The opioid abuse epidemic has become a major issue on the campaign trail because the number of people who die each year from opioid overdoses is approaching 30,000.
But it's important to note that nearly two-thirds of those deaths are due to overdoses of prescription opioids, not heroin.
A recent report from the Centers for Disease Control and Prevention estimated that 4.3 million Americans a month engage in nonmedical use of prescription painkillers, and 1.9 million Americans meet the criteria for prescription painkiller-use disorder.
Politicians from both parties are responding—belatedly—because the epidemic has spread to teenagers and young adults from suburban, middle-class families. Many of them graduate to heroin after getting hooked on prescription pain relievers.
But while the mainstream media may focus on such families—one headline in October read, “In heroin crisis, white families seek a gentler war on drugs”—the actual demographics of this epidemic are more Walker Evans than William S. Burroughs. Poor, white, semi-rural Americans in states such as Kentucky, New Hampshire and West Virginia are the ones getting hooked.
Burroughs was a hipster/junkie who wrote in his 1960s cult classic Naked Lunch that “the junk merchant doesn't sell his product to the consumer, he sells the consumer to his product. He does not improve and simplify his merchandise. He degrades and simplifies the client.”
He also knew about addiction and its relationship to pain, the disease that prescription opioids are designed to cure. “It is not the intensity, but the duration of pain that breaks the will to resist,” he wrote.
The medical profession took a new interest in chronic pain in the 1970s, which coincided with the decline of the manufacturing economy that had provided jobs and middle-class incomes for Americans without a college education. By the mid-1990s, a new specialty—pain medicine—and a new product—Purdue Pharma's OxyContin—found a new market in areas of the country losing jobs, income and hope.
People unable to find employment could get on disability due to chronic back pain, severe headaches or fibromyalgia. The pain clinic became a fixture on the American landscape.
OxyContin and other prescription opioids became the drug of choice for treating chronic pain. Three Purdue executives pleaded guilty in 2007 to misleading regulators about their illegal marketing tactics. The company paid over $600 million in penalties.
The culture they helped create endures. Barry Meier, a New York Times reporter and author of Pain Killer (2003), the story behind OxyContin, has done probably more than any other journalist to describe the roots of this epidemic. In 2013, he told Terry Gross on NPR's “Fresh Air” about a doctor who told him “what we didn't realize (was) that the people who take them would opt out of life. … We've created a legion of chronically unemployed people who are dependent on these drugs.”
The medical profession understands its role in fostering this epidemic. The American Medical Association's opioid abuse task force encourages doctors to check state registries for patients doc-hopping to secure more pills.
But there is still widespread opposition among pain-treating physicians for tighter controls. The CDC's attempt to promulgate clinical practice guidelines restricting some practices was postponed after some physician groups and pain treatment advocacy groups raised objections.
Prescription opioids can be a godsend for people with severe long-term chronic conditions. But their use for milder disorders has unintended consequences. As a group of emergency room physicians from the University of Cincinnati Medical Center wrote in 2014 in the American Journal of Public Health: “Some individuals transition to nonmedical use and addiction despite their intention to use medications only as directed and only for pain relief.”
The title of their article provides a useful guidepost for healthcare professionals wanting to help in this new war on drugs: “The urgent need to consider the role of iatrogenic addiction in the current opioid epidemic.”