How corporate greed and duped doctors unleashed an epidemic of opioid addiction across America
Writer: Rachel Rubinsohn
Editor: Maddie Wigmore-Sykes
Art: Chika Nwaka
It kills 130 Americans every day. Like a virus, it has swept ruthlessly across the country, leaving burgeoning orphanages and mass memorials in its wake. Its pervasive reach transcends class, age and ethnic divisions, uniting communities in agony. This is America’s opioid epidemic – a tragedy whose seeds were sown and diligently cultivated by a medical community in the pocket of big pharma. Twenty-first century medicine has become entangled in a web of corruption. It, and its patients, need rescuing.
Opioids are a class of drugs originally derived from the opium poppy, including morphine and heroin. Humans have been exploiting them for pain relief and euphoric highs since 3400 BC Mesopotamia, thoroughly aware of their addictive nature. In the early 1900s, the West was so acutely afraid of addiction that opioids were virtually eliminated from medical practice and were reserved solely for palliative care. Now, just a century later, America is ravaged by a humanitarian crisis in prescription opioid abuse. How did the pendulum swing from one extreme to the other, so quickly?
Like many tragedies, this one began with good intentions.
Stringent restrictions on opioids throughout the twentieth century left doctors ill-equipped to manage chronic pain. The worn-out bones and inflamed joints that plagued everyday life for millions went untreated. Pain specialists in 1980s America began to question the establishment’s dogmatic dismissal of opioids: why deprive patients of the drugs that relieve end-of-life pain so wondrously?
What started as a perfectly honest question quickly descended into a ruthless crusade.
Saturating news media with the image of a nation crippled by pain, dissident campaigners extolled the virtues of opioids. The risk of addiction, they promised the masses, was negligible, because chronic pain would “neutralise” the feelings of euphoria; that this theory was based on the experience of a single patient was hidden from the cameras.
Their campaign gained the support of Purdue Pharma, a pharmaceutical company that had recently patented a morphine-based pain-killer called OxyContin. The powerful coalition demanded recognition of pain as a “fifth vital sign”, for which treatment with opioids was a fundamental human right.
In 2001, their efforts paid off: the Joint Healthcare Commission declared that every single patient, irrespective of their reason for seeking medical help, must rank their pain level on a scale of 0 to 10, and be referred to a pain consultant should they exceed a 5. It put pain at the forefront of doctors’ and patients’ minds, medicalising the discomfort of everyday life and creating an unachievable expectation that pain could be totally eradicated. Months later, legal restrictions on medical opioids were relaxed and the floodgates were opened for mass prescription.
No stranger to aggressive advertising, Purdue Pharma besieged doctors with promotional material and sponsored illustrious conferences at holiday resorts. Video after video, doctors were promised that OxyContin’s “delayed release” formulation had made addiction a relic of the past.
It was a lie; delayed release or not, OxyContin was heroin in a pill. As prescriptions were doled out freely, the opioid-binding receptors in the brains of unassuming patients began to undergo biochemical changes that would pave the way to addiction. Within a few months, they would feel their pain returning as they developed tolerance to the drug, and would plead for higher doses. Invariably, doctors would comply – showing reluctance to prescribing opioids landed many doctors before hospital ethics committees. When prescriptions ended, patients would be racked by withdrawal symptoms, driving many to seek relief through illegal substitutes.
It took the FDA (US Food and Drugs Administration) seven years to mandate that the risk of addiction must be openly stated on OxyContin’s packaging. When Purdue Pharma was finally taken to federal court in 2007, company officials admitted to having known for years that OxyContin was being stolen, snorted, injected – all the while espousing its safety – and were charged $600 million, a mere fraction of the drug’s $3 billion revenue.
The tide may finally be turning; as of June this year, 45 states have filed independent lawsuits against Purdue. But for the hopeless addicts, broken families and destitute towns, it’s too late. Close to 200 million opioid prescriptions are still written each year, and opioids now kill more people than traffic accidents and firearms combined.
One might think that the FDA would have learnt a thing or two as they’ve watched this harrowing tragedy unfold. However, their decision in 2012 to approve a new opioid, Zorohydro ER, ten times as powerful as OxyContin, indicates otherwise. The FDA, once a beacon of scientific integrity, has been corrupted from within. An investigation by Science magazine in 2018 found that many “independent advisors” who vote on drug approval panels receive personal payments from pharmaceutical companies, these conflicts of interest going unnoticed because the perks were being rewarded after a drug’s approval.
This, if nothing else, is a potent warning to healthcare systems around the world. Murky relationships, creeping privatisation, and unchecked corruption can sabotage any organisation, even those whose very purpose is to keep us well. It is high time that we take back control of our health.