Across the United States today, nearly every adult has been touched in some way by the opioid epidemic. It is safe to say that almost everyone knows someone- whether it is a friend, family member, loved one, or acquaintance- who has struggled with addiction to opioids or even lost their lives to overdose. Many people have watched as the challenges that stem from opioid addiction have torn apart communities and families.
The impacts of the opioid epidemic are not restricted to any one state or community. The problem is widespread and touches nearly every corner of the United States (and far beyond). For proof that addiction knows no bounds, one only needs to look to their local surroundings. The effects of addiction have touched people of all ages, socioeconomic levels, upbringing, race, and religion.
If there is a blessing to the widespread and pervasive nature of the opioid crisis, it is that there has been a renewed furtherance of understanding regarding addiction and recovery. There has also been much more open and honest discussion about how significant the effects of addiction and opioid use are on individuals, families, and their communities. Today, rather than hide their child’s or spouse’s addiction, people may be more likely to seek out help and support from others who share similar situations or from a treatment center like The Hills that specializes in addiction treatment.
As more people understand the seriousness of the epidemic and move to take steps to end it, many individuals and communities are left to ask how and why we got to where we are. When it comes to placing blame for the opioid crisis, public opinion is largely split. Some choose to place blame on the pharmaceutical companies (“Big Pharma”) who are thought to have pushed opioid drugs out into society. Still, others blame the doctors who prescribed these drugs (sometimes on a continual and long-term basis) to patients who were seeking relief from pain.
To better understand how we got to where we are today, it may be beneficial to take a brief look at the past drug epidemics that have impacted the United States.
Past drug epidemics in the United States
The current opioid epidemic is not the first time the United States has struggled with widespread and pervasive drug issues. There have been several others leading up to today.
In the 1980s, the United States struggled with three separate epidemics related to drugs. Beginning in the early 1980s, the United States saw a staggering rise in addiction to heroin and cocaine. In addition, the use of crack also escalated. The crack epidemic continued into the 1990s, which also saw the rise of methamphetamine use. There is a question today regarding whether the methamphetamine epidemic was gotten better or worse in the last twenty years.
The country has never experienced anything quite like the opioid epidemic we currently face. It is already the deadliest drug epidemic in American history. The death toll from the current opioid crisis continues to rise, killing tens of thousands of people each year.
What are opioids?
Opioids are a class of drugs responsible for producing a variety of effects in the brain. They are believed to block pain signals from being received by the brain when sent from different areas in the body. Opioids can either be prescription medications (generally known as painkillers) or street drugs such as heroin. In addition to blocking pain signals, opioids can also cause feelings of intense relaxation and a “high” that inhibits the feeling of certain emotions. Unfortunately, users quickly develop a tolerance to and a physical dependence on opioids, which makes them highly addictive.
The most commonly used (and abused) opioids are prescription medications such as OxyContin and Vicodin as well as the street drugs heroin and fentanyl. Fentanyl is an incredibly strong synthetic drug that is between fifty and one hundred times more potent than morphine, making it highly dangerous.
Are doctors to blame for the opioid crisis?
According to a survey conducted in 2019, almost forty-six percent of people blame doctors and dentists for the current opioid crisis. Many doctors are quick to dispute this accusation and insist they, like their patients, were unaware of the dangers of prescription pain medications such as OxyContin. Doctors state they were misled by pharmaceutical companies who marketed OxyContin as a safer alternative to many other previously prescribed pain mitigation medications.
Some doctors also point to the pain-related patient advocacy movements, which were prevalent in the 190s and called for more aggressive pain treatment and pain relief standards for patients. The advocates for this movement expressed vocal disappointment in the medical community and its lack of progress and focus on pain management. Advocates for pain management in a more aggressive form asked (and demanded) that pain be treated as the “fifth vital sign” when doctors were speaking with their patients.
Within a year, the American Pain Society had issued new guidance for pain management, and related bills were pushed through Congress. Within a decade, mandatory pain scales were used on specific areas of health care which is why you are now presented with questions asking about your “pain on a level from 0-10” or your children are given a photo card with happy and frowning faces to help explain their current pain level.
Many doctors raise concerns that this movement and the associated bills passed through Congress put them in a position of conflict. Some doctors feared (and rightly so) their patients would become too dependent on opioids, but they were at risk of violating pain mitigation guidelines or patients’ rights if they were to refuse to prescribe them or to try and limit access to pain medications.
While these explanations have a ring of reasonability to them, other factors such as statistics related to doctors’ roles in the opioid crisis raise additional questions.
In 2019 a study found there was a direct association between OxyContin marketing and payment to medical providers and opioid overdoses. The study showed that countries where OxyContin was heavily marketed to doctors, with doctors receiving payment, experienced higher overdose rates, even when researchers controlled for other potential influences. That same study also found nearly 475,000 payments totally almost $40 million to 67,500 physicians. That averages out to roughly one in every twelve doctors and one in five family doctors having received these “marketing” payments.
In recent years as the opioid epidemic rages, there has been an overall reduction in opioid prescriptions across the country. However, today the prescription rate remains triple what it was in 1999. During a period of peak opioid over-prescription, “pill mills” (doctors and medical practices prescribing opioids for a fee without qualifying patient problems) became a widely known problem and a clear indicator of doctors’ corruption and involvement in the opioid crisis. On average, doctors whose volume of opioid prescriptions were in the top five percent nationwide received about twice as much in “marketing” from opioid companies as their counterparts who were in the median area of prescriptions.
While the above information tends to point the finger squarely at doctors as a leading cause of the opioid crisis, we also need to consider how drug companies factor into the picture.
Are drug companies to blame for the opioid crisis?
The same 2019 poll mentioned above found that the majority of Americans (roughly sixty-three percent) placed blame on the pharmaceutical companies for the opioid epidemic. Another poll conducted by NPR (National Public Radio) in 2019 found that about seventy percent of respondents think pharmaceutical companies should cover the costs of additional treatment and medications used to revive patients after an overdose.
As mentioned above, drug companies have paid out millions to doctors who prescribe their products. They have also paid out hundreds of millions in fines related to lying, misleading the public, patients, and medical providers about their products. This is particularly true of Purdue Pharma, the makers of OxyContin. In 2007, Purdue Pharma and its top executives pleaded guilty to felony charges related to false marketing of OxyContin. They also confessed to accusations that they directed their sales team to tell doctors the drug was less addictive than other opioid medications. This is not the only evidence of this specific pharmaceutical company’s role in the epidemic.
Purdue Pharma has been in the press many times over the last decade alone defending its marketing and sales practices. A court document from 2019 revealed that top executives made the decision not to take steps to correct the false impression among doctors that OxyContin was weaker and less addictive than morphine. The same document indicated plans to persuade officials in other countries to classify OxyContin as an uncontrolled substance which would make it obtainable without prescription from a provider.
Other records show that drug companies, including Purdue Pharma, have spent millions on global marketing of their products despite the ongoing impacts of the opioid epidemic. A similar investigation shows that Purdue Pharma also spent millions on a website called “Partners Against Pain,” which provided patients with a connection to doctors who worked with the company.
Despite the growing body of knowledge and statistical proof that OxyContin was not a safer and less addictive alternative to other opioid medications, no action was ever taken by the drug company to mitigate false representations that had been provided to the medical community.
Concluding thoughts-is there a true culprit?
There is indeed overwhelming and undeniable evidence that drug companies-particularly Purdue Pharma-repeatedly (and knowing) lied about the dangers of their most profitable drugs to boost sales. These lies were told to doctors, patients, and the public alike. As a result, it would be easy to place more blame on these pharmaceutical companies than anyone for the current opioid epidemic in the United States.
However, if one looks at the amount of money doctors received from these drug companies and the direct connections between the number of prescriptions and the payouts provided in “marketing” payments, it is clear that some doctors bear a significant portion of the blame as well. Even if the pharmaceutical companies misled them, there were clear and distinct elevations in addiction levels across the country. It is not hard to wonder if the marketing payments from the pharmaceutical companies helped the medical community to turn a blind eye toward the emerging opioid crisis.
It is hard to place blame in one concrete direction as both pharmaceutical companies and the medical community seem to have their fair share of responsibility for the current epidemic. At this point, there does not seem to be a strong decline in the use of opioids, whether prescribed or obtained via alternate means. If you or someone you know face the challenges associated with opioid addiction and are ready to seek treatment, contact us here at the Hills. Our specialized treatment programs are designed with your individual care and needs in mind.
We look forward to working with you and helping you achieve your sober and clean-living goals.