Beyond Addiction

The sad story of another superstar's drug-propelled streak into oblivion concluded Nov. 29, when Dr. Conrad Murray was sentenced to four years in prison for his role in the death of Michael Jackson.

Of course, nothing will bring back Jackson, who died of a drug overdose administered by Murray in 2009. But instead of turning the criminal tragedy of a life lost into a teachable lesson in the national spotlight, the judge abdicated his opportunity to help other doctors understand their role in the lives of addicted people.

Murray should have been ordered to spend the next four years lecturing in medical and nursing schools, at health care conferences and in hospitals.

In sentencing him, the judge said Murray is a "disgrace to the medical profession." Indeed. But equally disgraceful is the lack of comprehensive training for up-and-coming doctors to recognize alcoholism or dependence on other drugs, whether among homeless people who show up in the emergency room or with long-term patients in their private practices.

Six years ago, a survey of doctors by The National Center on Addiction and Substance Abuse at Columbia University found that 4 in 10 doctors said they had received no training in medical school on prescribing controlled substances, and more than one-half had received no training on identifying prescription drug abuse or addiction in general. The percentages were the same for pharmacists. They said they had received no instruction since pharmacy school in identifying prescription drug abuse or the diversion of prescription drugs.

"Not much has changed since our last survey," Joe Califano, CASA's founder and chairman, told me the other day.

What has changed is the spike in addiction fueled by doctors prescribing drugs such as Valium, Vicodin and oxycodone to treat everything from broken bones to broken hearts. "Pain management" has become big business for pharmaceutical companies and an unmanageable problem for the rest of us.

The United States consumes 80 percent of the world's supply of hydrocodone, according to Dr. Paul Earley, an addiction psychiatrist and medical director at Talbott Recovery, a treatment center in Georgia. He said more people experiment first with prescription drugs than do with marijuana. No wonder unintentional overdose is a leading cause of unintentional death in America.

"Physicians are often unwitting accomplices in addiction, because in general they aren't trained to recognize when the addiction monster is leading them down a primrose path," Earley said.

Even people in long-term recovery, who are intimately familiar with addiction's power, are at risk. Earley and other addiction experts know many who have relapsed after decades of sobriety when things got out of control after they started taking doctor-prescribed medications. "At first, it was a legitimate, legal high ... but after my injury healed, I kept taking it and taking it and taking it, until — well, here I am," a man in treatment shared with me. He had been sober for 22 years.

This fall, my son broke his foot in a football game. The well-meaning doctor, a renowned orthopedic expert, successfully treated the injury and prescribed Vicodin without first doing a quick scan on the history of addiction in our family. My son is especially susceptible to pain medication because he is the product of a mother and father in recovery from addiction.

It turns out he didn't need the drug. Regular doses of aspirin worked just fine, so the prescription went unfilled. But for a few days, I obsessed over the sheet of paper with the doctor's signature authorizing a 20-count supply of the big white tablets. I rationalized that it made sense to keep it handy just in case my son's pain got worse or for future use, until I realized that the unfilled prescription was like keeping a loaded handgun in the house. Not only was it unnecessary. It was dangerous. The next day, the scrip went into the household shredder, and I realized just how cunning addiction is, even to people in long-term recovery, who know what — and what not — to do.

Doctors know even less.

"What medical students are learning is changing, but too slowly," Earley said. "Most medical schools have several hours in their classroom work about addiction, but only rarely will they rotate through or visit an addiction treatment center, despite the fact that addiction is seen in every medical specialty."

William Moyers is the vice president of public affairs and community relations for the Hazelden Foundation and the author of "Broken," his best-selling memoirs, and "A New Day, A New Life." Please send your questions to William Moyers at wmoyers@hazelden.org. To find out more about William Moyers and read his past columns, visit the Creators Syndicate Web page at www.creators.com.

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