Over-Prescription as Normalcy

The Attorney General’s I-STOP bill, proposing the institution of a computer system that would track the medical history of patients to prevent against drug abuse, is facing backlash from some members of the medical community. As this Forbes article notes, New York “ranks 11th in the nation for admissions to chemical dependence programs for abuse of opioids other than heroin.”

The article’s discussion of the dangers inherent in over-prescription retains a focus on “crooked doctors, street-level drug dealers, and doctor-shopping addicts”. Little attention is paid to the addiction that rages within the employed upper-middle class. This focus perpetuates the stereotype that drug problems are confined to a particular subset of society that doesn’t include. ‘us’

This drug problem extends to law school and often starts there. The use of caffeine, alcohol, aderol/riddelin, cocaine, marijuana, ambien, etc. for coping with work and social situations is normalized and embraced. An example of this can be seen in the Career Services event title "How To Survive Your Law Firm Summer With Your Liver Intact and a Warm Fuzzy Offer". After all, who would knock a good cup of joe and rum and coke? A person who declines to partake in the coffee, alcohol or energy drink culture runs the risk of being stigmatized as a radical or, as Shefali notes, being ogled at as a 'mythological creature' that defies logic by managing to 'survive' without performance enhancing substances. By overwhelming us with volumes of reading, which we barely have time to read much less comprehend, law students are being trained to rely on any energy boost they can find (except for actual sleep).

Worst of all, this behavior is seen as training for our future demanding careers. Self-medication – through prescription and illegal drugs, alcohol and caffeine – is pervasive in the legal profession. It is used to disassociate from the ‘soul splitting’ to cope with the times when a lawyer is working on a deal that will ruin the lives of thousands of people. Dependency on these substances to cope with moral compromise and cognitive dissonance is accepted by the profession, not rejected as an addiction.

The lack of resources to truly address soul-splitting further drives the problem of self-medication and over-prescription. Good luck finding a psychologist or therapist who is not a psychiatrist. If you do, it won't be long before you are referred to a psychiatrist for medication. It's cheaper for the insurance company to give you pills instead of treating the problem.

A separate but related problem is the prescription of drugs based on ties with pharmaceutical companies. It is unsettling to watch a doctor prescribe a drug while writing on a clipboard that bears the logo of that drug. There is no good reason why prescriptions for OxyContin? have gone up 82% in 3 years. The drug is notoriously abused, and according to the article, has "contributed to more deaths than any other prescription opioid there since 2006." If reform is to come, changes to the marketing practices of pharmaceutical companies are necessary.

There is a stigma in the United States that you're a weakling if you can't function due to internal strife; it's your own fault not to be able to deal with your issues. That in part leads to the normalization of self-medication. After all, our society wouldn't function with lawyers and other professionals being unable or unwilling to do their job due to internal conflicts or strife.

Still, a morning cup of coffee or evening cocktail may not be a manifestation of a subconscious attempt to cope with soul-splitting. It may instead be the result of social conditioning to use. It may also be an indication we are pushing our mind and bodies beyond a healthy amount of work. But if all you’re selling is time, not judgment, who cares? If we dismiss the econodwarf and start measuring our worth by judgment proffered instead of time spent, society might take notice of our profound substance dependence instead of the tacit endorsement of whatever it takes to pawn our license and bill our hours.

-- MeaganBurrows, PrashantRai, AgnesPetrucione, ShefaliSingh, HarryKhanna, and SkylarPolansky 04 April 2012

The skyrocketing use of prescription drugs over the last decade is alarming, and the fact that the Attorney General is trying to solve the problem is an admirable goal. However, I believe it is too lofty.

The attorney general's plan of implementing a computerized database would doubtful attain the desired result of decreasing drug use. Ultimately, people will do what they want. It is a dismal reality, but reality indeed.

As Eben has continually reinforced, law is a weak-possibly the weakest-form of social control. Drug users will not change their habits as a result of their actions being tracked. (In a less serious, though analogous, situation, we all continue to use facebook daily, despite knowing that the corporation gathers and sells information about us each time we do.) Similarly, those using drugs have addictions, changing their biology, psychology, and social relationships. At the most basic level, we respond to our anatomical needs. A drug user, needing his/her fix, is going to satisfy that need, completely ignoring the force of the law.

Additionally, as you mentioned, substance use has become part of our social culture. Even in the law school, a place rife with ambitious and accomplished young adults, the majority of events lure us with promises of "Free Beer," "Open Bar," and the like. Moreover, we rationalize our behavior-whether it's a ritual coffee from the Halal Cart on 116th or the drag before bed every night-saying it's necessary to cope with the overwhelming "stress" of our lives. The law will have a tough time overcoming such psychological and sociological forces.

What most interests me about this problem is why exactly it happens and who it happens to. I completely agree that the problem is rampant among the upper echelons, a reality often ignored in our society. In Black's "Behavior of the Law" article, he stresses how poor and disenfranchised people have less law, and that the law disfavors. It is undeniably true that wealthier people, and those with close family and friends, tend to receive more sympathy when facing legal troubles. Maybe, for this reason, wealthy, privileged people believe they have immunity from the law, making it an even weaker form of social control than it already is. Thus, they use drugs, thinking the law won't, in fact can't, touch them. Additionally, though some people seem well-integrated on the surface, their psychological make-up puts them at the fringes, mentally apart from society, disenfranchised. A person less integrated in society is more likely to lose protection under the law. Ultimately, people will ignore the law as opposed to social, mental, and biological forces. For this reason, I regrettably doubt the I-STOP Bill could have any drastic impact (besides pissing off hard-working doctors).

That being said....can you put the link to the article you refer to on the Wiki?

-- AbbyCoster 4 Apr 2012