J. Wesley “Wes” Boyd, MD, PhD, is on the faculty in psychiatry at Harvard Medical School and is a staff psychiatrist at Boston Children’s Hospital (BCH) and at Cambridge Health Alliance (CHA). He is the co-founder and co-director of the Human Rights and Asylum Clinic at CHA and works in the Adolescent Substance Abuse Program at BCH. Dr. Boyd teaches medical ethics and the humanities at Harvard, and is a graduate of both Yale and the University of North Carolina at Chapel Hill. In the middle of his many commitments, Dr. Boyd penned the book “Almost Addicted: Is my (or my loved one’s) drug use a problem?” We were able to contact Dr. Boyd and ask him a few questions regarding drug abuse, specifically in terms of the rising trend of prescription drug abuse.
TestCountry: Dr. Boyd, can you talk to us about the term “almost addicted” and the role the state of almost addiction plays in drug use intervention?
Dr. Boyd: We coined the phrase “almost addicted” to describe individuals whose drug use does not rise to the level of a formal diagnosis of either substance abuse or substance dependence but who nonetheless are suffering to some extent from their drug-related behaviors. So even if someone doesn’t have a full-blown addiction or hasn’t had major difficulties in life because of substance abuse, drug use can still negatively impact one’s life.
The role that this concept can have in intervention is that taking action when someone is “almost addicted” might prevent their drug use from escalating into full-blown addiction and might thereby prevent major problems from developing later. In Almost Addicted, we tell the story of just such a person, someone whose opiate use was in the “almost addicted” range for a long time but without intervention, at that point, it went unchecked and eventually developed into full-blown addiction with devastating professional and personal consequences.
TestCountry: You discuss prescription drug abuse in great detail in your new book. Do you see the trend of prescription drug abuse on the rise? If so, to what would you attribute the increase?
Dr. Boyd: Prescription drug abuse is the fastest-growing drug problem nationally, and the CDC has classified it as an epidemic.
In our book, we cite several statistics taken from a 2009 survey called Monitoring the Future: “16 million Americans in 2009 used prescription drugs for nonmedical purposes at least once in the previous year.” We also note that kids are also getting in on the act, with 2.7 percent of eighth graders and 8 percent of twelfth graders have abused Vicodin in the year prior to the survey and 2.1 percent of eighth graders and 5.1 percent of twelfth graders have done so with OxyContin, the brand name for the drug oxycodone.
Furthermore, 70% of those 12 years or older who abuse prescription drugs obtained them from friends and/or family as opposed to strangers, drug dealers, or others. Additionally, almost one-third of folks who used drugs for the first time began by using prescription medications in a non-medical manner.
I assume the rise in prescription drug abuse is multifactorial, including the fact that doctors might be prescribing more of these drugs than is warranted—which then sets up for the possibility of them being diverted away from their legitimate medical uses. Furthermore, I assume that many individuals see these drugs as safer than they actually are because they are used for medical purposes. In addition, I assume that in general drug use is more socially sanctioned than it might have been in the past.
TestCountry: What are some of the dangers of prescription drug abuse? Do you see prescription drug abuse as a larger threat than abuse of other substances?
Dr. Boyd: The dangers of prescription drug use are mostly identical to abusing drugs generally, but the fact that they are prescribed and legal in many settings makes them more insidious in certain ways. The particular danger can vary from one drug to another. For example, with many of the opioid medications, there is a very real potential for overdose and death. In addition, individuals can be highly vulnerable to the euphoria that these drugs can cause, which means that this class of drugs can be highly appealing to vulnerable individuals. Driving while intoxicated, perhaps especially on opiates or benzodiazepines, can be quite dangerous and is potentially lethal. These drugs also carry with them the risk of becoming physically dependent on them.
In the case of stimulants, I have seen many young adults abusing these medications and justifying their use because they have friends who are receiving prescriptions from physicians for the same medications.
I do not see prescription drug abuse as a larger threat than abuse of other substances—I see both of them as major issues and significant threats.
TestCountry: In your opinion, what demographic do you see as the most affected by this problem?
Dr. Boyd: I think that any demographic is vulnerable, but perhaps young adults are the ones who are most at risk. They are more at risk because that their frontal cortex is not fully developed until the mid-late 20s, and as such, they might be more likely to make ill-informed decisions and not consider possible consequences of their decisions. Using drugs while the brain is still developing can influence how it develops and result in moderate to potentially significant downstream problematic effects. Youth can also be less susceptible to the sleep-inducing effects of some drugs and more susceptible to the euphoria certain drugs produce, making them more at risk than older adults of using more drugs.
TestCountry: How does prescription drug abuse impact not only the user but the family and the community surrounding the user?
Dr. Boyd: Drug use, in general, can tear apart families because once someone is abusing drugs they often lie and steal to support their habit. Users also often exhibit dysregulated behavior, can be moody, easily angered, and even paranoid, any one of which can have a significant impact on loved one.
If the individual is abusing prescription drugs, perhaps that person is stealing a family member’s pain medications who legitimately need them. Once discovered the rift in the family can be dramatic. Or the user is stealing money to support a habit? Or raiding mom’s jewelry box, stealing jewelry to sell for drugs.
TestCountry: Are you aware of any work currently being done to address the problem of prescription drug abuse, governmental or otherwise?
Dr. Boyd: The problem is well known to authorities and experts on addiction. I know the DEA tracks the prescribing practices of certain physicians and tries to ensure that pain medications are being prescribed legitimately. In the case of Suboxone, for example, the DEA began doing random audits of Suboxone prescribers a couple of years ago to try to ensure that Suboxone (which has significant street value) is not being diverted or misused otherwise. Furthermore many communities have locked drop off facilities in which residents can deposit prescription medications that they are no longer taking in an effort to get more bottles of prescription pills out of medicine cabinets and properly disposed of.
TestCountry: What steps would you recommend a family member or friend take to address someone who they believe is abusing prescription drugs, starting with step 1? At what point should a person intervene or bring the problem to the attention of others?
Dr. Boyd: Step one is to see the problem for what it is and not try to sweep it under the rug or otherwise deny reality. Above all, do not enable the behavior by subtly or otherwise making it possible--or easier--for the individual to continue using drugs. Once you’ve reached this point the best way to start is to open a dialogue with the individual and stick with facts, stating what you have observed and what your concerns are. Bring in another family member or a close friend if that seems like it might help facilitate a dialogue. If the individual is placing anything important in their life at risk—like a job, a marriage, housing—then absolutely some kind of intervention is necessary.
TestCountry: You currently teach classes dealing with medical ethics at Harvard. Are there any ethical considerations to take into account when dealing with a person who is abusing drugs of any kind, prescription or otherwise? If so, can you describe one or two of them for us?
Dr. Boyd: Ethical issues arise when one basic tenet of medical ethics conflicts with another basic tenet. When someone is abusing drugs, ethical principles frequently butt heads.
For example, one of the basic medical ethical principles is that we should respect the autonomy of others. Drug abuse is a situation where fully respecting a drug user’s autonomy might result in them dying as a result of their drug use.
Another principle is non-maleficence, which means that we should either try not to harm people or that we should prevent harm from happening. Yet another principle is that of beneficence, in which we try to do good whenever possible.
Treating a drug abuser with dignity and respect while also ensuring that he or she gets needed treatment almost necessarily means that these principles will be in conflict with one another because the individual’s right to autonomy might best be overridden in order to promote the principles of non-maleficence and beneficence.
TestCountry: What is your bottom line on drug abuse? In other words, what is the one thing above all else that you believe our readers should take away from this interview?
Dr. Boyd: It is the norm rather than the exception that the individual using and/or abusing drugs thinks that his drug use is not causing any problems whatsoever. Nonetheless, the fact is that even casual drug use can create significant problems for vulnerable individuals and that taking action here and now can potentially prevent addiction from arising down the line.
Dr. Boyd’s book “Almost Addicted: Is my (or my loved ones) drug use a problem?” can be purchased on Amazon.com, in both the Kindle edition and paperback.