Letter to the Editor
I applaud Dr. Leon Gussow's article on carfentanil as a new and dangerous drug on the block. (“Who Said the Opioid Crisis Couldn't Get Any Worse?” EMN 2016;38:1; http://bit.ly/2gDoM6f.) With each day the number of drugs of abuse increases, and with each new drug, often synthetic or biological, it seems impossible to turn the tide or to even maintain our position to adequately treat this growing crisis.
New drugs are being produced every day, many by the pharmaceutical industry itself that are quickly diverted, and even more by the ingenious “chemists” in the “private sector.” Synthetic drugs or herbal products become available so quickly, many over the internet, that the legal and medical systems cannot begin to stay abreast. Couple this with the almost unstoppable push to legalize previously banned drugs, marijuana most recently and now perhaps ecstasy (http://nyti.ms/2jfSkvv) and even cocaine for treating depression and PTSD (http://bit.ly/2iVmKzW).
The problem seems insurmountable. The government is regulating the sale of recreational drugs from alcohol and tobacco to marijuana and energy drinks, and they collect taxes on their sale. We as practitioners are being told we must curtail our prescribing habits while the same agency that tells us this is enabling the use of the drugs, alcohol, and tobacco that kill more people than any of the ones we prescribe. I am not suggesting that we don't need to address opiate use or that the government should attempt to abolish alcohol or tobacco use, but I am saying that the medical professional is but a small part of the problem.
The lesson here is not that we are being pushed in every direction at once and then are blamed for moving the “wrong” way; it is that we are not capable of solving the drug problem alone. The appetite for drugs, alcohol, narcotics, or synthetics is greater than any simple solution. We as practitioners can and should decide not to supply the drugs that kill our patients, but the solution is not a medical one; it is a societal one.
I practice in Massachusetts on the border of New Hampshire. The heroin in this area comes through Caribbean nations, not Mexico. If we block its entry from these sources or from Mexico, the entrepreneurs will find other means to import their products and those who use them will find other new drugs to substitute. We are not the cause of the problems and while we can contribute to a solution, we cannot solve it without addressing the problems within fundamental structure of our society.
Paul Janson, MD