From Arab Spring to a uniquely American scourge

Six short years ago Ahmed Eid was at the epicenter of a Middle East storm, hitting the streets with his fellow Egyptians as the Arab Spring spread across the region. At the time, Eid had never known a president besides Hosni Mubarak. He didn't know what it meant to be able to criticize a leader or to freely express an opinion, not until Mubarak was driven from power in 2011.

While his country was searching for a new identity, so was Eid. He was an addiction counselor at a psychiatric hospital in Egypt, and he had spent time designing a drug program in Al Wathba Prison in Abu Dhabi.

He knew that he wanted to plunge deeper into addiction research and work, and there was only one place in his mind to do that.

"Hazelden is a fabled place around the world," said Eid. "It's like saying you're going to Harvard Business School."

Eid left Egypt and came to Minnesota to enroll in the M.A. program at Hazelden Betty Ford Foundation's Graduate School of Addiction Studies. He carried a small suitcase, and as he traveled through a very foreign landscape to Hazelden's Center City location, he panicked.

"I'm thinking, 'Nobody knows where I am,' " Eid said with a laugh.

Today, Eid is at the epicenter of another storm, but this one is very American: opioid addiction.

I spoke with Eid the day after Minnesota Attorney General Lori Swanson joined her counterparts from 34 states to sue the company that makes the drug Suboxone, trying to force them to make a generic version of the drug, which reduces cravings for opioids. Swanson also wrote to insurance companies, asking them to eliminate prior authorization rules that impede some addicts from getting the drug.

It is an interesting time for facilities such as Hazelden, which promotes abstinence as the ultimate treatment for addiction. The facility, however, has recently added the use of Suboxone to its opioid treatment plan because of the enormity of the problem and the difficulty addicts have staying in programs without it.

Opioid addicted patients "were not utilizing our services," said Eid. "They suffered numbness, apathy, and were unable to experience joy."

Swanson's push to make drugs such as Suboxone more readily available was inevitable, Eid said, but Hazelden's philosophy is that they are part of a way to keep addicts in a holistic program that eases them off the drugs. "They are effective when used in a robust program," he said.

Eid's international experiences give him a unique viewpoint to this American problem. While the United States makes up only 4.6 percent of the world's population, it accounts for more than 80 percent of opioid use, Eid said.

Unlike other drugs, whose prescriptions are precise, those for opioids such as oxycodone are often vague and loosely monitored, and thus ripe for abuse, intentional or unintentional, Eid said.

I asked whether he thought Americans think about pain differently than other countries.

"I think they think about addressing pain differently," said Eid. "I think there are people out there who absolutely need the help [of opioids for pain], but we have to have a neutral discussion about it. If you can give me something that stops my pain immediately, it's very hard to explain why you are not going to give it to me."

Working with addiction in Muslim countries was very different. For Muslims, use of alcohol "was against our religious beliefs, so people don't get together after work for a couple of drinks," Eid said.

In the U.S., people are in prison because addiction caused them to commit crimes. In Egypt, people were in prison because they used drugs.