By now, most Americans are at least partially aware of the role played by Purdue Pharma in the genesis of the current opioid epidemic. In 1996 Purdue Pharma marketed their blockbuster wonder drug OxyContin (OC) as a non-addictive pain killer. Their marketing was so wildly successful that it led to a wholesale change in the treatment of pain. Prior to the advent of OC strong opioids were only used for the most severe pain, often at the end of life. That all changed with OC; because it was deemed “safe and non-addictive” doctors started using it to treat conditions (e.g. arthritis, chronic back pain) that had never warranted the use of opioids. This means that many of the early casualties of the opioid epidemic had no addiction history, they were merely being medically compliant. This cannot be overstated – the opioid epidemic is, to a large degree, an iatrogenic phenomenon. This means it is a condition induced unintentionally by physicians to their clients. In other words, the treatment caused the addiction.
How did this happen? Before the 1990s doctors never prescribed more than three- or four-days’ worth of narcotic pain medication. Any doctor worth his salt knew that to prescribe any more than that was court serious addiction. However, starting in the late 80s and early 90s we started hearing the chronic pain was a major medical issue in the United States. Organizations like the American Pain Society (dissolved in 2019) effectively lobbied to loosen regulations surrounding the use of narcotic medication. Around the same time “chronic pain syndrome” (CPS) became a “medically treatable diagnosis” or MTD. Prior to that time pain was regarded as a symptom and not a diagnosis. CPS quickly became such a common diagnosis that hydrocodone – an opioid designed to treat around the clock pain – was the most prescribed drug in America from 2006 thru 2015.
Over time, many of the newly addicted would move from prescription opioids to illicit drugs like heroin and fentanyl. (This move had everything to do with costs, availability, and the progressive nature of opioid addiction.) The opioid epidemic is an American tragedy of epic proportions. 399,000 Americans died of overdose from 1999 – 2017. But it should be noted that in counties where the pills were most vigorously marketed – in West Virginia, Kentucky, and Virginia – the fatality rate was three times that of the rest of the country. These were rural counties hard hit by the economic recession of 2008, places aptly described as “communities of despair.” Over a seven-year period those counties were flooded with over 76 billion pills by some of the nation’s biggest drug companies.
What is the takeaway of all this? Consumer beware!!! If it sounds too good to be true it probably is. And sadly, it means that we can no longer blindly trust the products of the medical industrial complex. Here is a quote from noted researcher Dr Marcia Angell, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”
At Rockland Recovery we believe that it is of the first importance that our clients and their families be informed. Addiction is a socio-cultural phenomenon. If we are going to beat the epidemic, then it is imperative that we understand the forces that brought us here. Knowledge is power, and that is especially so for the addict in early recovery.