Complicit: Doctors, The Medical Industry, and the Exploding Opioid Epidemic
A “public health crisis” involving America’s opioid epidemic was declared this year, something long overdue if you look at the statistics. “Front line” doctors, pharmacists, and others with patient-facing contact had started sounding the alarm more than a decade ago. How did we, as a nation, get to the point where hundreds of Americans are dying or getting hospitalized every day from opiate-related causes, many of which involve black-market heroin? One ominous theory growing in popularity is that complicit healthcare and regulatory industries, nudged forward by pharmaceutical companies, are largely to blame.Take, for example, Oxycontin—a blockbuster drug when it came out. Perdue, the company responsible for its invention, also revolutionized modern drug marketing in the late 80s and 90s to gain the trust of doctors and insurance companies everywhere, while making itself a pile of money in the process. Unless the user is suffering pain from end-of-life cancer or a major operation, Oxycontin provides a powerful and extremely addictive high. Needless to say, it proved to be a popular drug. Even after it had to be modified to reduce the risk of abuse, the company maintained that the drug was safe. Meanwhile, Perdue continued to take doctors to lavish conferences and lobby the government for friendly regulation.
“Do No Harm” and Pain
The main problem with treating pain is that it is completely subjective. Healthcare providers have no other way to measure pain beyond observed behaviors and the patient’s own description. Medical training since the time of Hippocrates has emphasized “do no harm”—including the duty to ease pain. Opioid-derived treatments are an effective way to to temporarily do this, something also known since ancient times. Administering pain medications to sufferers of serious injuries or illness is the correct thing to do, but clinicians have also known since ancient times that poppy-derived medicine can be very addictive. In the past, the balance between treating pain and considering the potential for addiction was left to doctors’ individual discretion. This balance has been disturbed in a variety of ways in the last few decades, and now America is suffering the consequences on a truly epidemic-level scale.The rise of a powerful pharmaceutical industry, combined with changes in the US healthcare system that have left doctors with higher caseloads and increasing fears of medical malpractice, are two of the most powerful factors that got us to the present crisis. Doctors began prescribing more narcotic painkillers (that were aggressively marketed to them) as an easy and fast way to address pain. At the same time, costly medical malpractice lawsuits were on the rise—and their cause could include failing to adequately address pain. Finally, there was an economic downturn that caused job and housing losses, and the number of Americans claiming disability for chronic pain exploded into a perfect storm – today’s opioid epidemic.
Addictive Prescription Painkillers
While many doctors were well-intentioned, “pill mills” also began to spring up. At these offices, doctors were making plenty of money doing little else than writing thousands of prescriptions for oxycontin and other narcotics per month. Pharmacy companies profited enormously, and some of these profits went back into lobbying both government agencies and insurance companies to embrace these drugs while turning a blind eye to the potential dangers. Although this cynical marketing of painkillers debuted in the 90s with Oxycontin, a recent report found that as late as 2012, this was happening with a new Fentanyl-based drug called Subsys.Fentanyl was another blockbuster for pharmaceutical companies; superstar Michael Jackson even died from an overdose of it in 2009. There was grief, but still no grand acknowledgement of America’s simmering prescription drug problem in America from ruling bodies like the American Medical Association. However, starting in about 2010, public health experts and law enforcement—the agencies who saw first-hand what was happening—began to lead the pushback. Laws were passed that cracked down on pill mills, but medical associations and the FDA still moved slowly to get behind the cause. It took a few years, but laws and policy changes involving narcotic pain medicine started to work, and pill mills began to disappear. Painkillers became harder to get, and doctors’ and pharmacies’ roles in the situation shrank. Unfortunately, this only turned the fire they’d started into an inferno.
The Rise of Heroin
Heroin—a blackmarket, unregulated drug—quickly emerged as a quicker, cheaper alternative for opiate addicts everywhere. Fentanyl can be manufactured instead of having to be grown and processed, so it’s a very cheap way to “cut” opium-based street heroin while boosting its potency. Fentanyl and other synthetic opioid additives (including drugs meant for elephants) have made heroin an even more profitable drug to sell, while killing an astounding amount of addicts in the process.
The Opioid Epidemic
If you chart the numbers of legal narcotic painkillers prescribed, heroin use, and death over the last twenty years, you can clearly see where the sides flipped. Legal prescriptions peak in 2010-12, and heroin use starts growing in 2012-13 as the legal gateways to these drugs dry up. Overdose deaths have been rising steadily since the beginning of the Oxycontin era, but as street opioids have taken their place, overdose deaths have increased markedly in the last five years.Ironically, as pharmaceutical company and doctors’ roles in the opioid epidemic faded, the “low skilled” health providers—EMS and police—became the front line responders. Now that the sheer number of opioid/opiate overdoses is destroying entire communities, and the subsequent cost of treatment (including the expensive drug naloxone) is bankrupting local governments, America’s “problem” is finally being acknowledged. How did we get here? Doctors and politicians alike stayed complicit for too many years, ignoring red flags and ominous trends in favor of fast treatment and profit, leading Americans to the full-blown opioid epidemic we now face.Treating addiction to opiates is a complicated, time intensive process that is best done with a dedicated treatment team that includes long-term support and therapy. To succeed, the most devastated communities may need entirely new medical and behavioral health treatment infrastructure. Bigger questions have arisen, too: how will a whole lost generation learn to be productive again? How will communities get back what they’ve lost? The bottom line is that the behavior of powerful pharmaceutical companies and the complicit attitude of many medical establishments have cost many Americans everything. The road out of this opioid epidemic disaster will require the help of the medical community, but with the precise opposite of the attitude that created it. Opioid addiction needs to be faced head-on, and dealt with quickly, even if the solutions are complicated.