can someone explain how the opiod crisis happend?
In: 19
prescription opioids became a huge hit for mitigating pain in the 90’s. Doctors prescribed them a lot. They were frequently abused. This created a wave of opioid use disorder (OUD). The FDA cracked down hard on prescription opioids but that just led to people seeking out heroin and other opioids on black markets.
Pretty much a pharmaceutical company came out with OxyContin (oxycodone) and marketed it as a wonderful painkiller that wasn’t addictive. It was very good at its painkilling job and doctors prescribed the shit out of it. Oxycodone, however, is super duper addictive and millions of people got addicted.
a large part was the pharmaceutical companys paying doctors to write scripts. they also lied about the addictiveness.
deep dive big pharma, you wont be ok after
Sure. In 1996, the company Purdue Pharma told doctors that patients would probably *not* become addicted to drugs containing opioids. Doctors then prescribed opioids to many patients, even if they did not really need them. Doctors don’t normally question whether their patients really feel pain or need painkillers if the painkillers are considered non-addictive.
However, many of those patients *did* become addicted. In 2007, Purdue Pharma was fined $635 million for their misleading and harmful sales practices. The judge said this was because Purdue Pharma did not warn customers about the side effects enough. Since then, there have been many other similar lawsuits. There are ongoing negotiations to settle these lawsuits for billions of dollars.
So we discovered a new kind of painkiller that worked really well. It was also very addictive so it would have to be used carefully. The company that made it knew about both things, but decided to hide the information about it being addictive.
Medicine is a business and not regulated as much as you might think. It was (and probably still is) perfectly normal for people from pharmaceutical companies to visit a doctor, give him a sales pitch with a lot of samples, and offer to pay him money if he starts prescribing a medicine more. The company that made the painkillers did this.
Pretty soon people started getting addicted. The company was clever, though. The doctors they sent salesmen to usually catered to poor people who needed the painkillers after workplace injuries. These were people who already tended to go bankrupt and end up homeless, so the company argued these were people *already* addicted to drugs and that their drug was a symptom, not a cause. And considering it cost money to get the drugs, a lot of people once addicted couldn’t get more. So they *would* start turning to illegal drugs. It fit the narrative the company told.
This is a weakness in our culture. We have a tendency to look down on poor people and believe they got there because they are bad people who make bad choices. So when we’re told they’re drug addicts we don’t think, “Well why couldn’t they get help?” but “Well that’s what they get.” So while there were people talking about the problem, a lot of people weren’t listening because it made sense, to them, that these people were doing it to themselves.
To make more money, the company kept talking doctors into using smaller doses for things that wouldn’t normally require painkillers. They were interested in maybe getting it approved to give to children. The entire time they knew the medicine was very addictive but they were not publicizing that information.
So basically: the company knew the drug was dangerous, hid the information, paid doctors to prescribe it even when it wasn’t needed, particularly targeted the people most vulnerable to addiction, and still insists they’re the victim.
1 people that weren’t supposed to be taking, prescribed by doctors either for quick profit or not knowing how opioids work.
Pain management anesthesiologists know and knew what the stuff was. I was under a good drs care. Took oxy for a few years with other drugs never became addicted.
Lots of people have covered the ‘inception’ part of the crisis really well. Just wanted to add the ‘continuation / proliferation’ part.
Supply / Substitution: illegal synthetic opioids that were hundreds or thousands times more potent were chemically engineered to meet the exploding demand that could not be fully served by the legal / prescription market. Drug manufacturers (mostly illegal) from overseas (in particular China) manufactured and exported large quantities of synthetic opioids or their precursor ingredients to North and Central America.
Distribution: driven by the profit on offer Mexican drug cartels expanded into the distribution of opioids just as they had expanded into distribution of Colombian cocaine in the 1970s and 1980s to serve the largest market for narcotics in the world: the United States.
Most others have said the important part:
*Purdue claimed they were not addictive, then they got over prescribed.*
One level deeper: Purdue made billions off Percosets (Oxycodone) the 70s and 80s. They needed something newer, bigger, stronger, because that’s how you keep your stock price up.
But everyone acknowledged that Percosets were addictive if over prescribed. So they were regulated.
So this time around, in the 90s, Purdue consciously created a strong drug (OxyContin) that was stronger but slow releasing, and then claimed it was not addictive. So it was less regulated. And then prescribed to millions. And then millions became addicted.
Two levels deeper: the study Purdue provided (to show lack of addictiveness) was so blatantly simple that it never should have gotten past the FDA. But because of deregulation in the 80s and 90s, the FDA started taking big pharma “at their word” that they do the studies with honesty and integrity, instead of actually regulating.
Dopesick is a great show with Michael Keating demonstrating what Perdue Pharma did. Even has a few real clips of the awful family
The company Purdue Pharmaceuticals engaged in a long-term campaign of lies, half-truths, and distortions, to promote their product, oxycontin, which is a slow release type of opioid. They did this in various ways. In no particular order:
1. they pushed hospitals and doctors to adopt a new model of thinking about pain. For example, they pushed for a new vital sign to be asked about in hospitals: how much pain you are in. All those pain charts in hospitals? That apparently was majorly pushed by Purdue. It put pain management front and center and made it a priority
2. they pushed the line that Oxycontin lasted for 8 hours and caused absolutely no problem with addiction if use as prescribed. Doctors face an enormous, bewildering array of information they need to assimilate and work with every day. They’re taught to believe what the authorities tell them, like about what drugs can do, the risks, the benefits, etc. So they believed this. Why shouldn’t they? Well, it wasn’t true. First of all it didn’t last 8 hours and many people would suffer from returning pain after much less time. So then they’d take the next dose earlier than they should and they’d run out too soon. They’d get new prescriptions from their doctors, for higher dosages, because everyone was told that was safe. Eventually if docs cut them off or wouldn’t increase, some would turn in desperation to street opiates.
3. use of these drugs became more prevalent, first legitimately, then as there started to be problems, the black market. People who never took them from a doctor started trying them at parties and such because they were just around and being offered. In this way, legal use turned to illegal use just to feel normal, and then bled into other communities of people using them because they had become so common
4. this leads us to the fact that they were relatively easy to obtain illegally. The laws were lax. This was particularly evident in places such as Florida, where “pill mills” opened up. Facilities in strip malls and similar where a crooked doctor would just start writing prescriptions for large amounts, all day, every day. People started driving from distant places daily to get pills, either to feed their own addition, or to get pills to sell to other people. Little to no oversight. Cash only. One place even would just burn all the 1 and 5 dollar bills because they had so much money and didn’t know what to do with it. Many pharmaceutical companies would see this as a RED FUCKING FLAG and raise concerns. Why was one place prescribing so ridiculously many pills? Purdue Pharma did not care. Purdue pharma donated lots and lots and lots of money to politicians. Here’s an article for more information: [https://apnews.com/article/west-virginia-fires-health-wv-state-wire-us-news-0ced46b203864d8fa6b8fda6bd97b60e](https://apnews.com/article/west-virginia-fires-health-wv-state-wire-us-news-0ced46b203864d8fa6b8fda6bd97b60e)
5. Pharmaceutical reps: these are people who promote their pills to doctors and hospitals. They’ve long been known for providing huge financial incentives to these organizations to prescribe their products. The movie *The Fugitive* (which you should definitely see, a simply fantastic and extremely enjoyable movie) highlights the shadiness of this. Stereotypically they have young, beautiful women as pharma reps (certainly not always, but I mean stereotypically). They have huge budgets with which they provide doctors and hospitals with free samples as well as numerous perks, from office pens to all expenses paid trips to the Caribbean for doctors to go to seminars with education credits to hear about the benefits of their particular product. Doctors got kickbacks for the volume of prescriptions. And doctors trusted that what they were told was true. I remember a talk by a pharma rep who I think only had a pretty rudimentary education, who was good at parroting back the information about the products, but with no medical training whatsoever. They were shocked that doctors were asking *them* medical questions about product usage, thinking they knew more than they actually knew. The guy was thinking “I’m just a salesman, I sell things. Might as well be aluminum siding as life-saving medication.” If their company told them Oxycontin was safe, that’s what they said, even though they had no real knowledge. They used the sales techniques of used car salesmen to sell medications.
6. As people became increasingly dependent on their opioids, they promoted larger and larger dosages, still saying they were safe, but they weren’t safe, and they entrenched people in addiction even more.
7. there were some gateway drugs in that some of the lower strength, less addictive drugs were not in the category of most closely guarded and were easy for anyone to prescribe. You got folks like Paul LeRoux capitalizing on this by selling Oxycodone, hydrocodone, and tramadol with basically a rubber stamp via unwitting, naive, or corrupt physicians and pharmacies. Here’s a podcast on Paul LeRoux: [https://gimletmedia.com/shows/reply-all/dvhd9k](https://gimletmedia.com/shows/reply-all/dvhd9k) totally worth a listen. His role in this mess was small, it was mostly Purdue Pharma. But hearing what he did gives you a picture of the situation.
All of these factors led to the problem growing and growing, unchecked. But laws have since been passed and doctors now have new regulations. These things are more regulated, it is harder to get these drugs prescribed to begin with, and the dosages are smaller. The pill mills were cracked down on.
By the way, Apple TV had a great series that covered Purdue’s role in this starring Michael Keaton: *Dopesick*. Worth a watch!
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