America’s Opioid Abuse Epidemic
TV3, the Irish television channel, has been running a series called Doctor in the House. In March 2017 it featured the Reilly family who were all on the verge of diabetes and heart disease. All became low risk in a short space of time by a change in diet and lifestyle but without medication. Another interesting event was that the father of the family took Solpadeine (opioid) painkillers every day for his headache. He decided to give them up as part of his new health regime. To his – and everyone else’s – surprise, the headaches ceased. In other words, the painkillers were causing the pain.
This is only a minor effect of habitually taking painkillers. Currently in the US they are causing a huge pain by being addictive and leading to addiction to more serious drugs like heroin and causing death. So many white men are dying from opiate painkillers that the life expectancy of white men in America has reduced. In fact so many of them are dying that it has reduced the life expectancy rate overall. Ironically the problem, called “opidemic”, is caused by doctors prescribing opioid painkillers, often starting the addiction among teenagers.
Mr Reilly was caught in a drug-induced trap: the painkiller created the need to take it – like cola drinks making people thirstier. This trap has become a huge problem in the US over the last decade.
Opidemic – the Problem in Numbers
America is experiencing an epidemic of addiction to or abuse of opioid painkillers, known as the “opidemic”.
The opidemic has been prevalent among teenagers. In 2015 some 8% of teenagers abused opioid drugs according to a University of Michigan study, reports Bahar Gholipour for LiveScience. Increasing numbers of children are being admitted to hospital and experts blame overprescribed medications. Hospitalisation among 15-19 year-olds was up 176%, opioid prescriptions quadrupled generally since 2000 and new research, according to Gholipour, says teens who abuse opioids (an opioid is a synthetic drug that mimics opium) first got them from a doctor. In 2009, 11.7% of 202 million opioid prescriptions were for children. The abuse by teens may have decreased since 2013-2015 though it’s not known why. (At the same time it has got worse generally, as shown below).
Transitioning to heroin
The problem doesn’t end there. Much research has shown that abuse of opioids leads to heroin addiction. For example, Rachel Rettner quotes a study which claims: “About 85 percent of the teens said they abused opioid painkillers, which include Vicodin and OxyContin , before trying heroin. On average, the painkiller abuse started two years before heroin use.” And in a more recent article by Rettner: “Painkiller Abuse Tied to Skyrocketing Heroin Use in US,” she writes:
The findings highlight the strong relationship between heroin and opioid painkillers. Health officials say opioid abuse is one of the main drivers of the rapid increase in heroin use in recent years. Use of the drug in the United States increased more than 60 percent between 2002 and 2013.
Recent studies make similar claims; “The majority of new heroin addicts begin with a dependence on prescription painkillers, before transitioning after building high tolerances that make the pills too expensive. Heroin use among U.S. teens more than doubled over the past 10 years.¹ Officials with the Drug Enforcement Administration say four out of five heroin addicts started with painkillers” (Steve Birr, Daily Stream) and “Researchers looked at trends in the use of prescription opioids among U.S. adolescents from 1976 to 2015. They found a strong correlation between teens’ taking the drugs for medical reasons and then later taking them for ‘nonmedical’ reasons…” (Gholipour)
The numbers keep growing
Deaths generally from opioid abuse are growing. In 2013-14 the death rate increased by 6.4% nationally but some areas more so. In North Dakota it was up by 125%.
Further, deaths from the powerful synthetic opioid Fentanyl, from which the singer Prince died, and other synthetic opioids (excluding methadone), had large increases.
Six states had a combined death rate from Fentanyl of 392 in 2013 increasing to 1,400 in 2014, according to Rettner in her 5 Startling Facts about America’s Opioid-Use Epidemic.
David Brooks in the New York Times, writing this year (April 2017: Let’s Go for a Win on Opioids) quotes the Washington Post says the death rate is getting worse. In Stark County, Ohio, for example, opioid-related deaths have increased by 20% this year alone – “The county just asked the state to send over cold storage because the morgue is already full”!
In 12 states, he continues, there are more prescriptions than people.
How the Opioid-Abuse Epidemic Evolved
Gholipour says that according to the National Institute on Drug Abuse, the US consumes 80% of the world’s prescription opioid supply, rising from 26 million prescriptions in 1991 to 207 million in 2013. Many deaths are due to accidental overdoses – about 3,000 in 1999 increasing to 12,000 in 2007 and in the decade to 2011 there was a fivefold increase in people admitted to substance abuse programmes for opioid addiction.
According to Rachel Rettner at LiveScience.com, in 2009 research showed 56% of opioid prescriptions went to people who had a prescription the previous month and not all of them may be justified, she adds, quoting Thomas McLellan, director of the Center for Substance Abuse Solutions.
In her 5 Startling Facts, she writes, “… In 2014 at least half of the 28,000 deaths from opioid overdoses involved a prescription opioid, according to the Center for Disease Control.
Steve Birr says the number of deaths in 2015 was a record 33,000. Statistics can vary. Rettner refers to the Drug Enforcement Administration: In 2013, 46,471 died from overdoses compared with 35,369 from car accidents.
The number of prescriptions in 2010 was four times that in 1999 (American Society of Addiction Medicine). In 2012, 259 million opioid prescriptions equated to one for every American adult.
Revival in opioid acceptance
Christopher Caldwell reckons the problem began as a consequence of Reagan economics. Reaganism gave real power to corporations, he claims in his First Things essay American Carnage, but only rhetorical power to communities, so when the interests of both clashed, the corporations won.
The pharmaceutical industry has always exploited its position and aggressively sought to satisfy shareholders. Caldwell himself gives such an example. Drug companies have constructed a new medical condition – pain – whereby pain became a disease rather than an expression of it. As a consequence “pain centers” were endowed, the American Pain Society led an advertising campaign calling pain the “fifth vital sign” (after pulse, respiration, blood pressure and temperature). Today, more than a third of Americans are prescribed painkillers every year, he says.
Opioid Abuse – the Politics, Culture and Economics
In the twentieth century, Caldwell says, opiates and opioids were largely taboo being restricted to cancer patients and end-of-life care due to their addictiveness and dangerousness. Previous generations had obviously learnt a lesson. So how did the change occur? He tells us:
But two decades ago, a combination of libertarian attitudes about drugs and a massive corporate marketing effort combined to instruct millions of vulnerable people about the blessed relief opioids could bring, if only mulish oldsters in the medical profession could get over their hang-ups and be convinced to prescribe them. One of the rhetorical tactics is now familiar from debates about Islam and terrorism: Industry advocates accused doctors reluctant to prescribe addictive medicines of suffering from “opiophobia.”
And then Big Pharma, lying in wait, attacked under this guilt-inducing cloak:
In 1996, Purdue Pharmaceuticals brought to market OxyContin, an “extended release” version of the opioid oxycodone. (The “-contin” suffix comes from “continuous.”) The time-release formula meant companies could pack lots of oxycodone into one pill, with less risk of abuse, or so scientists claimed. Purdue did not reckon with the ingenuity of addicts, who by smashing or chewing or dissolving the pills could release the whole narcotic load at once. That is the charitable account of what happened. In 2007, three of Purdue’s executives pled guilty to felony misbranding at the time of the release of OxyContin, and the company paid $600 million in fines. In 2010, Purdue brought out a reformulated OxyContin that was harder to tamper with. Most of Purdue’s revenues still come from OxyContin. In 2015, the Sackler family, the company’s sole owners, suddenly appeared at number sixteen on Forbes magazine’s list of America’s richest families.
But why has the problem got worse and not been properly addressed? Caldwell already referred to the liberal attitude being a problem and Gillian Tett in the Financial Times makes a similar reference. In The drugs that kill more than pain she says:
But unlike the HIV epidemic back then, the opiate problem has not (yet) sparked mass outrage and concern. Yes, Utah has erected those billboards but there have not been any celebrity rallies or global media campaigns. And while some state-level politicians are focused on the problem and are unveiling bipartisan strategies, Hillary Clinton barely mentioned the issue during her own campaign last year.
Indeed, one of the few national politicians who has talked about the issue at all in recent years is Donald Trump. He cited the problem as proof of America’s demise, a factor that some political pundits think helped him to win support in rust-belt areas, particularly places with some of the worst opiate problems.
Why have politicians been so slow to act? One reason is that opiate addiction is often viewed as a self-inflicted social disease. Another reason is that it is prevalent in poor, white communities, places (as the recent election shows) that the liberal elite has often ignored.
Again, the issue comes back to a problem of culture and drug companies:
But the real elephant in the room is the fact that the whole cultural concept of “drugs” is deeply complicated — if not downright contradictory. Heroin is illegal in the US, and the very idea of it tends to inspire horror, but the pharmaceutical and medical industries are allowed to sell high-potency opiate drugs — which can have similar effects to heroin — to control pain, with precious few restrictions. (Tett)
Brooks, in the New York Times also gives credit to Trump. “To his credit Trump has already launched a commission to see how federal government can tackle the crisis.” Writing in an anti-Trump, pro-Clinton paper Brooks makes the empty claim that an anti-opioid push would be a viable step.
The Solution to Opioid Abuse
Real science, real language
For Caldwell the answer is restricting access. But surely doctors and drug companies need to be reined in? With drug companies advertising drugs as frequently as ads for toothpaste, giving the impression drugs are like nutrients, essential for optimum health and functioning, creates a drug culture. And with doctors having shares in drug companies (80% have shares in Pfizer), it’s likely patients will come out of a consultation with a prescription. A huge problem, Caldwell says, is that treatment is not scientific but political. He says the terminology used to address the issue has been changed, now employing preciously politically correct language:
The culture of addiction treatment that prevails today is losing touch with such candor. It is marked by an extraordinary level of political correctness. Several of the addiction professionals interviewed for this article sent lists of the proper terminology to use when writing about opioid addiction, and instructions on how to write about it in a caring way. These people are mostly generous, hard-working, and devoted. But their codes are neither scientific nor explanatory; they are political.
The director of a Midwestern state’s mental health programs emailed a chart called “‘Watch What You Call Me’: The Changing Language of Addiction and Mental Illness,” compiled by the Boston University doctor Richard Saltz. It is a document so Orwellian that one’s first reaction is to suspect it is a parody, or some kind of “fake news” dreamed up on a cynical website. We are not supposed to say “drug abuse”; use “substance use disorder” instead. To say that an addict’s urine sample is “clean” is to use “words that wound”; better to say he had a “negative drug test.” “Binge drinking” is out—“heavy alcohol use” is what you should say. Bizarrely, “attempted suicide” is deemed unacceptable; we need to call it an “unsuccessful suicide.” These terms are periphrastic and antiscientific. Imprecision is their goal. Some of them (like the concept of a “successful suicide”) are downright insane. This habit of euphemism and propaganda is not merely widespread. It is official. In January 2017, less than two weeks before the end of the last presidential administration, drug office head Michael Botticelli issued a memo called “Changing the Language of Addiction,” a similarly fussy list of officially approved euphemisms.
Should Cannabis indica (or Cannabis sativa), marijuana, be part of the opidemic solution? Is it just swapping problems? In the UK it has been claimed that six out of every seven patients with psychosis are psychotic due to marijuana. Will it be better than detoxing heroin addicts with a lifetime of methadone? Or is it better to do the Trump thing and give them a job with a sense of pride at the end of each day, improve their environment and create community?
The problem is bad enough but when one considers opioids don’t do what they are often prescribed for, according to three Australian studies, it all starts to seem quite dystopian.
¹Which means it began during the last two years of Bill Clinton’s presidency and grew exponentially during the Obama presidency.
Research by two eminent economists confirms the reducing life expectancy of white Americans: Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century by Anne Case and Angus Deaton