‘You are a coward’: Hate and misperceptions about substance abuse are broader than I thought

For more than 50 years, the medical community has recognized that people with alcoholism and substance-use disorders are suffering from diseases, not from failures of will or character. Today, there’s more frank and open discussion about drugs and alcohol than at any point in history. Movie stars, athletes, and politicians talk openly and unapologetically about their struggles and their pasts. Nevertheless, a stigma remains attached to these fatal, often misunderstood conditions.

That’s one of the reasons I wrote recently an article on STAT that also appeared in the Boston Globe about the fact that I am in remission for a substance-use disorder. In the piece, I expressed surprise at the absence of discussion or counseling when I was prescribed opioids after surgery at Massachusetts General Hospital for excruciatingly painful kidney stones — even though I had told all of my health care providers about my history with heroin. The reaction to my piece serves as a reminder of how far we have come and how much work still needs to be done.

Some readers of the STAT article let me know they had had experiences similar to mine. Several doctors and public health workers thanked me for raising what they viewed as a critical issue. But the majority of responses I received were decidedly critical. “I was disgusted about the article in the Boston Globe about your visit to MGH,” one self-identified PhD wrote. “Many normal people are sick and tired of you drug addicts blaming someone else for your transgressions. Yes, you are a coward. We have to pay for your problems and people like you.” (I was unclear how my treatment for kidney stones, which was fully covered by my medical insurance, meant other people were paying for my problems, but no matter.)

Other comments were in the same vein: “Your article is a joke and you should be embarrassed you wrote it. You’ll be on disability someday like millions of other americans [sic] who need coddling and blame everyone but themselves for their problems,” read one. Another reader wrote that he hoped my doctors would refuse to medicate my pain if I had “a compound fracture of [my] leg with [my] tibia sticking out.”

These aren’t fun to read. But I’ve been a journalist for more than 20 years, many of those spent writing about controversial topics. I’ve heard far worse — and have mostly learned how to let such aspersions slide off my back.

These mostly anonymous, drive-by insults illustrate one of the points I was trying to make in the article: if I was caught off guard by the effect that a round of prescription opioids had on me, just imagine what it’s like for people who feel embarrassed or ashamed about their pasts; those who haven’t spent years writing about health care and medicine; those who are intimidated by doctors and hospitals; or those who haven’t researched and written about substance-use disorders and their treatment.

It’s not just the general public that continues to attach a huge stigma to alcoholism, substance-use disorders, and other addictions. Some of the men and women trained to treat them do, too. That can be seen in something as simple as the language used to describe patients. In a 2010 study, more than 500 “highly trained” mental health professionals were given identical anecdotes in which the subjects were referred to as either “a substance abuser” or “a person with a substance-use disorder.” Those who received the “substance abuser” stories were significantly more likely to feel that the patient in question “was personally culpable and that punitive measures should be taken.”

A simple solution?

I think hospitals can and should be doing more than they currently are. Mass General, to its credit, has just released new guidelines that address some of the concerns I raised. But I’m also pragmatic. I realize that most hospitals don’t have the financial or staffing resources to have addiction specialists on call to meet with every patient being prescribed painkillers, just as I know that it’s unrealistic to expect surgeons or cardiologists or primary care physicians to have the expertise to know how best to handle questions about opioid prescribing when they arise.

Here’s a simple, straightforward, and eminently doable idea: create a pain-control information sheet that a doctor and his or her patient can spend a few minutes reviewing. Such a sheet could explain to the patient that he or she is about to be prescribed a powerful drug that is uniquely effective in mitigating some types of pain; that these drugs have a range of possible side effects; that they can become addictive; and that they can cause symptoms of withdrawal. The sheet could emphasize that special care should be taken by individuals with a substance-use disorder, and offer suggestions to minimize the risk of relapse, such as having the medication administered by a spouse or family member. It could also include resources for people who feel like they need additional help managing their use of prescription medication.

My desire to enact sensible solutions is not, as some readers suggested, the result of my looking to blame someone or something else for my past. Instead, this suggestion to use a simple information sheet acknowledges that we are in the midst of an opioid epidemic that has been fueled, in large part, by prescription drugs. Anything we can do to reverse that trend is a victory for us all.

Seth Mnookin is the director of the MIT Graduate Program in Science Writing and the author of several books, including “The Panic Virus” and “Feeding the Monster.”