Why Don't We Stay Present?

Yep. It’s Everywhere. And it’s Increasingly Easy to Obtain.

Recently I noticed a couple of packages of candy on my hospital inpatient's table.  On closer inspection, these were tobacco vape pens in fruit flavors.  Then, I learned from one of my outpatients of a new way to get high: the hallucinogen DMT.  What's DMT you ask?  It's the active ingredient in Ayahuasca.  What's Ayahuasca you ask?  A potent South American hallucinogen that has prompted a whole tourism industry serving Americans wanting to have a Central or South American vacation trip -- that's also a, you know, "trip."

Cannabis is now on roll, with state after state rolling out legal pot.  Virginia just decriminalized possession (up to an ounce) and personal growing (4 plants). Connecticut was the most recent to legalize sales, possession and cultivation.  Currently, there is a trend of legalizing psychedelics. And then there’s the traditional (and wildly harmful) drugs: alchohol, tobcco, and opioids – which Americans have and continue to consume and abuse.

Do Americans Have a Problem?

Using substances to achieve altered states is far from new. From inducing states of prophetic trance and freedom from inhibition, to intoxication to soothe anxiety and lubricate social interaction, these practices date back thousands of years.  The Romans and Greeks had gods of wine and celebration.  We see it in the Bible, in ancient Norse tales, in virtually every culture.

However, take a moment to look at the stats: Americans, representing less than 5% of the world's population, consume 80% of the world's opioid prescriptions.  Think about that.  Western Europe and Canada combined, with 150 million more people than the US, only consume 15%.  And the rest of the world, just 5%. 

And it’s not just usage – it is abuse. According to the CDC, in 2019, 50,000 Americans died of opioid overdoses, out of over 70,000 overdoses from all causes. In 2020, the estimate is over 90,000 deaths from overdose during COVID.  

How about Americans and tobacco? We just lost 600,000 people to COVID.  A disaster on a scale that is unimaginable -- unless you look at the 250,000 people who die every year from tobacco addiction. 

Then there's alcohol -- the American solution to every social situation.  We toast to weddings and get drunk at wakes.  We drink to celebrate and drink to console.  Alcohol is the number one most used psychoactive substance in the world.  The cost in motor vehicle accidents, domestic violence -- it is implicated in 1 of 8 sexual assaults – and other harm is staggering.  

But of course, that’s not all. In 2010, the UNODC estimated that 40% of global cocaine was consumed in North America (that's mostly the US).  And I lose count of the rest...  PCP, Ecstasy, glue... patients are even getting high on Diphenhydramine and Dextromethorphan! 

There is something especially and seriously wrong that Americans are consuming this many drugs at this level.  

As providers, we see it up close and personal. We see the damage flowing through our emergency rooms and on the floors of our hospitals.  It fills our prisons and is a catalyst for gangs, whose victims also show up on our floors. And it seems there is very little we can do.  

As health care providers, we must ask ourselves, what is fueling this epidemic?  What is it about America that makes it so preferable not to be here and face life on its own terms? What is the rest of the world doing differently? Do we have more pain?  Or can we just not stand that life is sometimes painful? Can we find non-chemical happiness? 

SAMHSA notes that 21.4 million people need substance use treatment, but we don't have good treatments and we don't have a robust research establishment that can outsmart the research establishments of the cartels, the distillers, and companies like Purdue Pharma.  We pack people off to treatment facilities that fail most of the time.  And we don't even get basic treatment because insurance coverage is so poor.  

What is it about America that has created this vulnerability?

No answers here folks. Sure, to deal with the effects, we need better infrastructure: better treatment, better insurance, a better regulatory environment. But looking at the cause side: how can we stem the demand? Maybe we need to rethink how our culture teaches people how to experience their lives. Whatever the cause, whatever the solution, the current situation is shocking and very distressing.  

I need a drink.  

For an excellent counterpoint view, please see:

How Should We Do Drugs Now?
https://www.nytimes.com/2021/07/09/opinion/sunday/drug-legalization-mdma-psilocybin.html?referringSource=articleShare