Drug addiction is essentially acquired mental burden. Someone with an addiction is singularly focused on getting their next fix, which can lead to destructive behaviour like breaking & entering and theft. Many people with problematic substance use have said that they found themselves doing things they never thought they would, because getting drugs was the only thing on their mind.

For someone with an addiction, their list of worries (so, their mental burden) includes

  • getting drugs,
  • risking an overdose,
  • avoiding law enforcement, and
  • facing the stigma of addiction,

among other survival concerns, especially because many people with substance use problems end up homeless.

A trial that prescribed heroin to people with otherwise untreatable addiction helped participants get jobs and lead meaningful lives, which is completely consistent with model of mental burden relief. Prescription heroin meant that participants didn’t need to steal to get money for drugs, they didn’t have to worry about their drugs being laced with fentanyl or carfentanil, and they knew they had a steady supply of opioids so that they wouldn’t get dope sick. Free of these mental burdens, people were able to work, learn, innovate, and contribute.

So far only people with severe addictions have been accepted into the prescription heroin trials, which is probably how it should be. People whose addictions aren’t as entrenched and who may be able to get sober are probably still better off clean than on prescription drugs, because they don’t have to worry about regularly showing up to a clinic for injections, and being on opioids carries its own health risks that are themselves a source of mental burden.

I think of opioid addiction like type II diabetes: some people may be able to control their blood sugar with diet, exercise, and oral medications, but others will need to inject insulin every day to function and thrive.