Astronauts and addiction: Ending the stigma (op-ed)

Michael D. Shaw is a biochemist and freelance writer. A graduate of the University of California, Los Angeles, and a protégé of the late Willard Libby, winner of the 1960 Nobel Prize in chemistry, Shaw also did postgraduate work at the Massachusetts Institute of Technology. Based in Virginia, he covers technology, health care and entrepreneurship, among other topics.

Astronauts sometimes face the gravest threats after they return to Earth. Facing depression, alcoholism and substance abuse in general, astronauts are not immune from addiction. 

As Buzz Aldrin has explained in his memoirs and interviews, addiction among NASA astronauts is real, prevalent and serious. In an interview with The Telegraph, Aldrin talked about his "lost decade" in the 1970s, when he went through two marriages and worked as a car salesman at a Cadillac dealership in the years following his historic Apollo 11 moon landing. He said he was marginalized and shunned by NASA and the Air Force when he revealed his struggles with alcoholism and depression.

It was not until 2007, when NASA reviewed allegations (since disproved) of "heavy use of alcohol" by two shuttle astronauts within 12 hours of flying, that things began to change. And yet, despite a 1991 law directing NASA to create a policy for alcohol and drug testing of its employees, no such policy was in place in 2007.

Related: 10 ways that astronauts are helping you stay healthy

NASA now has a Drug Free Workplace Program Employee & Supervisor Guide that consolidates several of our previous publications into a single booklet for both supervisors and employees, and is suitable for training. The guide has sections involving testing and privacy, employee rights, mental health services, and more.

More recently, NASA Administrator Jim Bridenstine ordered a workplace safety review at SpaceX and Boeing, two companies contracted to launch NASA astronauts to the International Space Station, after SpaceX founder Elon Musk smoked marijuana and drank whiskey publicly. Musk's activities happened on "The Joe Rogan Experience" podcast in September 2018. 

"I will tell you, that was not helpful and that did not inspire confidence, and the leaders of these organizations need to take that as an example of what to do when you lead an organization that's going to launch American astronauts," Bridenstine told reporters during a news conference in Washington two months later, referring to Musk's actions. Bridenstine added that the workplace culture assessment would "ensure the companies are meeting NASA's requirements for workplace safety, including the adherence to a drug-free environment."

If NASA wants to be more proactive about workplace safety, the agency should also consider how astronauts deal with depression in space, not only how its workforce could be using drugs or alcohol on Earth. In a live broadcast from the International Space Station on Feb. 7, 2019, Canadian Space Agency astronaut David Saint-Jacques said, "The problem you develop here is that everything is a little bit the same every day. It can be depressing sometimes if you're not careful." 

Further increasing the risk of substance abuse disorders among astronauts, the medical treatment astronauts may receive for injuries sustained during spaceflight can also be addictive. For example, because back pain is common among astronauts, it is not uncommon for doctors to write an opioid prescription to treat this ailment.

Now, consider that more Americans die from opioid overdoses than car crashes. The Centers for Disease Control and Prevention (CDC) reports that 47,600 overdose deaths, or 67.8% of all overdose deaths in 2017, were due to opioids.

How we treat opioid addiction or polysubstance abuse, then, is crucial. Take, for instance, the use of ibogaine: a naturally occurring, plant-based psychoactive substance, which, along with medical treatment in general, can help reduce opioid addiction. While not available in the U.S., which is a separate matter involving law and politics, ibogaine is, in my opinion, a credible way to lessen or eliminate opioid dependency.

"While ibogaine treatment is an extremely effective solution for interrupting polysubstance abuse disorders, the full continuum of care is required to maintain lasting abstinence," said Dr. Alberto Solà, an emergency medicine physician and medical director of Clear Sky Recovery in Cancún, Mexico.

As a biochemist, I agree with Sola's statement. I also think NASA needs to focus more on astronauts' vulnerability to injury and opioid dependency, as the physical demands of training for a mission may cause or worsen back pain.

Between acknowledging the existence of a problem and treating it, between screening for alcohol and drug abuse and having a plan to help people who recover from addiction, NASA has a lot to do. Society has a lot to do, too.

Rather than firing or ostracizing workers who have chemical dependencies, all of us can take a giant leap to improve humankind. We can be more candid about addiction, without letting fear of rejection or reprisals hold us back. We can save lives, and offer hope, to those who need it, now more than ever.

• Cocaine Found in NASA Space Shuttle Hangar
• Spaceflight Can Be a Real Pain for Astronauts 
• Neil deGrasse Tyson Reminds Us Why Smoking Weed in Space Is a Bad Idea

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