For more than thirty years, state and federal politicians have addressed drug use primarily as a criminal justice issue rather than a public health problem. That decision was made in a political environment that made politicians afraid to appear “soft on crime.??? The resulting harsh punishments, including mandatory minimum sentences, have been costly to the taxpayers who finance overcrowded prisons while doing little to resolve the problems associated with drug use.
A recent article about overdoses in the Orange County Register suggests that legitimate drug use may be just as dangerous as illicit use and equally deserving of attention. The risk of overdosing while using prescription medication has taken on the dimensions of a public health crisis.
THE AT-RISK POPULATION
A report by the OC Health Care Agency might surprise readers who assume that deaths from overdoses usually affect young, poor, and minority populations. According to the report’s analysis of hospital and coroner records, those most likely to die from an overdose in Orange County are white males between the ages of 45 and 64.
In the OC, overdoses most often occur in upper-middle-class communities like Dana Point and Seal Beach. The statistics suggest that overdoses are most likely to result in the deaths of the middle class, middle-aged males.
While overdoses of prescription drugs are a growing problem, the drug that places most people at risk of death continues to be alcohol. Cirrhosis of the liver is a leading cause of death from substance abuse. Regardless of income or ethnicity, alcohol is the drug of choice for men over the age of 50.
THE INCREASING DANGER OF DRUG OVERDOSES
Most deaths resulting from overdoses, particularly in the elderly population, are accidental. Some are caused by taking a lethal mix of prescriptions while others are caused by consuming prescription medications and alcohol at the same time.
Deaths from prescription medication overdoses probably occur more often in affluent communities because residents in those areas have better access to health care and thus to prescription drugs. Deaths resulting from illicit drug use are more likely to occur in younger populations, but they are overshadowed in Orange County by accidental deaths resulting from prescription overdoses and from alcohol abuse.
PUBLIC POLICY IMPLICATIONS
The emphasis of existing laws that target substance abuse is punitive. Illicit drug use is criminalized and offenders are sentenced. While treatment may be required as a condition of probation for those who are lucky enough to avoid a prison sentence, the treatment alternatives made available by the criminal justice system are limited.
If the goal of drug policy is to protect health and safety, the Orange County study shows that the emphasis on criminal justice is misplaced. Most deaths from overdoses result from the legal use of prescription drugs, from alcohol, or from a combination of the two. Criminal laws cannot prevent those deaths.
A more effective approach to reducing drug-related deaths would recognize that the problem is best addressed by public health authorities rather than law enforcement agencies. Existing educational efforts that begin with cautions provided by doctors and pharmacists should be strengthened. Elderly patients in particular should be monitored closely to assure that they are not taking a deadly combination of medications.
Funds that are currently allocated to the failed attempt to control drug abuse through law enforcement should be redirected to treatment programs. Public health problems are best resolved by public health authorities. Warehousing drug users in jails and prisons without addressing underlying causes of addiction is at best a costly and temporary solution to the problem. Moreover, the criminal justice approach ignores the reality that alcohol is the most frequently abused drug. Making treatment available to those who need it is a more productive and cost-effective use of tax dollars than arresting and prosecuting users.
HOW TO AVOID ACCIDENTAL OVERDOSES
California residents who take prescription medications should view the study as a warning. It is imperative to review the possibility of drug interactions with your doctor and pharmacist if you take more than one medication. If you take medications that have been prescribed by more than one physician, make sure that all your doctors know about every prescription so that they can caution you against taking dangerous combinations of drugs.
If you have elderly parents or relatives who take medications, make sure they understand the doses that have been prescribed. If they are forgetful and you fear that they might mistakenly repeat a dose, buy them a medication organizer and help them fill it each week. That way they can see the pills they need to take each day and are less likely to take an accidental overdose.
ORANGE COUNTY TREATMENT PROGRAMS
If you live in Orange County and have a substance abuse problem, you can get help. A good starting place is the 24-hour Alcohol and Drug Referral Network available through Addiction Services. You can obtain a referral to a detoxification center and to counseling programs, as well as information about financing or eliminating the cost of drug and alcohol rehabilitation services.
Orange County Alcohol and Drug Abuse Services is part of a government agency that provides crisis intervention, assessment, and referral services to Orange County residents. That agency can give you information about residential and outpatient treatment programs for either drug or alcohol addiction.
The substance abuse page on the Orange County Social Services Agency website provides helpful links to a number of programs for OC residents who want to overcome addiction to drugs or alcohol. The linked programs include AA and Al-Anon, a directory of Sober Living homes, and a number of fee-based and non-profit substance abuse treatment centers.