Today, nearly every adult in the U.S. has been affected in some way by the opioid epidemic.
Almost everyone knows someone — a friend, a family member, an acquaintance — who has struggled with opioid addiction or even died of an overdose. Many have seen opioid addiction ravage their community, tear families apart, and turn kind people on the road to desperation, addiction, and despair.
The widespread impact of the opioid problem has shattered some aspects of the stigma attached to drug addiction and substance use. No longer can those struggling with addiction be cast aside as nameless “addicts” or criminals on the outer edges of society.
They are sons and daughters, parents, and neighbors — proof that addiction knows no bounds and can affect people of all ages, upbringings, and socioeconomic levels.
This has allowed for a further understanding of — and a more honest discussion about — addiction and recovery. Rather than hide their child or spouse’s substance problem, people may be more likely to seek help and support from others in similar situations or a treatment center.
As more people recognize the seriousness of the problem and try to put an end to the epidemic, offering support to individuals and families dealing with opioid addiction, many in communities across the country are left wondering how we got here.
When it comes to who is to blame for the opioid crisis, the public is often split. Some think the big pharmaceutical companies who pushed their opioid drugs bear the blame, while others blame the doctors who prescribed these drugs to patients looking for relief.
The U.S. has experienced many drug epidemics in its time — a heroin epidemic in the 1980s, a cocaine and crack epidemic in the 1980s and 1990s, and a methamphetamine epidemic that began in the 1990s and is now perhaps getting worse.
The U.S. is currently experiencing an ongoing opioid epidemic. In the late 19th century, it’s estimated that more than 300,000 people were addicted to injected morphine or smoked opium.
The country has never experienced anything quite like the current opioid crisis. It is already the deadliest drug epidemic in American history, killing tens of thousands of people every year.
Opioids are a class of drug that produces a variety of effects in the brain. They are believed to block pain signals from the brain to the body.
Opioids can be prescription drugs (usually called painkillers) or street drugs, like heroin. In addition to affecting pain signals, opioids make users feel high and relaxed. Users quickly develop a tolerance to and physical dependence on opioids, making them highly addictive.
The most commonly used opioids are prescription opioids (painkillers like OxyContin and Vicodin), the street drug heroin, and fentanyl (an incredibly strong and dangerous illegal synthetic drug that’s 50 to 100 times more potent than morphine).
The opioid problem in the U.S. is huge and complex. Many factors have contributed to it becoming the deadliest drug epidemic in American history. Some events surely shaped the crisis and helped to explain how the situation spiraled out of control.
According to a 2019 AP-NORC poll, about 46 percent of participants blame doctors and dentists for the current opioid crisis.
Of course, many doctors dispute this logic, insisting they were also unaware of the dangers of prescription opioid painkillers like OxyContin. They claim they were misled by the pharmaceutical companies, particularly Purdue Pharma who marketed OxyContin as a safer alternative to many other types of painkillers.
Some doctors also point to the pain-related patient advocacy movement in the 1990s that called for more aggressive pain treatment and pain relief standards. The advocates for this movement — which perhaps began with a 1990 editorial in Annals of Editorial Medicine by Dr. Mitchell Max, the president of the American Pain Society — expressed disappointment in the medical community’s lack of progress or focus on pain management. Advocates for aggressive pain management asked that pain be treated as a “fifth vital sign.”
Within a year, the American Pain Society had issued guidelines for pain management and related bills passed in Congress. By 2000 (well after OxyContin’s release), mandatory pain scales were used in certain areas of health care, sometimes requiring an “acceptable” pain score for release. The standards suggested using a numerical scale based on patients’ self-reported pain.
Many doctors claim this movement put them in conflict. Some feared their patients would become too dependent on opioids, but they were at risk of violating pain guidelines or patients’ rights if they were to try to limit access to painkillers.
While these explanations may sound reasonable, other aspects and statistics related to doctors’ roles in the opioid crisis raise more questions.
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The 2019 AP-NORC poll found that a majority of Americans (63 percent) placed blame on the pharmaceutical companies for the opioid epidemic. According to a 2019 poll from National Public Radio (NPR), about 70 percent of respondents think pharmaceutical companies should cover the costs of addiction treatment and naloxone, a drug used to revive individuals after an opioid overdose.
It’s not hard to see why. As discussed above, drug companies — particularly Purdue Pharma, the makers of OxyContin — have paid out millions in “marketing” to doctors. Purdue Pharma has already paid hundreds of millions for fines related to lying and misleading the public, patients, and doctors about their drug.
In 2007, the company and its top executives pleaded guilty to a felony related to the false marketing of OxyContin, even confessing to directing their sales team to tell doctors that the drug was less addictive than other opioids.
There is further evidence of the pharmaceutical company’s role in the opioid epidemic.
There is overwhelming evidence that drug companies, particularly Purdue Pharma, repeatedly and knowingly lied to doctors, patients, and the public about the dangers of their most profitable drugs to boost sales, even as it became clear that a deadly epidemic was underway. Because of this, it’s hard not to conclude that these pharmaceutical companies are perhaps more to blame than anyone for today’s deadly opioid epidemic.
However, when looking at the amount of money doctors received from these drug companies — and the direct connection between the number of opioid prescriptions written by a doctor and the amount of “marketing” payments received from the opioid manufacturers — it’s clear that some doctors also bear a large portion of the blame.
It’s particularly bleak when considering the trust many have in their doctors, who have taken an oath to serve their patients, not their bank accounts or a drug company.
Even if they were misled by the drug companies, could they not see the levels of addiction rising? One has to wonder whether their marketing payments from drug companies helped them to turn a blind eye.
Perhaps the larger question here is, “Why are drug companies like Purdue Pharma allowed to market dangerous drugs to doctors using payments?”
Are payments really marketing? Or are they payoffs? Should a doctor be deciding what drugs to prescribe based on marketing payments from a drug company?
Based on what we’ve seen during the devastating opioid epidemic, there needs to be a reassessment of how opioids are prescribed and how pharmaceutical companies motivate doctors to choose their meds.
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