The Need for Prescription Drug Harm-Reduction
Today I had the second appointment with my psychiatrist. In ten minutes, I was prescribed a 5 month supply of the stimulant medication Adderall. I'm concerned at how casually I was just prescribed a schedule II drug with a “high potential for abuse” that “may lead to severe psychological or physical dependence". As our movement looks beyond the the Marijuana legalization debate, I think it is important to discuss the future of regulating all types of drugs. Considering the current hysteria about prescription drug abuse, there is clearly something wrong with today's prescription drug regulations. Here I would like to share my own experience and concerns about legally obtaining a drug which is not so different from Cocaine.
Let me begin one year ago when I first set out to get an Adderall prescription. At college, I had bought Adderall from friends to use as a study-aid. I don't believe ADD is a disease, but I do believe certain people have more difficulty concentrating than others, and I think I am one of those people. Having an immense respect for drugs, I researched the potential harms of Adderall before I used it. I knew there was abuse potential, so I used it once or twice per week at the most. Last year, I decided to get my own prescription to save money. I found a psychiatrist though my insurance. Before I met with him, he sent me a 20 page questionnaire asking me various questions about my mental health. I honestly answered questions concerning my concentration, anxiety, and overall mental health. I brought the questionnaire to the first appointment. He spent about ten minutes reviewing my answers, and diagnosed me with general anxiety and ADD. Five minutes later, I left with a prescriptions for four months worth of Adderall and Paxil, the latter one I never filled because I don't believe I have an anxiety disorder. I didn't talk to him again until today, one year later, when we met for 10 minutes and he refilled my prescriptions. He asked me two questions: if school was stressful, and if I experienced any bad side effects. Yes, school is stressful, no, no debilitating side effects.
I see several concerning issues with my experience. This might sound hypocritical, considering I set out to legally obtain a drug, and I did. Why should I be complaining about how easy it was? Because I'm worried about society treating powerful substances so casually. I believe the increase in prescription drug abuse, especially among youth, has to do with precisely this lack of oversight and nonchalant attitude among some psychiatrists at passing out drugs. Here are my concerns:
1) The diagnosis process. It's not okay for a doctor to spend 15 minutes with a person and determine they have a psychiatric disorder in need of medication. This is a process which should take several visits and discussions between patient and doctor on the unique needs of the patient, not a generic questionnaire.
2) The prescription. Right off the bat, I was prescribed 30 mg a day of Adderall. This is way too much Adderall for anyone to be taking, in my opinion, never mind someone just beginning.
3) No follow-up. My situation was complicated because I was going to college, but still, to give me a 4 month supply of powerful drugs and make no effort to contact me on how I am tolerating the treatment is ridiculous and dangerous.
4) No education. He should have given me warning signs to expect if I am having problems with the drug. Not everyone would have done the extra research I did, he should have told me how the drug effects my brain and body. It is easy to build up tolerance to Adderall, which is why it is important to start with low doses and never take more than you need. He never told me that unlike drugs for depression or anxiety which you must take everyday because the effects are gradual, Adderall works instantly and it is okay not to take it everyday. In fact, in my experience it is best not to take Adderall everyday, but instead only when you need it.
I'm not sure how common my psychiatric experience is. I'm guessing my psychiatrist is more irresponsible than most, and I hope that the average psychiatrist spends more time with patients. Still, my experience points to a general lack of proper procedure among psychiatrists at doling out drugs, and the lack of any sort of oversight on the actions of psychiatrists. If a psychiatrist has their heart set on making money, they will squeeze as many patients as in as possible, meaning no patient will receive adequate care.
I'm struggling to figure out exactly how I feel about my experience. I am a firm believer in my right over my own body. I want to be able to obtain any substances which I please, I want it to be my choice. At the same time, like everything else in society, we need drug specialists to facilitate the decisions we make regarding drug usage. There is a necessary place in a legalized drug market for "psychiatrist" type people, we can't expect everyone to research which drugs they need and how to use them safely on their own. If we truly want to reduce the harms of drugs, we need to start being proactive by making sure psychiatrists educate patients about drugs from the moment they can obtain them.
There is a common conception that certain people have "addictive personalities" or are simply prone to abusing drugs, as if a certain group of genes are programed to abuse drugs. I believe this philosophy severely underestimates humans. We have much more will-power than we give ourselves credit for, the problem is that we don't have the necessary resources to make smart decisions concerning drugs. It is the psychiatrist's job to educate patients on their bodies and substances. As much as I hate the government exaggerating the harms of drugs, I wish psychiatrists would make people more scared of truly dangerous drugs. I'm worried about the people who visit my psychiatrist who are oblivious to the nature of drugs and addiction and blindly follow the word of an incompetent doctor.
As drug policy reformers, it is in our interest to assess current legal drug regulations if we hope to eventually move all substances into a regulated market. This is important for transforming public opinion on legalization. The public is being bombarded with stories about how harmful prescription drugs are, take Michael Jackson's case. We can't expect people to support moving Cocaine, MDMA, or Heroin into a regulated market, when the current market looks pretty scary and problematic.
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reddit"legal"?
Comment posted by mlang52 on Sun, 08/09/2009 - 11:28amElephant,
Everybody has trouble concentrating while studying! If this is why you took the drug, illegally, then going to a doctor to obtain them for a disease (that you do not feel exists) is just as illegal as the addict buying heroin from the dealer! Until society figures out how to stop this illegal behavior (which I doubt we ever can), then your ideas will fail. The system that regulates controlled drugs is exactly the system you went through, to obtain the Adderal. Medicine is supposed to be taken for diseases, diagnosed by doctors, and not used at the whim of every Tom, Dick, and Harry who thinks he has an untreated medical problem.
How, can you out-guess the doctor on whether he took enough time to decide on your diagnosis and treat you? Ever been to a real doctor's office? He usually takes care of your problems in five minutes, and sees up to 100 patients per day!
It is so hypocritical to admit you illegally obtained drugs that had no ill effect on your life, then turn around and "worry" about how easy it was to get them! Sounds like your thinking process still needs to mature a little more! Grow up! I don't think we need another nanny trying to control our lives! Government intervention is, exactly, why the problems, we have, now exist.
And I find it a little naive, at best, to assume people don't understand the harms of controlled drugs. They are controlled for some reason!? You are making assumptions that don't add anything to a reasonable argument.
Regulated retail outlets
Comment posted by TrebleBass on Fri, 07/31/2009 - 9:18pmIn the future (when drugs are legal), i've always thought there should be some way of regulating drug stores. It would be good if you could walk into, lets say, an opiate store (they sell smokable opium there as well as other opiates in different forms). There are small tvs strategically placed constantly playing educational videos about opiates, explaining things about dosage, drug interactions, methods of administration and their differences, addiction patterns; there's pharmacists there (or rather, opiate specialists) who you can ask questions to, there's an addiction counselor you can talk to, as well as referrals to rehab centers; there's the smoking paraphernalia aisle, where they have a little tv playing an educational video about the pros and cons of smoking opiates, the injection paraphernalia aisle, with its own little tv, the pill aisle, with its own tv (there's, lets say, a somewhat long video about opiates in general that's always playing at a certain place in the store, as well as these shorter, method specific videos). They sell all the videos. They also have literature, from free pamphlets to books you can buy. In general, it is a store and an opiate education center in one, as well as a first aid counseling center and a referral center. All of this is regulated by law, so that anybody who wants to sell opiates has to do it this way (or perhaps it would be easier to just have them be government run; either way).
A similar model (with variations) can be used for different types of drugs. This would not be a place to consume drugs, although those would exist as well, but there would be different models for those with different regulations. In general, however, the idea would be to emphasize safety, educated consumption, and referrals to rehab (along with, of course, in the case of consumption centers, the freedom to enjoy onself).