What is drug abuse?.,According to National institute on drug abuse “””Addiction is defined as a chronic relapse disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder .Low dopamine D2 receptors may contribute to the loss of control in cocaine users”.
It is important to find out about the patient upon admission by gathering information such as the previous drug use and interaction, medication schedule, the attitude towards medication administration.Has patient any allergy to medication.Is there a drug seeking behavior, patient history mental problems, seizure disorder. Every patient has life before hospitalization and patient data should be collected rather than assumption.He is young should not be in pain,or Asia people don’t need pain medication. Or she is too old to be in pain. Says who? Here are the factors that can contribute to drug abuse.
(1)SEVERITY OF INJURY: Person developed an injury due to trauma such as car accident, burns, traumatic fall,severe pain,fibromyalgia and so many others. These pain leads to emotional stress and physical pain.Then you go to seek professional help.
(2) OVER MEDICATION.:You seek medical help or you are picked up by ambulance (BIBA)and brought into the hospital. The doctor ordered for general surgery consult, neurosurgery consult,plastic surgery consult. Surgical intervention done.Pain medication ordered based on the disease process, who you are.Do you have insurance?. Are you rich or white?. If you are.Then, you can get morphine, dilaudid intravenous or and by mouth dilaudid PO, norco 10/325mg PO Q4hours prn pain, zofran intravenously Q4hours prn nausea/Vomiting, ,Flexeril 5mg PO Q8hrs muscle spasms. Then comes the enabler who could be a wife,a girlfriend, a family member or a medical professional. Some of these group get emotional about these drugs and ask for more and the enablers supply and supply death becomes eminent if the behavior is not monitored and stopped. I see it in white ,black and Hispanic. The drug just make him or her feel great. The money is there to pay for it.Why not if not?. If you the nurse refuses to over medicate,she will be reported immediately to the doctor,supervisor or administrator even though you are doing the right thing.
(3) UNDER MEDICATED : If you are a minority and undergo procedure such as surgery, back pain, knee pain you will be under medicated because the general assumption of most of these doctors is that, if you are black you have the tendency to be doing drug, and your brain is wired towards doing drugs. Which is very depressing and unfounded.These put every black in one box, if you are not rich and famous. You had knee surgery and the doctor order norco 10/325mg PO Q6hours prn pain. There is no medication for muscle spasms.Only very few doctors will order without basing it on the color of your skin or socioeconomic status. Eventually the nurses call and ask for the patient to be properly medicated but the doctor claims that the patient is addicted. Addicted really how?.Let the patients irrespective of race or socioeconomic status be well medicated.If patient is well medicated for pain,they can work with physical therapist, smile, eat their food and discharged on time and minimize frequent fliers.Since patient is under medicated he or she will start to solicit for street drugs.So when they come in for procedure or any intervention, they just sleep all the time. And you ask do you want your pain medication?.He replies,” no I am find”.,Who is guilty here?. The supplier,the patient or the doctor?. There are exceptional cases very few.What has genetic got to do with this ?.Stop been judgemental and medicate patients well.Black,brown or white, PAIN is PAIN.If you are a nurse and solicit for your patient to get the right medication then you are enabler if you are minority and the patient is minority.
More Education is needed on cultural competence to improve understanding rather than labeling.
(4 )DENIAL OF CARE : Minorities are often denied care.The doctor does not pay attention to your diagnosis but want to make money from you as a patient. If you don’t have insurance tough luck.With COVID19 PANDEMIC. I feel sorry for minorities who have COVID19 because they might not survive based on denial of care. Please take note of that and don’t jeopardize your health and the health of your family. Do not expose yourself.Do not be a statistic.
(5) ENVIRONMENT : Bad neighborhood and peer pressure. In every race there are losers and winners.Some group know how to protect their own through resources availability. But some groups don’t and don’t have the resources. And there are naturally unintelligent people who see drug as a great adventure.And their stupidity must not be used as a yardstick on other people of the same skin color that is STEREOTYPE. It is in every race but we don’t stereotype them even if we know the truth.When you live in a run down neighborhood it takes lots of courage not to get involved in gang related activities and crime. Nobody to stop you.No parents or uncles,or aunts and nobody to look up to.I am glad that the younger rich black folks are paying attention to their children.
(6) GENETIC VS POVERTY: Drug lords lured poor kids to become their agents. These kids become exposed to these wonder drugs at a tender age. They become addicted .It is difficult to stop them.They have nothing to look up to. For them drug became something to look up to.The argument become generic or hereditary. Their brain could be wired differently. In every race some people brain are wired differently and when they become exposed they are hooked. They have no incentive. The drugs are their only incentives.
In those days in Africa countries,specifically Nigeria the general believe is to work hard.It takes a village to raise a child.Every kid is taken care of by family or extended families .The poor kids do not have access to drugs and were not involved in drugs. They grew up with hard work all their lives.There were less than 0.1% that were exposed to drugs. And that was quickly stopped as soon as their families interfered. But here in USA in my perspective it is is always genetic and heredity. What about lack of care ,systemic racism, lack of immunization programs for the poor,safe sewage system,lack of control of communicable disease,brain washing for so many years. Idle mind is a devil workshop.These black children were exposed at a tender age .They feel better, feeling good, inquisitive and they wanted to belong,hunger not anymore because the drug kept them feeling good. When I was a student at USC, I attended all the program to see things for myself .Some of these people involved in excessive alcohol and drug have mental issue that are not properly addressed.And these young men and women do not trust their psychiatric or their doctors.If you do not trust your provider how do you get help?. Sadly you do not and these people ended up committing suicide or thrown into jail due to drug abuse or DUI.Some families have lost their children due to alcohol and drug related death.
Stop pretending that drug and alcohol is only minority problem.We know that it is a general disease that need to be addressed.”I am not the problem,you are not the problem the system is the problem”””. And the system is the solution.
It is very important for healthcare professionals to broaden their mindset,aware,understand,and appreciate the cultural diversity and similarities between different cultures. And should be in alignment with the Human and Department of Health Services. Identify and eradicate prejudice, stereotyping and unnecessary discrimination. Support treatment and behavior that encourage and value diversity. And exploit richness of different groups. The offenders most often will resist systemic change.It is easy to create racism but very difficult to eradicate. Us versus them.
Modified with permission from Volkow et al.1993.