(Editor’s note: Every month, the team at Ravenwood Health posts about a mental-health topic. This month, Brock Bodenbender, Medication Assisted Treatment Coordinator at Ravenwood and Graduate Faculty member at Cleveland State, writes about the differences between a drug and medication.)
I would like to share with you a conversation that I have many times a week. Before I do, I must share a disclaimer. Every person I have discussed this topic with has had a different vantage and opinion, and every one of them is accurate in their own way. An old mentor of mine was fond of saying, “this is an area where many very brilliant people are going to very much disagree.”
What I present here is simply my own personal version. I leave it to you as the reader to decide which pieces connect in your own puzzle and which do not. It is my hope that even if you vehemently disagree with these ideas that they spark a conversation with yourself and others in your life about the roles we as a community have given to substances.
What is the difference between a drug and a medication? When I ask this question, I receive so many different answers that I do not have room to record them here. However, a pattern has emerged. What I have noticed is that whom I am asking oftentimes determines the general response. When I ask my graduate students this question on the first day of classes each semester, they proceed to have a four-hour long debate about chemical make-ups, uses, benefits, side-effects, medical oversight, and costs of every type.
Now part of this lengthy discourse is due to thinking that I am giving them a trick question, which is not completely untrue. Yet, a greater part is that they, and we, are often searching for a difference within an object, in this case a substance, so that we can defend a moral or subjective judgement. The substance does not contain morality so we must apply it to explain what it does in a moral world.
When asking the exact same question to an individual in the Medication Assisted Treatment Program (MAT) here at Ravenwood Health, typically their first response is that, “one is good and one is bad.” When asking them to elaborate on this they explain that not only is the substance good or bad, but that by proxy that they are as well for taking it.
I wanted to share the difference in these responses, from thoughtful students compared to insightful individuals in recovery, to highlight the difference between lived experience and usually not-lived. At the end of every one of these long classroom discussions, I present the other component that I just shared with you. The students typically grapple with this for a few minutes before wanting to dive back into nuance and the “well yeah, but …” responses, which they employ to try to preserve some semblance of personhood for themselves or for their real or future clients. I hope that we can do the same as a community.
Again, in the case of substances, there are two broad judgements. One branch of substances is GOOD while the other is BAD. Our blood pressure medication and anti-depressants are good while heroin and cocaine are bad. The LABELS of drug and medication are reflective of this judgement. If someone says the word “drug” to you, you may have a reflexive response that bases in some mixture of fear, aversion, sadness, curiosity, or excitement. The word “medication” may bring up something similar, but also maybe memories of doctors’ offices and feelings of relief or safety.
These reactions often have little to do with the actual chemical compounds, but very much derived from the stories and experiences that we have had with these compounds. Think of the recent debates, discussions, and sensationalism on both sides of the current marijuana/CBD saga. Many people have thoughts challenged about whether marijuana as an object is good or bad. Vaping is another prime and immediate example that is rapidly swinging around.
My purpose for bringing these concepts to light is not to defend any kind of illicit or prescribed medication use, or to defend abstinence at all costs. I hope to raise awareness that anytime we as a society start to operate in black and white thinking about a particular substance, we corner ourselves into reactionary modes of feeling that leave little room for objectivity. Now, is binary thinking so much easier for the processor between our ears? Of course, it is and that is why we employ it. What I can attest to personally and professionally is that by doing so many of our community here have been stigmatized, stereotyped, and have died as we have struggled with these judgements that do not account for the underlying issues and actually act as a distraction.
As an example in the last year, I have seen more clients come in to my office because of prescribed medications than illicit heroin/fentanyl use. Let that sink in. What I have learned is that what matters is the person who sits here is in pain, right now. There is no judgement attached to that pain regardless if it is emotional, physical, or both. The particulars of their use, illicit or prescribed, injection versus inhalation versus oral, are of interest to me clinically, but are not the underlying issue. Somewhere in their journey through life, maybe in childhood or in their golden years, they were introduced to some kind of pain that they were not prepared for and instead of finding a way to manage through that pain, they have turned to (or were prescribed) substances to tamp it down.
As a society we have drifted further into quick fixes for pain and discomfort and deeper into reactionary judgements because they are both simply easier for us to integrate into our worldviews. I am using “pain” in the broadest sense here and this could represent for instance mental health, trauma, or physical ailments.
All of the information I have provided here comes to a singular point in my daily work, providing Medication Assisted Treatment (MAT) for opioid and alcohol use. How should I feel about it? The assertion that MAT is a drug for a drug is a valid one, if you are applying the above-mentioned moral judgements. You are replacing a BAD with a BAD. If we consider MAT with something such as buprenorphine, a medication, then we are replacing a BAD with a GOOD. Notice how those words stand out, capitalized judgements of a substance.
What reverberates back is that the judgement is landing back on the person and this leads to continued stigmatization and stereotyping that just furthers our community’s pain. So is MAT another quick fix then? If we were only talking about the medication, I would be inclined to say yes. However, if this medication is a part of an intensive program that supports and examines an individual’s relationship with their pain than I am inclined to say no. Those that have been in or are currently in MAT programming can attest that this is no quick fix. It can be years of therapy and support that hopefully results in a greater knowing of who they are and where their pain originates.
If this medication is the bridge to get through such a difficult journey, then I believe it is our duty as a community to have these conversations. Someone who is struggling with their personal pain and the addiction that tragically—all too often follows—has every resource available to them.
Brock is currently reading Witness to the Fire by Linda Schierse Leonard