Harm reduction via opioid agonist substitution therapy, decriminalization (as in Portugal), or supervised injection facilities has been a measurable reality. Yet more money is spent on enforcement despite its failures. People tend to self-medicate, and depending on their varied brain chemistries, have turned to alcohol, stimulants and opioids, even food, just to feel “normal.”
Further reading: Malpractice reforms could ease physician burdens
The specific opioid antagonist naltrexone is used to treat alcohol addiction and is a component of a diet pill (Contrave), suggesting multiple pathways to opioid receptor activation. To be free of pain, emotional and physical, has become the Holy Grail of our culture, and doctors have been conscripted to join the search.
My friend, now in his late 60s, is currently doing well. He has intermittently been prescribed antidepressants, and had one more short psychiatric admission years later, precipitated by the stress of his wife’s losing battle with breast cancer. He had a brief flirtation with opioids when he found they could calm him down, but quickly realized the folly of this, and desisted. He is to this day grateful that I tried so desperately to keep him out of the hospital those many years ago.
My medical student seemed quietly upset. She will likely not look to treat chronic, opioid-requiring pain patients, and will refuse their care or refer them out, as so many of us feel compelled to do.