No matter where you turn these days, it’s common to find people fixated on their next dose. At family gatherings, it’s not unusual to find someone hidden in the corner of their room, or even taking the bold step of using in front of family members. It has become ubiquitous among all socioeconomic groups, classes, races and religions, and it is no longer limited to income, or geographical location. People are willing to spend anything to get their next fix, and what started out as occasional use has mushroomed out of control to even multiple times an hour. People that at one time were in control of their lives now find themselves addicted to the point that their habit is disruptive to their personal life, their family relationships, and enjoying simple pleasures. Some can’t even complete a bathroom trip without reaching for their next jolt! In traditional cases, rapid dopamine influx affects the nerve cells in the central nervous system. Of course, in this case it’s just the opposite, as your cells strip away dopaminergic pleasures. Naturally, what I’m talking about is cell phone usage.
It occurred to me while observing people (including myself) at a dinner table, in a meeting, or with my grandson, that my cell phone was doing just that. I see people crossing the street oblivious to traffic, texting while driving, or distracted from entire conversations because a text must be answered within 1- minute of receiving one, or something popped up on Twitter or Instagram. So, it occurred to me to ask some very practical question in comparison to opioid usage…
- What is the death toll from cell phone usage?
- What is the revenue from smartphone manufacturers and/or service providers compared to Big Pharma?
- Is there a cell phone epidemic, and if so how does it compare to opioids?
- What has the government done to enforce controls on cell phones compared to opioids?
- How have cell phones affected society compared to opioids in terms of addiction?
- Should the CDC place similar restrictions on cell phones as they have for prescribed opioids?
- Should cell phones be treated as a controlled substance?
- Should cell phones require a REMs program of sorts and be dispensed with requirement for counseling?
- And finally, is there a naloxone equivalent that can reverse a cell phone overdose?
I decided to engage a true millennial, Dr. Mena Raouf to collect some data and put this in perspective. Here’s what he has to share…
Out of the world’s 7 billion people, 6 billion own a cell-phone, which is surprising considering that 4.5 billion people have access to a working toilet and 5.3 billion have access to electricity.1,2 More people have access to a cellphone than running water, indoor plumbing, or consistent electricity. Wait a second, more people have access to cell phones than electricity – How are they charging their phones?
It is safe to say that we have a cellphone “epidemic”. Most people now check their smartphones 150 times a day, which is once every 6 minutes, including sleep hours.3 Approximately 46% of smart phone users say “they couldn’t live without their phone” and 60% of U.S. college students consider themselves to have a cell phone addiction. In one study, one-in-three participants would rather give up sex than their cellphone. Another study found that 35% of people think of their cellphone when they wake up while 10% of people think of their significant others.
How does one become addicted to their cellphone you may ask? One cannot shoot up an app, inject an emoji, snort an Instagram filter, or pop some signal bars? When we hear the word “addiction”, we immediately think of opioids, alcohol, stimulants, etc. However, addiction does not have to involve a substance or a drug and can be behaviors associated with pathological pursuit of reward such as gambling or sex. Addiction is a chronic disease of the brain reward, motivation, memory, and related circuitry. Characteristics of addiction include inability to consistently abstain, impairment in behavior control, and craving.4
A 2016 NIH study found that DSM-5 criteria for substance use disorder can be applied to effectively identify cell phone addiction.5 A breakdown of the symptomology for cell phone and substance use disorder is available HERE! (hyperlink or include the picture below)
The cell-phone “epidemic” has inspired new pathologies such as:5
- Nomophobia :No-Mobile-Phobia
- FOMO: Fear of Missing out
- Textaphrenia: false sensation of receiving text message that leads to constantly checking the device
- Ringxiety: false sensation of receiving a call that leads to constantly checking the device
- Textiety: compelling urge to respond immediately to a text message upon receiving
A millennial like myself might say “cell-phones connect people and improve communication so what is wrong with having a cellphone epidemic”? Nevertheless, here are some of the individual and societal harms from excessive cellphone use:
- Motor vehicle accidents: Cellphone use while driving leads to 1.6 million crashes every year leading to 330,000 injuries and over 3000 deaths.6 Texting while driving is 6x more likely to result in an accident than driving drunk.7 Texting while driving has reached an epidemic. A 2010 study found that nearly half US adults admit reading or sending a text message while driving and nearly one in three 16- or 17- year olds admitted texting while driving.
- Pedestrian injuries: A study of pedestrians in midtown Manhattan found that 42% of drivers that enter traffic during a “Don’t Walk” signal were using their cellphone.8 No surprise, a 2013 study found 10-fold increase in injuries related to pedestrians using cell phones from 2005 to 2010.9
- Loss of work productivity: the average worker spends 5 hours on their cell-phone for non-work related activities. 10
- Impaired sleep: smartphone screens emit blue light and decreases melatonin production – a hormone involved in regulation of sleep/wake cycle
- Myopia epidemic (near sightedness): There has been a 35% increase in people developing myopia since 1997 when cellphones were launched.11
- Pain: if you are reading this blog while looking down at your phone, there is a force equivalent to having a 60-lb weight or an 8-year old child on your neck.12 One can only predict a parallel rise in disorders of the cervical spine, maybe a new diagnosis “Text neck” will arise.
Let’s shift back to the presumed opioid epidemic and continued efforts to limit opioid prescribing.
The rise in opioid prescription overdose deaths in 2010 to over 16,000 cases has sparked major policy changes to reduce opioid prescribing by placing “morphine equivalent daily dose” cutoffs or other means. The CDC released its Guidelines for Opioid Prescribing in March 2016 with recommendations against prescribing more than 90 mg morphine equivalent daily dose for chronic non-cancer pain. Insurance companies have placed morphine equivalent dose restrictions. Despite these efforts, opioid overdose deaths continued to rise.13 Legitimate chronic pain patients are facing difficulties obtaining and filling their prescriptions and some resort to buying opioids off the street to avoid withdrawal.
There is no doubt that opioids have been liberally prescribed with lack of risk assessment and mitigation strategies. Opioids are not for everyone with chronic pain and should never be first line options. For a carefully selected subset of the population whom other options are not viable, opioids may provide relief and help restore their quality of life.
Similar to cell-phones, opioids are can be a double-edged sword. For individuals with intractable pain, opioids may provide relief, functional improvement, and help restore quality of life. For other individuals, opioids are abused and can lead to morbidity and mortality. Simply placing ubiquitous morphine equivalent limitations is not the answer and this has been evident by continued rise in overdose deaths despite reductions in opioid prescribing.
For cell-phone users with personal or business emergencies, cell-phone could be a lifeline, but overuse and addictive behaviors have led to harm and death as noted above. Cell phones can restore quality of life that connects various persons to loved ones or friends, but can also distract from important direct human contact.
Is the answer to the opioid epidemic is continued efforts to limit prescribing? Then for the cell-phone epidemic, do you think cellphone carriers should have a maximum daily tweet dose? Should local agencies enforce a Snap Chat equivalent daily dose? Should the CDC place restrictions on Instagram posts? Should cell phones be Schedule II Narcotics because of a high abuse potential? Should Apple and other Cell Phone manufacturers be sued for the “cell-phone epidemic” by various state agencies?
Cell phone usage and patients requiring long-term opioids have an important correlation. Proper doses and disciplined usage of cell phones and opioids could be lifesaving. And for chronic pain patients, these worlds may overlap. Cell phones can actually connect patients with chronic pain syndromes that are unable to leave their home (possibly due to Draconian abrupt drops in their opioid dose) with the outside world because they are trapped in their body and in their home. Cell phones could be a lifeline to emergency services if a patient falls and can’t get up, if there is an opioid overdose emergency, or a call to the suicide prevention hotline due to unrelenting pain.
No matter how you slice it, cell phones may prove to be similarly addicting compared to opioids. We wonder what would happen if regulatory agencies abruptly cut-off cell phone use, reduced the maximum allowable daily cell phone dose, or set up a cell phone state monitoring program. Would there be a black market for cell phones? Would people kill for cell phones? Would the cost of prescription cell phones increase as the street value decreased? Would phone manufacturers be encouraged to develop abuse deterrent cell phones, the dose of which needs to be used gently over 8-12 hours instead of immediate release bursts?
Perhaps Drake had the foresight to understand the lifeline between human touch, pain and cell phone access in his song Hotline Bling…
You used to call me on my cell phone
Late night when you need my love
Call me on my cell phone
Late night when you need my love
There is much to think about here. We encourage you to comment and share your thoughts.
Dr. Mena Raouf, PharmD, BCPS. is currently completing PGY-2 Pain and Palliative Care residency at the Stratton VA Medical Center in Albany, NY. Dr. Raouf received his PharmD from Albany College of Pharmacy and Health Sciences and completed a PGY-1 residency at the VA Tennessee Valley Healthcare System in Nashville, TN.
- American Society of Addiction. Definition of Addiction. [Webpage on the internet]. Available from: https://www.asam.org/resources/definition-of-addiction. Accessed January 25, 2018.
- De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-Phone Addiction: A Review. Frontiers in Psychiatry. 2016;7:175.
- National Center for Statistics and Analysis. Distracted Driving: 2015, in Traffic Safety Research Notes. DOT HS 812 381. March 2017, National Highway Traffic Safety Administration: Washington, D.C.
- Wilms, Todd. It Is Time For A ‘Parental Control, No Texting While Driving’ Phone. Forbes Business, September 18, 2012.
- Nasar JL, Troyer D. Pedestrian injuries due to mobile phone use in public places. Accid Anal Prev. 2013 Aug;57:91-5.
- Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov;25:277-9.
- National Institute on Drug Abuse. Opioid Overdose Death Rates. September 2017. [Webpage on the internet]. Available from: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed January 25, 2018.