What's a drug of abuse anyway?

Just because the doctor prescribed it doesn't mean it's not abuse

I was recently contacted by an attorney who wished to be assured that if his client came into jail she would be able to receive all of the medication she felt she needed.  The drugs are all prescribed by a doctor, he assured me.  So far, so good.  When I reviewed the medical information supplied by the patient I was pretty surprised:  out of six medications listed, at least four were common prescription drugs of abuse; the remaining two, while not actually abuse drugs, had no relation to the conditions for which she was supposed to be taking them.  Probably this person was weighing a plea bargain choice of a relatively short jail term compared to a lengthy, costly period of probation.  She needed to make sure that her drugs of choice would be available to her inside the jail if she chose that option.  We weren't able to accommodate her requests--all jails and prisons avoid administering abusable drugs.

So who is at fault here?  Doctor?  Patient? Both? Perhaps the patient visited several different doctors, seeking her own drug of choice from each particular physician.  Perhaps she just has an incompetent doctor--maybe the physician is impaired, or just doesn't keep up with medical progress.  Maybe he runs a "pill mill" and routinely supplies local addicts with  any drugs that they request.  It's hard to shut down such physicians.  I recently referred one to the Texas Medical Board for investigation and no action has been taken.

Drugs that come from a nice clean pharmacy in a new bottle can be just as dangerous or wrong to use as those obtained illegally from a street dealer.  Heroin or hydrocodone, cocaine or amphetamine, xanax or marijuana--no big difference.  The effect of misuse on the individual and on society is just the same.

What is the answer?  Drug abuse isn't a law enforcement problem--police, courts and prisons are not helpful but are merely costly, ineffective approaches to a medical problem.  Patients need the right diagnosis, the right medication, and the right care from a physician who cares about them and won't charge them more than they can pay.  They also need to get away from old friends and old patterns of behavior that will entrap them again.  Find a church that welcomes those in recovery.  Find new friends.   And stay away from that doctor who is just as dangerous as a dealer on the street.