can someone explain how the opiod crisis happend?
In: 19
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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