11 strategies for change in the war on drugs

We’re experiencing the worst drug problem the U.S. has seen in some time and quite possibly of all time, said Frank Greenagel, LCSW, LCADC, executive director of College Recovery, adjunct professor with the Rutgers School of Social Work and first lieutenant of the Pennsylvania Army National Guard, to a packed session at the National Conference on Addiction Disorders (NCAD) in St. Louis on Sunday morning.

Prescription drugs (Rx) have changed the game. In 2011, he said, prescription drug overdoses surpassed car crashes as the number one cause of accidental death in the U.S. The same year, opioids arrived on the drug scene like The Beatles during the British Invasion with the allure of being seemingly safe, legal and pure. As of 2013, hydrocodone took over as the most prescribed drug in America after Xanax.

We are an Rx nation
Opiates are the most widely prescribed class of drugs in the United States, Greenagel said. Total Rx opioid sales in 2001 were $3.97 billion, a number that increased to $8.34 billion in 2012, according to New York Times data. Similarly, data shows overdose deaths associated with Rx opiates are up from 4,030 in 1999 to 16,651 in 2010, and Rx for opioid treatment is up from around 100,000 in 2002 to 8 million in 2012.

“No other country is facing this. We really have to look at how we deal with it, especially among young people," he said, citing the ever-present drug messaging in popular music, online social forums detailing everything one would ever want to know about any substance every created, and youth marketing of certain drugs like synthetic marijuana. "I hear from parents about a dead kid every week. I have hundreds of stories and you'd think I'd be numb to it but I'm not.”

Using the word "epidemic" to describe the current state of things would not be a hyperbole, he said, but it’s never too late for the industry to enforce change. 

“It’s constant adjustment: we adjust, they adjust, we adjust,” Greenagel added. “And we keep having to do more with less, but we do it because we have hope.” 

Here are 11 strategies he recommended getting started with: 

1.    Ask local emergency departments what their prescription protocols are as well as other providers in the community; 

2.    Work on training future professionals—in law, nursing, pharmacy, social work, student affairs and medicine—because it all starts there; 

3.    Help people get educated and find jobs, not just get sober; 

4.    Advocate for more quality prevention and education programming for middle school and high schoolers;

5.    Advocate for recovery programs in colleges, because 85% of students relapse upon returning to school; 

6.    Increase training of peer counselors and amp up the selection process;  

7.    Motivate those that are struggling with drug use with potential reasons why they should go to therapy—not just the drug use—and convey a positive message about recovery; 

8.    Consult with experts and share what you know with colleagues and clients;

9.    Ask more in-depth questions about alcohol and drug use with clients to avoid misdiagnosing; 

10. Consider testing for ADHD drugs and prescription opiate painkillers to see if patients are getting too much/too little in their prescriptions in order to scale back on the recreational use of others; and

11. Utilize regulated prescription monitoring programs and drug turn-in programs in your community, and make sure people know they exist because they're inexpensive resources that work. If they're not available in your area, don't take no for an answer. Take the next step. 

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