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Monday Oct 30, 2017

Could Better Coping Skills Curb Rampant Drug Use?

[Runner stretching]

"She said baby I am not afraid to, die
Push me to the edge
All my friends are dead
Push me to the edge
All my friends are dead
Push me to the edge
All my friends are dead
Push me to the edge"
-- Lil Uzi Vert

When I first heard the lyrics of this popular hip-hop song, my jaw dropped. Bold, real and honest, the lyrics could be the soundtrack for the health crisis that the opioid epidemic has become, especially among our youth and young adults.

The CDC recently published its Annual Surveillance Report of Drug-related Risks and Outcomes,(www.cdc.gov) and the statistics are as jarring as this music:

  • There were 52,404 drug-overdose deaths in 2015, a record high. Eighty-four percent of those deaths were unintentional.
  • At least 63 percent (33,091 persons) of total deaths attributed to drug overdoses were due to opioids.
  • In 2016, 61.8 million Americans had at least one opioid prescription filled or refilled, a rate of 19.1 patients per 100 persons.

In XO Tour Llif3, the song quoted above, Lil Uzi Vert grieves the loss of his friends due to his recent fame. He says that he now takes comfort in the faces of the dead presidents on his newfound money and uses his wealth and drugs to deal with the pain of disappointment and change.

For too many, drugs are an unhealthy coping mechanism to escape the pain of human existence. A friend dealing with a relative's death recently told me that another family member tried to force her to take a Xanax. She declined, not wanting to swallow her emotions along with the pill. For others, the choice is more difficult. Access to prescription drugs in our homes and in the streets is all too easy. In 2015, roughly 47.7 million Americans aged 12 years or older used illicit drugs or misused prescription drugs.

Periods of sadness and hurt will inevitably come as we live our lives. Family members and friends die. Jobs are lost. Marriages end. Disappointment, and worse, will occur. Pain at some point -- whether physical or emotional -- is a part of being human.

Do we set our youth up for disappointment and distress by not talking about the realities of life? I suppose these are conversations we think will happen in the home, but as the consequences spill more and more beyond the home, does the medical community have a responsibility to do something different?

Walking along the main street of my community last month, I saw men and women who were obviously under the influence of drugs. One man was curled up on the sidewalk in a fetal position, and another leaned forward in an almost inhuman position of balance. It made me ponder the string of disappointments that could have led to such drug use and/or dependence.

Discussing coping mechanisms in our primary care offices could be one step to curbing this epidemic. I have become more mindful of asking patients of all ages about their coping mechanisms and strategies for stress. Many times my patients respond with, "I don't know," or "I just deal with it." However, I have found this to be a great opportunity as a family physician to provide counseling on healthy alternatives to aggression, hopelessness, overeating and substance use.

I emphasize certain coping mechanisms:

  • Exercise -- I discuss the benefits of endorphin release during exercise, which can improve a person's mood and make life more tolerable. I encourage patients to find an activity that allows them to blow off steam and clear their minds. For some people, it may be a calming activity such as walking or yoga, and for others it may be more intense activities such as kickboxing or marathon training. The key is finding something they will stick with.
  • Prayer and/or meditation -- I encourage patients to take time during the day to relax their mind and bodies, and to connect to themselves with a higher power if they feel this is a source that sustains them. This allows conscious awareness of one's feelings and thoughts, and their body's reaction to them. Consistent mindfulness meditation exercises(journals.lww.com) have been found to result in lower heart rate and blood pressure, as well as with feeling less emotionally exhausted.
  • Talking it out -- Not bottling up emotions, but releasing them by speaking with others can be extremely helpful. If patients do not have someone to speak with, this is the opportunity to offer counseling or mental health services.

Other healthy coping mechanisms I often discuss include good sleeping habits, healthy eating, journaling, positive thinking, focusing on gratitude, organization/preparation, and choosing to not sweat the small stuff in life. Familydoctor.org and my website(thecitydoc.com) have resources to help patients with stress and coping.

We are losing too many of our community members, family members, and youth to drugs. I challenge us as stakeholders in this epidemic to become more proactive in our approach and get at the root cause of drug use.

Venis Wilder, M.D., is a board-certified family physician who practices at a federally qualified health center in Harlem, N.Y. She also considers herself a community health practitioner working at the intersection of primary care and public health.

Posted at 03:30PM Oct 30, 2017 by Venis Wilder, M.D.

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