Tribute to our children who survived the Death Squad of El Salvador but did not survive the Canadian Opioid Crisis

A while ago, a good friend shared with me his story.  Shortly after arriving in Canada as a teen refugee from El Salvador, he along with a group of “new arrivals” were invited to a party.  At the party, they were all given the “choice” to snort lines from a table covered with cocaine. He politely declined and left with his little sister.  He said other than him and his sister, everyone in that original group of “new arrivals” have since died.
I know banning cocaine did not save his young friends.  I suspect legalizing cocaine would not have helped. I somehow also suspect a governance similar to Bill 2 would have been also futile.  

I believe giving individuals the “choice” to use cannabis without providing the knowledge of the nature of addiction represent not freedom but enslavement.  

I believe age is an inadequate predictor of awareness and understanding. The opioid crisis does not seem to spare individuals past their teens.

These rules and policies all seem to be a substitute for a real need.  A need for authenticity. A need to have conversations about addiction that brings more awareness.

I am often asked by patient to prescribe cannabis, benzodiazepines or opioids.

My approach is similar for all medications and substances with potential addiction properties.
I explain to them that no one (for emphasis of course, I point out the obvious) including myself is immune to addiction; that given the situation, anyone can become addicted. (They usually don’t believe me at this point)
I then explain to them the mechanism or cycle of addiction (fear of some suffering/ craving for end of it; seeking a quick relieve / a substitute solution; relieve from suffering; effect of quick solution begin to wear out; triggers the fear of suffer... then the cycle’s intensity compounds); I talk about some real life examples; and there is no lack of stories.  By now, they begin to see how addiction applies to them personally.
I then help them understand the lengthy list of other unintended and serious side effects of the substitute solution ( Eg.  Increased risk of falls in seniors; respiratory arrest, quality of life, etc.; I try to use examples most relevant to the individual.
I ask them and help them identify what is the suffering they are hoping to alleviate.
I then offer them a real solution to their sufferings.  (Eg. A Basic Wellness Messages)
In my experience, above approach has resulted in various satisfactory outcomes; many embrace the knowledge and come to attend my wellness groups and learn more about the Basic Wellness Messages;

Some are disappointed but still respect the time spent and reasoning; none leaves with a quick fix or substitute solution without a clear understanding and an agreement on a solid plan to eliminate the substitute with the real solution.

In my opinion, the key ingredient of addiction management are:
That I take the time.
That I understand addiction is a common humanity. ( remove stigma and judgement of which self-judgement or shame is most intense)
That I explain the mechanism of addiction in a way that can be understood by the individual
That I help find a real solution to replace a substitute.
That a reasonable plan is agreed upon to safely wean off the substitutes and apply the real solution.
That I use “physician-led self-management education and support groups” to help patients begin personal transformations.

Disclaimer:
Above are my personal opinions based on my clinical experience.

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