“Pharmacovigilence” in a Culture of a Pill for Every Ill
Posted on Wednesday, July 25th, 2018
Orange may be the new black, but according to a recent Newsweek headline, benzos are the “next opioid crisis.” Prescribed for everything from anxiety to insomnia, restless leg syndrome to acute alcohol withdrawal, benzodiazepines are being used more frequently than ever.
According to a commentary published earlier this year in the New England Journal of Medicine (NEJM),
Between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67%, from 8.1 million to 13.5 million, and the quantity of benzodiazepines they obtained more than tripled during that period, from 1.1-kg to 3.6-kg lorazepam-equivalents per 100,000 adults. According to data from the National Institute on Drug Abuse, overdose deaths involving benzodiazepines increased from 1135 in 1999 to 8791 in 2015….
Notably, most of those deaths – 75% – also involved an opioid.
That brings us to a new commentary in the NEJM, in which FDA Commissioner Scott Gottlieb and other FDA officials lay out a plan for “pharmacovigilance” in light of the better known opioid epidemic – to tame the one and prevent new one from occurring.
Now, we tend to be pretty optimistic folks, but pursued within the paradigm of orthodox Western medicine, we doubt even the most elaborate plan of attack is doomed to ultimate failure.
For the truth is, we live in a culture that values quick fixes and holds faith in a pill for every ill. When we feel bad, we want to feel better fast. Drugs such as opioids, for instance, are great at obliterating pain. Once the symptom is gone, you get the illusion of health. Too often, though, the actual causes of pain go completely unaddressed, assuring long-term dependence on medication.
And because every drug comes with side effects, all too often, those effects get diagnosed as completely new conditions for which different drugs may be recommended, further perpetuating the cycle. Meanwhile, the body’s biological terrain – its internal environment, which drives health and illness alike – becomes more burdened and more compromised.
More, we see how the many stressors of modern life – constant, chronic, sometimes brutal – are driving more people to abuse substances that might help take the edge off, at least for a while. Just last week, for instance, we learned that death rates from alcohol-related liver disease have gone up sharply among young adults.
“It correlates with the global financial crisis,” [study co-author Neehar] Parikh says. “We hypothesize that there may be a loss of opportunity, and the psychological burden that comes with that may have driven some of those patients to abusive drinking.”
Earlier this year, we learned that life expectancy has fallen, especially for middle-aged white and rural Americans. The main factors driving the change? Drug abuse, alcohol abuse, and suicide.
“We are seeing an alarming increase in deaths from substance abuse and despair,” said Steven Woolf at Virginia Commonwealth University, a co-author of the latest report. The idea of the “American Dream” is increasingly out of reach as social mobility declines and fewer children face a better future than their parents, he said.
Other factors feed into this, as well. As USA Today reported back in January,
The report found Americans have poorer health than other nations in many areas, including birth outcomes, injuries, homicides, adolescent pregnancy, HIV/AIDS, obesity, diabetes and heart disease. Americans also engage in unhealthy or risky behaviors — such as high calorie intake, drug abuse and firearm ownership — live in cities designed for cars rather than pedestrians or cyclists, have weaker social welfare supports and lack universal health insurance.
“The consequences of these choices are dire: not only more deaths and illness, but also escalating health care costs, a sicker workforce and a less competitive economy. Future generations may pay the greatest price,” the report concludes.
Unfortunately, there are no quick or easy fixes for the systemic issues that fuel such problems. But as individuals, we can choose to prioritize our own health and well-being, and that of our families. We can take a more active and holistic approach, foregoing the false promise of quick, illusory fixes to tackle the root causes of our problems.
This is the way that creates longterm healing on a path to true wellness and resilience.