Opioid Epidemic: Who is to Blame?

I have been reflecting for some time regarding how to discuss the ongoing opioid epidemic, particularly given that my family has been personally impacted by it. Then it struck me this week during my classes when I was talking about the science of addiction with my students how differently we have been socialized to approach prescription medication versus those that have been criminalized and have to be obtained illegally.

For instance, when I talk about how dangerous a drug like heroin is from the perspective of indicators of addiction (e.g. how quickly it triggers tolerance or withdrawal) students aren’t surprised. However, when we start talking about prescription medications like Xanax or OxyContin—which many of them are regularly prescribed or using—a somber mood takes over the class. That’s right, the only thing separating the heroin from the Oxy is that thin veneer of legitimacy afforded by the script, otherwise, the body—and notably, the brain—is reacting very similarly to both drugs.

Which brings me to the real focus of this post: namely, how different is the Sackler family, head of the pharmaceutical company Purdue, that made billions from producing OxyContin, and the cartels that produce similar amounts of money dealing in illicit drugs? To clarify, there have been a host of allegations of criminality linked directly to the Sackler family business, most notably that they deliberately disguised the severity of addiction of their product, in addition to pushing hard for doctors to prescribe more and more to their patients (e.g. Willmsen & Bebinger, 2019). There are also allegations that when the severity of the opioid epidemic was becoming apparent, executives explicitly sent internal emails developing a strategy to paint patients/users as to blame for their addictions, deflecting their own complicity in pushing these drugs on doctors and ultimately patients.

Thankfully, there are a number of class action lawsuits against the company, Purdue Pharma, which will potentially unearth the full scope of criminal acts engaged by Sackler et al., in the pursuit of profit over lives (tell me again how these people are different from the cartels again?). For instance, as reported by the Washington Post, “the company, well aware of its products’ addictive qualities, reportedly began exploring the option of selling addiction treatment drugs alongside its painkillers” (Gebelhoff, 2019, para. 6).

The web of responsibility for this epidemic, of course, is wider than one family, or even one pharmaceutical company. It does point to the dangers that come from a capitalist society when very little regulation is initiated so that profits trump all else. The numbers are stark, and they obscure an even uglier truth, which is that the hundreds of thousands of lives that have been lost to this epidemic don’t even account for the family members and loved ones who survive those who died and are left grappling for answers, and missing their loved ones.

More than 11 million people reportedly abused opioids in 2016, and if anything, such a statistic is likely an underestimate, as the stigma of being addicted to substances—whether prescribed or not—likely masks many users’ attempts for seeking treatment or likelihood to report their own abuse (“7 Staggering Statistics”, 2019). To further blur the lines between the illicit drug trade and the legal one, more than 40% of all opioid deaths in the U.S. in that same year was from prescription narcotics—which defies the Purdue statement alleging that this epidemic is largely fueled by heroin or other “street” drugs (“7 Staggering Statistics”, 2019). In fact, many heroin users start with prescription opioids and their use eventually escalates to that of heroin. More and more families and communities are being ravaged by this epidemic, and willpower alone is not even close to enough to help individuals who have developed addictions to become sober again.

This is happening in our backyards—literally, in this case, I want to share the story of a family in Bethesda, MD, close to where I grew up in a suburb outside of our nation’s capital. They lost their son, Jamie Werner, to this epidemic. Please take the time to watch this PSA that was created by Mental Health First Aid operated by the National Council for Behavioral Health, encouraging all of us to get trained in how to treat narcotics overdoses:

Our family has been lucky that one of our own didn’t also become a statistic to this epidemic, but countless families, like the Werner's, have experienced the ultimate loss. The Sackler family and other industries that relentlessly pursue profit without oversight or safety concerns regarding their users need to be held accountable.

In the meantime, what do I tell my students, who ask question after question, naming endless streams of pharmaceutical drugs that they have been prescribed and taken without knowledge of their potential addictive effects? I tell them that just because a drug is procured by a medical doctor doesn’t make it safe, and to consider alternative therapies for the conditions that these drugs, such as potent painkillers like OxyContin, are being prescribed to treat. And we talk in depth about the science of addiction and what it entails and how to gauge how severely addictive a given substance has the potential to be.

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Copyright Azadeh Aalai 2019