This country has a serious opioid addiction problem. The number of fatal overdoses from both prescription painkillers and heroin an hour died from an opioid overdose that year. Approximately 2.35 million Americans had diagnosable opioid addictions in America, according to the Substance Abuse and Mental Health Services Administration. Popular painkillers such as OxyContin, Vicodin and Percocet all are opioids and heroin is a stronger, more refined opioid.
Three facts, when all considered together, point to how America got this way. One is that over the course of the last two decades or so, pharmaceutical companies have aggressively promoted opioid painkillers. Two is that this push worked, because the number of prescriptions for opioids written every year is simply outrageous. (See section below titled A Bottle for Every Adult). Three is that 75% of heroin addicts begin with prescription painkillers, whether taken legally or recreationally.
No part of the country is safe from this epidemic. Everywhere you turn, there are horrifying news stories about opioid overdoses and how opioid addiction is rampant. In Oregon, over half of overdoses involve prescription painkillers, and the state sees more than 500 people overdose every year. Republican presidential nominee Donald Trump, in a speech given on September 29th in Bedford, New Hampshire, told the crowd “They said the biggest single problem they have up here is heroin. More than any place, this state, I’ve never seen anything like it…” said Trump.
In Colorado, a golden retriever nearly died from consuming heroin thrown over a fence into a dog daycare, presumably by someone being chased by police. This September, 28 opioid overdoses occurred in the city of Huntington, West Virginia in a four-hour span. Even in Hawaii drug overdose deaths rose 83% from 2006 to 2014, creating the island chain’s own opioid epidemic. Every corner of the country is being affected.
From Prescriptions to Needles
Three out of every four heroin addicts began with prescription pills, as mentioned previously. Some used the pills recreationally and graduated to heroin, but many others simply substituted heroin for the painkiller they were legally prescribed. In a 2014 report by Al Jazeera on opioid addiction, several members of a heroin treatment center were interviewed. One unnamed man’s story is eye-opening: “I was hurting so bad that I ended up punching a four-by-four, breaking… three fingers… to get pain meds from my doctor. I’d do that several times.”
At that point in the interview, another man speaks up, stating how he’s heard of people deliberately taking a baseball bat to their wrists just to get more opioids from their doctors. Several of the people being interviewed chime in, saying how heroin is much cheaper than the prescriptions fueling their addictions.
A Bottle for Every Adult
There are far too many painkillers floating around this country. Vivek Murthy is America’s current Surgeon General, and he is well aware of America’s opioid epidemic. Just a couple of months ago, every doctor in America received this letter from Murthy, explaining how the nation is in crisis regarding opioids, and recommending more careful prescribing methods. During a speech on the topic, Murthy revealed an astonishing truth regarding prescriptions in the US. “We have currently nearly 250 million prescriptions for opioids written every year. That’s enough for every adult in America to have a bottle of pills and then some.”
More opioid prescriptions are written annually in America than there are people in Canada, Italy and Japan combined. However, it wasn’t always like this. In fact, starting with the drug war in the 60s and 70s, doctors became more and more skeptical of prescribing opioids. The term ‘opiophobia’ was even coined in the early-to-mid 1990s, referring “to a phenomenon in which exaggerated concern about the risks associated with opioids prevent appropriate medical use of opioid analgesics,” according to the Pain & Policy Studies Group.
It was in the late 90s that big pharmaceutical companies began excessively pushing opioid medication, especially the company Purdue with their drug OxyContin. From here, the story of how big pharma, the medical industry, and the pure nature of addiction created an epidemic begins.
OxyContin, and how the Medical Community was Duped
Part of the opiophobia was exaggerated, due to the drug war being waged by the country, but a part of it was also based in truth. Doctors were fearful of prescribing opioids because they thought it would lead to addiction. Originally, these opioid medications were reserved for patients with severe pain, say, from cancer or another life-threatening disease. However, with the push from companies like Purdue Pharma, opioid medication not only began to get prescribed again, it began to be given to patients for all types of pain, not just severe chronic pain.
OxyContin first hit the market in 1996. The opioid was heavily marketed by Purdue. As a part of the sales pitch, Purdue manufactured hats, swing music CDs, and even a gorilla plush toy. HBO Last Week Tonight host John Oliver can be seen with this plush toy during a segment the show did on the opioid epidemic recently. Purdue even went so far as to make promotional videos for OxyContin, clips of which can also be seen in the Last Week Tonight episode. It gets worse from here.
Purdue’s first promotional video for the opioid was released in 1998, called I Got My Life Back. The film featured seven people whose lives had changed for the better due to an OxyContin prescription. One charming grandmother says in the video that her relationship with her grandchildren has grown because of the drug’s pain-relieving effects.
Another promotional film released by Purdue around this time was called From One Patient to Another, and one particular claim made in the video is bewildering. The narrator says, “Less than 1% of patients taking opioids actually become addicted.” Not only has time and science proven this to be completely untrue, the source of the claim is shoddy at best. Taken from a letter to the editor of the New England Journal of Medicine by the Boston Collaborative Drug Surveillance Program (BCDSP), the ‘fact’ is not peer-reviewed and only regards one hospital’s findings. The BCDSP simply observed 11,882 patients over time, finding “four cases of reasonably well documented addiction in patients who had no history of addiction.”
Through these widely publicized videos, Purdue Pharma told doctors nationwide that opioids are not addicting, and based its information on one research team’s letter to the editor of a medical journal. They also told the American public that pain can be relieved (and life can be better) with a prescription for OxyContin.
The OxyContin Crisis: Precursor to the Modern Epidemic
The advertising worked. In its first year on the market, OxyContin yielded $45 million in sales for Purdue. They had a hot item, and seemingly every doctor wanted in. The crisis began to form once people began getting addicted to OxyContin.
In 2001, an article was published by the Associated Press regarding OxyContin abuse in Appalachia (a multi-state region on the eastern seaboard). The article tells the story of multiple West Virginian young adults losing the battle with OxyContin. One 18-year-old girl shot herself in the head when she couldn’t find more. Some girls in the area were prostituting themselves for the drug. Kristen Rutledge, interviewed in the article, says she would lie to her father and say drug dealers were threatening her, in order to get more money for OxyContin, which her and her friends called ‘hillbilly heroin.’
It’s not Addiction, it’s just Pseudo-addiction
Around this time, OxyContin-related deaths and overdoses were springing up across the country. In 2002, the New York Times reported how OxyContin deaths were higher than previously thought in 32 US states. Of course, Purdue Pharma became aware of this spreading crisis, and in another highly publicized video, the company’s own Dr. Alan Spanos explained what was really going on: “Pseudo-addiction is when a patient is looking like a drug addict because they’re pursuing pain relief,” said Spanos. “It’s relief-seeking behavior mistaken as drug addiction.”
Doctors with a lot of patients and not a lot of time were attracted to the idea of a non-addictive painkiller. By 2000, OxyContin sales rose to $1.1 billion and over 6 million prescriptions were being written annually. For the first half of the decade, doctors handed out OxyContin like candy to people with all degrees of pain, and more and more people became addicted.
Then, in 2007, it all came crashing down.
Caught in a Lie
In Guilty Plea, OxyContin Maker to Pay $600 Million read the headline of the New York Times business section on May 10, 2007. The article explains how Purdue Pharma misbranded their drug OxyContin, pleading to “criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.” The total amount of all fines paid was $634.5 million, which is an awful lot for what is essentially false advertising. Obviously an incredible amount of damage was already done.
Purdue was not the only pharmaceutical company to be exposed for such wrongdoing. The next year, Cephalon, Inc. was brought up on charges of promoting drugs for uses unapproved by the Federal Drug Administration. They had to pay $444 million in fines and also enter into a corporate integrity agreement to disclose their payments to physicians.
The most shocking instance of a pharmaceutical company lying to the public involves Insys and their fentanyl-based product Subsys. A former manager and a former sales rep were both arrested on anti-kickback charges. “The two former Insys employees are accused of making payments to doctors as part of what officials call a ‘sham’ educational program to prescribe millions of dollars’ worth of the fentanyl spray to patients,” according to the article by HG. This is scary stuff,
The Epidemic Continues
Zoom ahead to the year 2008. Two of the seven people featured in Purdue Pharma’s 1998 promotional video died from opioid abuse, and a third claimed that losing her health insurance saved her life. When she had the insurance, OxyContin was being delivered to her. “I lost my house. Oh yeah, I’ve lost cars. I lost a lot,” she said in an interview. Once the insurance was gone, so was the drug, and she believes that saved her life. The level of irony is unbelievable.
Still the drug continued to flourish. By 2010, OxyContin single-handedly accounted for 30% of the painkiller market. The year 2014 set the all-time high for drug overdoses in the US, and opioids played a major role.
The Centers for Disease Control (CDC) has recently issued a guideline for the safe prescribing of opioid painkillers for patients with chronic pain. The CDC first recommends using non-opioid therapies, attempting to avoid opioids altogether. However, because opioid medications are the perfect solution for those who actually need them, the CDC recognizes that these non-opioid therapies will not work for everyone. If opioids become necessary, the CDC recommends doctors “start low and go slow.” This means prescribing a lower dosage and for less time.
Dr. Anna Lembke of Stanford University believes these guidelines are not applicable to the whole country. “It’s easy to say ‘use non-opioid alternatives,’ but in a lot of rural areas, patients don’t have access to things like physical therapy and mindfulness meditation, and insurance companies won’t pay for it.” Her point is valid. In a country with 250 million opioid prescriptions, her point becomes truth.
Opioid medication suppliers are in no hurry to slow their sales down. In fact, a new drug is currently being marketed that counteracts the constipation associated with opioid medication use. (It was even advertised during this year’s Superbowl). There will likely be no shortage of opioid painkillers in America anytime soon. However, simply removing the drug from existence would create more problems than it would solve. Many people legitimately rely on opioid medications for a pain-free life.
What we need is more funding to treatment centers, and more availability of Naloxone, an anti-overdose drug that saves thousands of lives. Substance abuse treatment facilities only reach 10% of those that need treatment. For those already addicted, Naloxone can save their lives. In many cases, it already is.
In a documentary called Death by Fentanyl, a Revere, Massachusetts fireman is interviewed about Naloxone. What he says actually says it all. “We tend to have more overdoses than we do fires, so it’s a piece of equipment we can’t go without now.”
What we can go without is a nation plagued by opioid addiction.