Addiction is the Price We Pay for Neglecting Our Children

We can no longer afford to discard substance abuse programs from our health insurance benefits.

OPINION -- This was the first of many surprising conclusions discovered by our committee of citizens. We spent seven months attempting to understand Oregon’s addiction problem. Our report, issued earlier this week, reflects our goal of better policies in our state to improve addiction prevention, treatment, and recovery. This was a long and shocking process.

We began, according to plan, with extensive foundational documents issued by many government and professional agencies, such as Centers for Disease Control and Prevention, the office of the Surgeon General, the National Institute of Drug Abuse, the Oregon Health Authority, and many others. But our most powerful findings, however, came from our witnesses, most of whom spent their careers in the front lines of caring for people with addiction. These witnesses, who spend many hours sharing their experiences with us, provided a powerful new vision of addiction. Not new to them, but certainly new to us.

Our report, a product of a handful of citizens dedicated to using our resources to improve our state, goes beyond our initial expected focus on opioids (most addiction, or substance use disorder (SUD), involves alcohol) and adult treatment (most SUD begins in young adulthood or adolescence). We heard about a world of disadvantaged children where the only method of coping with overwhelming stress was an addictive drug.

We learned that the principle source of SUD in Oregon is a childhood filled with stress. This stress included physical and sexual abuse, homelessness, hunger, abandonment, absent parents, lack of healthcare, poor education, and a lack of the self-esteem and social skills needed to deal with any trauma. The greater the number of childhood stresses, the greater the intensity, the fewer the coping skills, the greater the certainty they will turn to and depend upon addictive drugs to survive the lives they lead.

There is much more in our report.

We confirmed that SUD is not a moral failing, but a chronic medical condition that, like hypertension, diabetes, and other chronic diseases, can rarely be cured but can be controlled with early and sustained medical attention.

We learned that treating this medical condition with punishment and social ostracism fills our justice system with prisoners and fills our streets with the destitute and homeless, without altering the ongoing devastation to our families and society.

We learned that harm reduction, not abstinence, is the goal of recovery, and that restoration of patients’ ability to function in their family, friends, and neighborhood is a success.

We learned that SUD prevention, treatment, and recovery needs to be integrated into everyday mainstream medicine rather than relegated to stepchild status. We can no longer afford to discard SUD programs from our health insurance benefits.

We confirmed that physician practice profoundly effects the creation and maintenance of our opioid epidemic, and that physician leadership is crucial to reversing that inadvertent contribution.

But our committee’s most important discovery is that Oregon’s SUD epidemic begins with children, our children and those of others much less fortunate than those on our committee. The fundamental basis for Oregon’s assault on SUD begin with a commitment to improve the lives of children whose families struggle and fail to protect them from the basic challenges of life.

We hope our report provides Oregon with fundamental and not necessarily obvious methods of stopping our SUD crisis. We believe that our greatest contribution to this campaign is put our children at the forefront of our efforts. Investing in our children today is our best chance at reducing our SUD epidemic tomorrow.

Samuel Metz, MD, is corresponding author of the Oregon Substance Use Disorder Research Committee, which produced “Substance Use Disorders in Oregon – Prevention, Treatment & Recovery.” He is a retired Portland physician. He can be reached at [email protected].

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Please tell more about the Committee and its goals, and its audience.

How is this valuable information to be disseminated, and to what purpose will it be put?

In my county -- as in most of USA -- there is an impenetrable barrier between the Criminal Justice approach and the Public Health approach to substance use disorder and its myriad baleful effects.

Our sheriff desperately wants a new and bigger jail.  We've been there, done that, but the beat goes on, and the smart money is behind him.