Claire was about to start at college when her counsellor recommended that she should not tell anyone that she was being treated for drug dependence. So she spent months leaving class early and making up excuses to sneak to the chemist to collect her methadone prescription: lying to teachers, administrators and her friends. Eventually, the pressure of the constant evasions became too much and she dropped out of the course, rather than reveal her secret.
Claire’s story is far from unusual. As her treatment counsellor had recognised, suspicion, fear and distrust of people struggling with drug problems are widespread. The result is that people with drug dependence, and their families, are suffering in silence, missing opportunities for treatment, and prolonging the process of recovery.
Research by the
UK Drug Policy Commission(UKDPC found these attitudes to be widespread, affecting those with drug problems throughout their lives. We encountered people who felt trapped in their homes because of the hostility they faced from neighbours. Being stuck indoors, without social contacts or the opportunity to find work, may be one of the hardest settings imaginable in which to fight drug dependence.
Everyday prejudice creates a host of obstacles for recovering drug users. Offers of work or housing are commonly withdrawn when it becomes known that the recipient has had a serious drug problem, even if they have stopped using. Yet employment and stable accommodation are two of the most important factors for helping people overcome dependence and stay off drugs. Anything that makes these harder to access will worsen drug problems.
Public hostility can even make it harder for people with dependence problems to get the treatment they need to help rebuild their lives. The fear of being exposed as someone with a drug problem can deter them from going to a pharmacy to collect prescriptions for methadone, for example, which could provide the stability they need to stop using street drugs.
These attitudes are not just those of an uneducated general public. Our
researchfound that many people with drug problems experience similar barriers in their dealings with the professionals who should be helping them. Some find it impossible to convince doctors or nurses that they need help, even when they are in agonising pain or suffering from long-term conditions like Hepatitis C. The suspicion of the medics is often that their patient is just looking for drugs to relieve their cravings.
Others are made to wait at pharmacies for as long as it takes to serve every other customer in the store, including those who arrive after them. For recovering drug users, treatment can mean daily visits to pharmacies. Such long waits can make it impossible for them to be reliable in keeping other appointments, such as work obligations or job interviews.
Disapproval
Such problems are not just faced by those still using drugs. Even after they have managed to overcome drug dependence, former drug users can face similar hostility and distrust. The negative attitudes they face go beyond simple disapproval. Disapproval is usually linked to a person’s behaviour, and so disappears when that behaviour changes. Social disapproval of drug use even has a useful role in dissuading some from engaging in potentially risky behaviour.
But perceptions of people with drug problems go far beyond this. They are seen as bearing a stigma, an enduring mark that defines them and which cannot be removed by their stopping using street drugs. For many people with serious drug problems, suffering not only from a debilitating health condition, but also from social exclusion, the prospect of never being able to move past the label of drug user or addict can be one more barrier to overcoming their dependence.
The families of those with drug problems are also affected by this stigma. Such is the fear of being associated with the shame of addiction, that family members may avoid situations that could lead to their being identified as the relative of a drug user, even at risk to their own well-being.
In our research, we met Patricia, a mother who avoids contact with her old friends because she is afraid they will mention her son’s drug dependence. We also spoke to Tom, the brother of someone with a drug problem, who will not seek the support he needs himself because he is worried others will find out and would think less of him and his family.
Public opinion on dependence and recovery suggests that this worry is not misplaced. In one survey of public attitudes that UKDPC carried out, we found that, while people want top-quality help to be made available to those recovering from dependence, they are nevertheless suspicious and afraid of those who have had drug problems.
More than four in five agreed that people recovering from drug dependence should be part of the normal community. But the public still wants to keep its distance, with 43 per cent of those asked saying they would not want to live next door to someone who had been dependent on drugs. More than a third felt it would be foolish to get into a serious relationship with someone who had suffered from drug dependence, even if they appeared to be fully recovered.
Beating stigma
To a certain extent, these attitudes reflect how dependence is portrayed in the media. People with drug addictions tend to labelled as “junkies” not as people with a health problem that can be addressed. The term “addict” has itself become pejorative and frames the issue in a particularly negative way.
If a media story about a drug user is not about a celebrity, it is most likely to be about a criminal, who, for example, has mugged someone or broken into a house in order to pay for drugs. And if an article features someone who used to be dependent on drugs but is now drug free or on medication, their previous addiction is invariably mentioned, even when it has no relevance to the story. The implication is that no one can truly move on from dependence.
But if television and newspapers can perpetuate attitudes that make recovery more difficult, changes in how they report such stories could be similarly effective in making recovery more achievable. A forthcoming guide for journalists and editors, produced by the Society of Editors and UKDPC, will suggest ways to reframe news stories to avoid the assumption that drug dependence is a life sentence.
But media coverage cannot stray too far from where the public is. The stigma of drug dependence will only be overcome if it is acknowledged and confronted directly.
There is a parallel with attitudes to mental health. Public perceptions of those suffering with mental illness have shifted over recent years. Nonetheless, it is still less than a decade since the
Sun
newspaper
ran a front-page storyabout boxer Frank Bruno being taken to a psychiatric hospital under the headline “Bonkers Bruno locked up”. The editor belatedly realised this was out of step with British attitudes and later editions carried the headline “Sad Bruno in mental home”. Even today, the
Time to Change campaign “Get Talking”, which aims to encourage debate about mental health, demonstrates that shifting these views takes a lot of work over a long period.
Attitudes to those who suffer from drug dependence may lag behind perceptions of other stigmatised groups. But the process has begun. Earlier this year, the Duchess of Cambridge became a patron of the charity
Action on Addiction and said specifically that she wanted to
break the stigma associated with addiction, as Princess Diana had done with Aids.
UKDPC, along with other organisations, is working on a project to determine practical measures, such as the media guide, that can make recovery and inclusion achievable for everyone.
* Names have been changed
EARLY diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening.
It is a precept that resonates with the intuition of the general public: obviously it’s better to catch and deal with problems as soon as possible. A study published with much fanfare in The New England Journal of Medicine last week contained what researchers called the best evidence yet that colonoscopies reduce deaths from colon cancer.
Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children.
The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer ... is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.
Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in its recent large studies of prostate and ovarian cancer screening . But it definitely drags many others into the system needlessly — into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms .
This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system.
It wasn’t always like this. In the past, doctors made diagnoses and initiated therapy only in patients who were experiencing problems. Of course, we still do that today. But increasingly we also operate under the early diagnosis precept: seeking diagnosis and initiating therapy in people who are not experiencing problems. That’s a huge change in approach, from one that focused on the sick to one that focuses on the well.
Think about it this way: in the past, you went to the doctor because you had a problem and you wanted to learn what to do about it. Now you go to the doctor because you want to stay well and you learn instead that you have a problem.
How did we get here? Or perhaps, more to the point: Who is to blame? One answer is the health care industry: By turning people into patients, screening makes a lot of money for pharmaceutical companies, hospitals and doctors. The chief medical officer of the American Cancer Society once pointed out that his hospital could make around $5,000 from each free prostate cancer screening, thanks to the ensuing biopsies, treatments and follow-up care.
A more glib response to the question of blame is: Richard Nixon. It was Nixon who said, “we need to work out a system that includes a greater emphasis on preventive care.” Preventive care was central to his administration’s promotion of health maintenance organizations and the war on cancer. But because the promotion of genuine health — largely dependent upon a healthy diet, exercise and not smoking — did not fit well in the biomedical culture, preventive care was transformed into a high-tech search for early disease.
Some doctors have long recognized that the approach is a distraction for the medical community. It’s easier to transform people into new patients than it is to treat the truly sick. It’s easier to develop new ways of testing than it is to develop better treatments. And it’s a lot easier to measure how many healthy people get tested than it is to determine how well doctors manage the chronically ill.
But the precept of early diagnosis was too intuitive, too appealing, too hard to challenge and too easy to support. The rumblings show that that’s beginning to change.
Let me be clear: early diagnosis is not always wrong. Doctors would rather see patients early in the course of their heart attack than wait until they develop low blood pressure and an irregular heartbeat. And we’d rather see women with small breast lumps than wait until they develop large breast masses. The question is how often and how far we should get ahead of symptoms.
For years now, people have been encouraged to look to medical care as the way to make them healthy. But that’s your job — you can’t contract that out. Doctors might be able to help, but so might an author of a good cookbook, a personal trainer, a cleric or a good friend. We would all be better off if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be.
H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”
Jefferson City, MO (KSDK - The state's Medicaid program will receive more than $289,000 to settle allegations that a St. Louis-based pharmaceutical company lied to customers by saying two drugs were approved for coverage under state and federal health care programs.
Under the agreement, KV Pharmaceutical Company, parent company of now-defunct Ethex Corporation, will pay approximately $17 million to the federal government and participating states to compensate for Ethex's conduct.
According to the suit, Ethex misrepresented the regulatory status of Nitroglycerin Extended Release Capsules (Nitroglycerin ER and Hyoscyamine Sulfate Extended Release Capsules (Hyoscyamine ER .
Despite not being covered by federal and state health care programs, the two drugs do not pose a risk to patients. At present, neither drug is on the market.
Koster said citizens should report suspected Medicaid provider fraud or abuse and neglect to his Medicaid Fraud Hotline toll free at 800-286-3932, e-mail the complaint to
attorney.general@ago.mo.gov or complete a complaint form at the
Attorney General's Medicaid Fraud Website.
Who would have thought that in this day and age we would experience a shortage of cancer drugs that are essential to a favorable outcome? Sad, but true, the US is facing a major shortage of some cancer drugs. Those taking methorexate or Doxil are hurting the worst, as slow and delayed production by the drugmakers have caused a substantial shortage. It doesn't stop at these two cancer drugs, unfortunately. There is a shortage of over 200 different drugs used to treat a variety of diseases and conditions, according to The American Society of Health Systems Pharmacists (ASHP . Want to check to see if your drug is in short supply? The ASHP has an
interactive tool that allows you to check the status of your drugs.
the PPRS report also shows that not a single drug company has taken advantage of new rules championed by Sir Andrew and introduced three years ago allowing price increases if new medicines prove more effective than initially believed. That implies disappointing levels of innovation.
On collective sales of drugs totalling ?7.7bn in 2009, the PPRS report showed 34 companies reported costs of ?7.9bn, representing a return on sales of -1.8 per cent. That was down on profits of ?123m in 2008 and of ?149m in 2007. The figures include a rise in research and development costs of ?1.3bn in 2009, up from ?1bn in the previous year.
The final figures accepted by the Department of Health, recalculated from company returns to exclude profits from “transfer pricing” on medicines they purchased from their foreign subsidiaries, show profits of ?1.4bn for 2009, representing a return on sales of 18.3 per cent.
We reported last week that drugmakers were seeking to get a
prescription diet pill passed, and that drug is now one stop closer to your local pharmacy. On Thursday, an FDA panel of outside physicians voted 20-2 in favor of the weight-loss drug Qnexa by Vivus.
Illegal internet pharmacies are selling illicit drugs and prescription medicines online and are increasingly targeting young people, a UN drug agency warns.
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