aka, The Polypharma Syndrome

The latest phase of America’s opioid epidemic has killed more Americans than the Vietnam war. By all accounts it is spreading A new study looks at why: partly, and paradoxically, it’s because we have more access to the pharmaceuticals we need for our other (and co-morbid) mental disorders. These complicate opioid use through unknowable synergies: it is mathematically impossible that all of the medications used to treat anxiety, depression, schizophrenia, etc. have all been tested together, much less combined with cocktails of illicit drugs. Only twelve variables makes up the entire canon of Western music. Twelve variables separates Johann Sebastian Bach from Bachman Turner Overdrive, Paganini to Public Enemy, Schopenhauer to the Selector. Imagine how many more permutations exist in medicine.

We emergency medical people, when we get a strange OD, just call it “polypharma,” and let the lab untangle the poly.

Your typical opioid adventurer also has mental illness, which can be both underlying and induced by opioid abuse. Often, they are being treated with legitimate medications, like Benzodiazepines (downers) for anxiety. I’ve met many addicts, have talked to to them more frankly than most, and found they are almost always seriously damaged people. Think of it this way: imagine you are with your friends, and someone said, “who wants to try some heroin?” Imagine which of your friends would volunteer. Saying ‘yes says something basic about who they are.

Those who have said ‘yes’ have about a one in four chance of becoming an addict (a surprising number of addicts simply outgrow their addiction, by the way). The Fentanyl escalation in the drug war will make living long enough to outgrow addiction far less likely (it will also kill a lot more of the ‘three in four’). Just a few weeks ago, I had a Fentanyl overdose drop like he was shot, on a subway platform during rush hour. He’d have met eternity if a medical student hadn’t dared mouth to mouth on him (“don’t kiss anyone with that mouth,” I teased her).

Many drug addicts treated with downers are entitled to anxiety, and anxiety is often the least of it. Many of them have PTSD too, which they are equally entitled to. It’s not hard to see why: their PTSD/anxiety/depression/debilitation is caused/exacerbated/continued by the things they have to do to be (and stay) addicts, like becoming drug dealers. This is because being a drug addict reduces employment avenues which demand functionality. They also have to make their ‘nut’ of addiction (it ain’t cheap). Dysfuntionality and needing lots of cash almost has to mean working in the drug underground. It’s hard to imagine a more stressful way of making a living than being a thrall to the most lethal criminals Man has ever known. Nobody puts a gun to my head when I make a mistake at work. Addicts also rightly fear being thrown into a cage for using illegal drugs. American cages are not known for their restorative qualities. They fear having their hopes for recovery and a future being erased by that cage-time record.

For female addicts, prostitution is utterly mundane. Imagine the fear-factory her life is, compared with the hundreds of thousands of Americans on anxiety medication just for the pressures of a prosperous suburban existence.

Now add in overdose risk, because every dose is Fentanyl roulette. To hear addicts describe it, they are in a warlike state of attrition.

It is accepted that the human brain reacts to stress. Stress the brain enough and debilitation follows. Something breaks. We know this from studying our war veterans. A Nobel Prize in medicine is yours if you can show that there is a morality bone in the brain that can make a distinction between stressors which are “right,” or “earned,” and the ones caused by immoral things.

To the Iron law of prohibition which holds that “the stronger the laws, the stronger the drugs,” we must add a corollary, let’s call the “Nicholas Drug War Amendment:” “the tougher the war, the harder the consequences.” People become addicted to drugs because of stress and damage. Our solutions cause and worsen stress and damage, which must be treated, which leaves the addict vulnerable to more stress and damage. Rinse and repeat.

America’s unique consequences from her unique War on Drugs is the outcome that proves the point.

• About the Author

About Eugene Darden Nicholas

Eugene Darden (Ed) Nicholas is from Flushing Queens, where he grew up sheltered from the hard world, learning the true things after graduating college and becoming a paramedic in Harlem. School continues to inform and entertain in all its true, Shakespearean glory. It's a lot of fun, really. In that career, dozens of people walk the earth now who would not be otherwise. (The number depends on how literally or figuratively you choose to add). He added a beloved wife to his little family, which is healthy. He is also well blessed in friends and colleagues.