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Canadian Medical Association Journal
CMAJ - May 19, 1998 JAMC - le 19 mai 1998

The stigma facing drug abusers impedes treatment

CMAJ 1998;158:1265

I want to commend CMAJ for continuing to highlight problems related to substance abuse and dependence.

As is hinted in Michael OReilly's recent article, "MD at centre of Somalia controversy finds peace in Northern Ontario" (CMAJ 1998;158[2]:244-5 [full text]), the Somalia affair involved an undercurrent of alcohol-related problems. Despite concerted efforts by some military physicians, a lack of education and a naïve, liberal attitude toward alcohol use stood in the way of adequate interventions.

Dr. Kirsten B. Emmott's article "A really bad locum" (CMAJ 1998;158[2]:235-6) highlights the indiscriminate prescribing of opioids and benzodiazepines that can complicate the problems of alcohol abuse and dependence. Physicians must take personal responsibility for becoming better educated about this issue.

In addition, better understanding is needed to avoid pitfalls such as those mentioned in Charlotte Gray's article, "Legalize use of marijuana for medical purposes, MDs and patients plead" (CMAJ 1998;158[3]:373-5 [full text]), in which the harmful effects of marijuana (including addiction) are acknowledged yet minimized. In addition, clarification is needed concerning the reply by Drs. Mark Latowsky and Evelyn Kallen to Dr. Robert A. Durnin's letter "Canada's drug problem: new solutions needed" (CMAJ 1998;158[2]:167-8). Latowsky and Kallen argue that illicit drug use is not abuse. By definition, continued drug use despite harm is drug abuse. Furthermore, preoccupation and compulsion, combined with impaired or sustained loss of control, characterizes dependence or addiction.1

Instead of moving away from making appropriate diagnoses, it is important to remove the stigma faced by people experiencing substance abuse or dependence. It is "the wrath of punishment" that needs to be curbed. Our patients deserve proper assessment and treatment, not punishment for "deviance," nor liberal access to potentially harmful licit and illicit drugs.

Raju Hajela, MD, MPH
Major (retired)
President
Canadian Society of Addiction Medicine
Kingston, Ont.

Reference

  1. Miller NS, editor. Principles of addiction medicine. Chevy Chase (MD): American Society of Addiction Medicine; 1994.

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