In the last several weeks, there have been several news articles relating to opiate use and changing definitions regarding drug classification and how doctors can prescribe. As usual this has brought a lot of the stigma surrounding medicine use to the limelight. Whenever these conversations get sparked again, a lot of people start talking about over-prescription, abuse of narcotics, and how big bad pharma creates fake conditions in order to sell drugs. People start talking about patients who abuse the system and end up addicted. These conversations are usually had by people who have no personal experience with chronic pain or the type of conditions being discussed. These same arguments then get used to discredit conditions like Chronic Fatigue Syndrome, Fibromyalgia, and ADHD.
The shaming inherent in a lot of these arguments not only make life more difficult for patients, but they are actually an example of how “a little” knowledge is a dangerous thing. Take, for example, the frequent argument that ADHD is often over-diagnosed and an excuse to medicate children. Some people have gone so far as to claim that ADHD meds are the shut up and sit still drug and that ADHD itself doesn’t exist.
The first half of the argument is based on two problematic ideas: the lie of more-diagnoses which I discussed in a previous article, and a tendency by certain studies to limit their focus on white males. While there is some indication that ADHD may be over-diagnosed in white boys, in every other category girls, people of colour, and so forth, the opposite appears to be the case.
In white children misbehaviour is believed to be pathological, whereas in the case of children of colour, it is believed to be genetic and inherent. When behaviours that are believed to be disruptive appear in class, white children are often send to counselors and psychiatrists, while black children in particular are punished. We’ve seen this discussed when activists and studies discuss the school to prison pipeline. In many cases the behaviours being punished are the same that are said to be caused by ADHD in white children.
In the case of girls versus boys, girls often present with Neurodivergence differently than boys, while the standard for diagnosis is based on boys. More and more studies are coming out showing how most women don’t get diagnosed with conditions such as this till adulthood. I, myself, wasn’t diagnosed until I was 25. Behaviours that are indicative of ADHD in girls, like chattiness, get instead blamed on their gender. Not being diagnosed until adulthood can have a serious impact on a person’s ability to thrive in schools. It creates antagonism between frustrated teachers who just want kids to pay attention and frustrated students who physically can’t. It takes away the opportunity to use therapeutic strategies to counteract the difficulties than can present themselves when it comes to studying and meeting deadlines, processing information in classrooms, and so forth. By preventing diagnosis in Children of Colour and in girls, society puts these children at an unfair disadvantage.
The statement that ADHD meds are the Shut up and Sit Still drug is also a fundamental understanding of how ADHD medication works. For one thing, they are a stimulant. In people who don’t have ADHD or who are on the wrong drug, the result would be increased energy and an inability to keep still. It is people with ADHD who would react by being better able to focus.
Shaming however works to discourage people who would benefit from medicine from actively receiving medication. Women and People of Colour who already have a harder time getting taken seriously by doctors have to fight against doctors own societal biases towards these medications. I’ve had one doctor claim that the only reason to get treated for ADHD in adulthood was to abuse the drug, while another tried me on a different medication first since the one discussed had a higher street value. Doctors are no more immune to societal bias as the rest of us, but they have a greater ability to impose that bias on those of us struggling.
Where this becomes especially dangerous is because untreated conditions can have impact on other conditions. It’s been found for example that untreated ADHD can make treating depression more difficult. That without being paired with ADHD meds as well, anti-depressants on their own do not work as effectively if at all.
It can also be dangerous when doctors become so afraid of potential addiction, that they risk patients’ lives in order to get them off the medication faster. Like what happened to me when rather than wean me off the medication gradually, doctors opted to put me in opiate withdrawal post admission, leading me to almost having a heart attack.
What many of the articles and discussions surrounding illegal use and abuse of medications and prescriptions ignore is the way some patients are forced to go through less than legal means in order to secure adequate treatment. Faced with doctors who cannot prescribe the needed dose for pain control as a result of restrictive laws may find themselves needing to rely on the black market or multiple prescriptions in order to get the full dose that would have otherwise been prescribed. Patients who have a hard time securing pain medication from doctors might have to rely on illegal acquisition for any hope of relief or assistance.
Consider for example the recent studies that have shown that black people are less likely to receive treatment for chronic pain and that as many as 10% of students at prestigious US law schools believe that black people and People of Colour feel pain less than white people. This idea is a call back to stereotypes as far back as the slave era, where torture of slaves was excused because “they couldn’t feel it anyway. That you had to whip a slave hard, or it wouldn’t have an effect.” It is racist.
But this means that People of Colour with chronic pain conditions might be left without any treatment for their conditions. A state which is dangerous in and of itself. Left untreated, pain and chronic pain can lead to conditions like fibromyalgia. It can cause all sorts of chronic problems and negatively impacts overall health. For their own safety, they may have no choice but to buy on the streets what they should have been given by a doctor. It gets even worse when you factor in the devastating impact that inaccessible healthcare has. When it is unaffordable, when it is not available to certain people, and so on.
It says a lot that states that have legalized marijuana have had a significant drop in opiate deaths as people who were required to use opiates can either take mmj instead of opiates. Alternately they can take it in addition to opiates, allowing them to take lower dosages with the same effect.
The shaming of med use also has an additional impact in actually limiting the development of certain types of meds and how they are available. For example, if people consider ADHD to not be something that is essential to treat, there is no pressure on pharmaceutical companies to develop different ways of administering the medication. People like me are left in the lurch, where instead of having the options of a quicker digesting method like chewable or non-digestive method like a patch, I have to hope that I’m actually digesting that day. If not, then I can swallow all the pills I like, but all I will get is a stomach ache but no help with focus.
Shaming the use of meds creates a culture that makes life difficult for patients and not for addicts. Time and time again we’ve seen that legislating and making drugs illegal does not work as well as legalization and treating addiction as the medical condition it is. Meds are important. Their prevalence is not a sign that something is wrong with the world, but rather a sign that we have a healthcare system that is constantly evolving, discovering, and working to help people. The solution to opiate abuse isn’t making it harder for patients to get pain medication but actually making it easier for them to access a variety of types of medication so that opiates aren’t the only choice. It’s about making it possible for doctors to evaluate each case individually rather than through generalizations that often exclude the very people most likely to need regular access.
The decision of whether or not to medicate is one that should be left to the patient and to the doctor and not up to society and every Sam, Dick, and Mike who believe they understand things that don’t affect them and think they’re experts because they have a 101 understanding of the subject.