Where’s the Rx?

Over the last few days I’ve been confronted – again – with the realization that far too many people don’t believe addiction is a disease, no matter what they actually say about it. First, the municipality where I live, one where no cannabis use is legal, decided to drop the first possession ticket to a fine of $1. Subsequent fines remain the same (over $300 with court costs), and possession is different than consumption, so it’s simply, as one legislator explained, “If I’m standing before the Chief of Police and 28 grams of marijuana fall out of my pocket, the fine will be $1.” Because that really happens a lot, right?

No. Not really. Our police officers don’t knock on doors doing cannabis checks, so why would police officers ever know that I had 28 grams of marijuana on me? Oh, right. They wouldn’t. Until I consume it. And that’s where the problem lies. Research shows that of those who do consume cannabis, 30% suffer from problematic use. Do we really think that it’s only the other 70% who use who are possessing it?

I understand how dropping the first possession ticket to a dollar sounds compelling given the fact that 72 percent of the residents of the municipality voted for legalized recreational use of cannabis. But it’s not legal for any purpose in our state, and the red herring used to propel this ordinance change forward was that THC is “medicine.” According to those who spoke in favor of this change, THC is medicine for back pain, narcolepsy, anorexia, and cancer treatments, and, according to one speaker, it even prevents cancer.

Except that in our state, where no cannabis is legal, it’s not medicine. I’ve written in this space recently about the idea that we like using drugs because drugs make us euphoric – high – which is a good feeling. If a drug can be prescribed and I’m taking it without a prescription to treat what ails me, it’s not medicine. That’s illicit use of the drug. It matters not if that drug is opioids, THC, ketamine, or gabapentin. If I am taking a prescribed medication to medicate, but that medication isn’t prescribed to me – because I’m taking someone else’s medication or because I’m taking it without a prescription at all, however I get it – that’s what we in the field call “self-medicating,” which is taking substances in order to mitigate discomfort without the guidance of a qualified health care provider. You cannot legally take a medication that can be prescribed if you don’t have a prescription. It’s just that simple. It’s NOT medication.

Next, another county in this fine state has decided to eliminate one of the greatest tools in the toolbelt of helping people recognize their detrimental use of mood-altering substances. That is, the county in question is eliminating direct biomarker tests for the impaired driver population. Drug tests, any drug tests, should never be used as a gotcha, but this misunderstanding is often the reason the powers that be don’t want to use them. The perception is that the tests are used to punish those who have positive results.

Drug testing is said not to be “evidence based,” but I am of the mind that there are two problems with this assumption: first, we don’t use the right tests. Direct biomarker testing of fingernails, particularly, gives great information about substance use, and if we believe that addiction is a health problem, then why aren’t we using tests to determine if a person is sick. Which brings me to the second point: not enough programs are using the tests, so we have too little data to refer to. When people hear “drug testing” their minds immediately go to the random urine cup that isn’t worth the effort. However, direct biomarker tests are an invaluable guide to show those who think they aren’t misusing substances how much they actually are. Consider another test, the one for a person with type 2 diabetes who regularly tests zir blood. It’s never a gotcha to say, “Why don’t you eat better?!” Instead, it’s a way to show that changes need to be made. That’s how direct biomarker tests work best, too.

Let’s recognize addiction for the disease it is and use the tools we have – including well-written laws and policies – to help those who have it to access treatment for it.