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Published: November, 2018; Vol 15, Num 5

Surgeon General: Addiction Is a Disease, Not a Weakness

To finally get a handle on the opioid epidemic decimating the U.S. and disproportionately affecting the construction industry, the public must change its attitude toward workers and others in need of help, take steps to help prevent opioid misuse and encourage recovery. So writes U.S. Surgeon General Jerome Adams in Facing Addiction in America: The Surgeon General’s Spotlight on Opioids.

“The first step is understanding that opioid use disorder is a chronic but treatable brain disease, and not a moral failing or character flaw,” said Adams, whose own brother struggles with addiction. “Like many other chronic medical conditions, opioid use disorder is both treatable, and in many cases, preventable. It is also a disease that must be addressed with compassion. Unfortunately, stigma has prevented many sufferers and their families from speaking about their struggles and from seeking help. The way we as a society view and address opioid use disorder must change – individual lives and the health of our nation depend on it.”

The new report comes as the U.S. opioid crisis continues to worsen. Preliminary figures from the Centers for Disease Control and Prevention indicate that more than 70,000 Americans died from overdose deaths in 2017 (an increase of almost 10 percent from 2016), nearly 48,000 of which were from opioids. While many in the industry know that a lot of these deaths include construction workers, what isn’t as well understood is why they and so many others become addicted. As Adams explains in his report, addiction occurs because opioids affect our brain function, creating changes that can remain even after someone has stopped taking the drug. These changes to the brain can produce cravings that may last many years and lead to relapse.

How Do Opioids Affect The Brain?

Opioids affect how the brain sends, receives and processes signals for pain and pleasure by attaching to cells in the brain. This changes how the brain interprets these important messages. When an opioid is in a person’s system, the brain doesn’t recognize pain, so the body doesn’t feel it. Unfortunately, when it comes to pleasure, opioids have the opposite effect on the brain. Instead of masking the sensation of pleasure, the body experiences a surge of euphoria that’s far greater than the pleasure naturally triggered in our brains by healthy pursuits like engaging in creative activities or interacting with friends.

Researchers now believe it’s this artificial burst of pleasure that can lead some people down the path of addiction. Opioids condition the brain to seek out the source of this inflated sense of well-being over and over again. This effect is so strong that cues associated with this feeling of pleasure, such as seeing the person who provided the opioid or hearing music that was playing when the opioid was taken, can trigger cravings when the drug isn’t available. This direction from the brain encourages people to make finding and using opioids their driving focus. Over time, this can lead to emotional and physical dependency that increasingly takes over a person’s life. That process includes these steps:

  1. Intense intoxication: the user experiences great pleasure
  2. Development of tolerance: the user needs a larger amount to experience pleasure
  3. Escalation in use: the user needs to use more often to experience pleasure
  4. Withdrawal symptoms when the opioid is unavailable: profound negative emotions and physical symptoms including pain, sweating and intestinal distress

What Can Be Done

Effective treatments for opioid abuse disorder exist; however, stigma is one of the greatest barriers that prevents many people struggling with substance abuse from seeking help. Having more honest and meaningful conversations about these powerful drugs and encouraging people to seek assistance will contribute to bringing the opioid epidemic under control. In the Facing Addiction in America report, U.S. Surgeon General Adams calls on the public to do the following:

  • Talk about opioid misuse, overdose and the effects opioids can have on the brain.
  • Be safe. Only take opioid medications as prescribed, store medication in a secure place and dispose of unused medication properly.
  • Understand pain and talk with your health care provider about treatments other than opioids that can manage pain.
  • Understand that addiction is a chronic disease. With the right treatment and supports, people do recover.
  • Be prepared. Get and learn how to use naloxone.

Owners, contractors, Local Unions, federal and state agencies and others must all get involved to stop the scourge of addiction among construction workers. It’s not enough to drug test and remove workers who test positive from the job. It doesn’t solve their problem and it contributes to the shortage of skilled labor that plagues the industry. Instead of zero tolerance drug-free workplace policies, we must consider policies that provide an opportunity for someone to get help and then return to work. Work sites must also be designed with safety in mind so that workers suffer fewer types of injuries that can lead them to take opioids in the first place. When we all work together, we can help keep workers healthy and keep projects staffed and completed on time.

The LHSFNA has developed a number of materials that provide information about addiction. Our new What to Ask Your Doctor Before Taking Opioids publication and Answering Your Questions on Opioid Abuse & Addiction and Heroin: Getting Help for Family, Friends and Loved Ones pamphlets can help LIUNA affiliates looking for more information on this topic. To order these or other publications, visit our online Publications Catalogue or contact the Fund’s Health Promotion Division at 202-628-5465 for more information.

[Janet Lubman Rathner]