cravings. I didn’t feel euphorically high, but I was in a good mood.

I went to work that day, and the next, and the next. I was able to fulfill all my family obligations and I even had the energy and inclination to do fun stuff on the weekend. It wasn’t perfect, but it was close enough. And I didn’t have to tell anyone what I was doing unless I wanted to.

I remember feeling sorry that I’d waited so long to get help once I realized what getting help would be like. I’m not saying that I took Suboxone and lived happily ever after. But Suboxone has given me the stability to sort out the mess that I made of my life, and to work on healing my body and my spirit. It also reminded me of how good it feels to be clear-headed and in control - now I don’t want to risk losing those things ever again.

What About You?

So what are you waiting for? There really is no need to suffer more, or for your addiction to progress further before you make the call and ask for help. Believe me, if I could do it, so can you.