In 2019, pending countless economic collapses, media frenzies, huge censorship concerns, and the shrinking planet, one topic seems to have everyone agreeing on two points: there is an opioid epidemic, and something must be done about it! There are so many people abusing opioids, and so many abusers dying as a result. And since addiction is a disease, we must be ever vigilant in treatment, otherwise abuse will spread until the nation is engulfed with useless poppy addicts! So, every politician, pundit and professor must drive home the extremity and severity of the issue, or society will surely collapse, won’t it?
Except these claims are largely exaggerated or untrue, and the people making them amount largely to clickbaiters—exalted among the yellowest rank of journalists and parroted even by the esteemed. After all, who could side against the poor, suffering addicts, and why would they seemingly assist the pushers, dealers and manufacturers in their undying quest to poison the world? What sort of madness is this?
Before we go any further, it may be good to hear what the other side claims. Below is an image taken from the US Department of Health and Human Services (DHHS), detailing their current numbers on the opioid epidemic.
Since this piece is intended to be brief, I’ll try to keep it that way by accepting these numbers at face value. So, with these terrifying numbers uncritically presented to an uncritical people, how could any thinking person disagree there is a massive problem? What is the government doing, and why isn’t it doing more? How far will the opioid crisis spread before action is taken? Many questions must be answered.
I’ll begin by highlighting the definition of “epidemic.” The Oxford Dictionary primarily defines it as “a widespread occurrence of infectious disease in a community at a particular time.” The “infectious” stipulation rules this definition out almost entirely. Opium is not infectious, and the “charm” of the stereotypically average abuser certainly isn’t a qualifier for the Affability Olympics.
The worst “infection” you’ll get from opioids is bloodborne disease from shared needle use. The State of Rhode Island Department of Health gives good reasons why needles shouldn’t be shared, naming “HIV/AIDS, hepatitis B, and hepatitis C” among the nasty diseases spread. But that isn’t the opium spreading, so to label this as an “epidemic” would be false. It’s really more a result of the average person’s medical illiteracy, or a general carelessness. Both can be addressed without once bring up opioids.
It’s interesting that DHHS lists deaths from overdose and not the fact that sharing needles creates comorbid conditions, leading not just to drug abuse but the spread of actual diseases that more frequently result in death. I guess it’s okay to stigmatize junkies but not people with disease; the primary definition of epidemic is irrelevant as long as you can make a buck scaring people.
So, what’s another definition? Oxford also calls an epidemic “a sudden, widespread occurrence of a particular undesirable phenomenon.” Obviously, anything that kills as many people as opioids is undesirable, but if it’s being pushed as an epidemic by the health industry, what do they do—and plan to do—about it? Like DHHS said, opioid misuse primarily comes from prescriptions, so how are doctors reacting? Harvard Business Review has this to say:
But whether opioids are truly overprescribed is difficult to tease out, because pain is hard to objectively quantify, as is the amount of pain relief that patients may receive from opioids.
Nevertheless, rates of prescribing are still very high, and opioid-related overdose deaths continue to rise. By some estimates, more than 50% of opioid pills are unused by the patients who are prescribed them after surgery, which suggests significant overprescribing exists.
This is purely anecdotal, but I can’t tell you how many people I know who can’t get the medications they need because doctors are afraid of malpractice suits. I can’t find information on it, but I wonder how cheap healthcare might be if doctors didn’t feel the need for such measures. Additionally, it’s worth noting, as did Philip DeFranco’s video on the Suboxone scandal, that often companies will actively push more expensive versions of medication in order to continue making profit and prevent generics from hitting the market. It’s also worth noting that DeFranco’s claim that you’re more likely to die from opioids than a car crash comes from an analysis claiming suicide is an even greater problem, and that opioid deaths didn’t beat car crash deaths by much. Somehow, the airwaves aren’t filled with news about the “traffic accident epidemic” or the “suicide epidemic.” Again, it seems okay to stigmatize junkies and not anyone else. One has to wonder why this is.
But who should really bear the brunt of this stigma? According to the Harvard School of Public Health, doctors will often be paid heavily to promote opioids:
Opioid manufacturers are paying U.S. doctors huge sums of money for speaking, consulting, and other services—and the more opioids a doctor prescribes, the more money he or she gets paid by those same manufacturers, according to a new analysis from Harvard T.H. Chan School of Public Health, Harvard Medical School (HMS), and CNN.
And, according to Vox, a doctor named Katherine Hoover practically doled out pills like candy:
[T]he West Virginia doctor wrote about 130 prescriptions per day, assuming she worked seven days a week....
According to [court records and what others closely involved with Hoover’s clinic], the clinic was basically a for-profit pill mill — charging $450 in cash for first-time appointments, and the doctors often didn’t even see the patients to whom they were giving prescriptions.
Unlike some of the doctors and clinics that have been prosecuted during the opioid epidemic, Hoover wasn’t charged and convicted for the excess prescriptions. When the police raided her clinic in 2010 due to its excessive opioid prescribing, she went to the Bahamas (where she owns an island and reportedly hopes to start a nudist resort).
Since then, she no longer appears to be a doctor, although court records obtained by NBC News “suggest she and [her husband] have been shuttling between Michigan, Georgia, California, Florida and West Virginia for much of the last 10 years.”
And, to avoid being anecdotal, this piece cites “non-evidence-based” medicine papering over non-treatment of underlying causes of back pain with pills. And with the government’s chief drug-fearmongering site claiming about a quarter of people prescribed opioids misuse them, and not-insignificant amounts of those misuses translate to heroin use.
So, is the undesirable phenomenon here really the use and abuse of opioids? Or, is it that the people to whom we entrust our care might care more about their wallet than long-term health and social effects? Because even if a doctor doesn’t overprescribe, they might overcorrect and underprescribe. And underprescription might drive people to substantially less-safe black markets, where stigma and criminality drive up drug purity while driving down costs, so more product can be moved faster. If you care about overdoses, this should be of great concern. It’s harder to get an accurate dose of injected black tar than it is to simply take a certain number of pills. Ultimately, the freedom with which people stigmatize junkies reminds me of the moral panic associated with marijuana. Puritanism never saves lives, yet most of the fear associated with this is supposedly distributed with good intent. I’m too cynical to believe that, but others are welcome to.
So, if we’re trying to care for people, the “don’t do drugs, kids” approach won’t work. Harvard Business Review suggests prescription drug monitoring programs and a refinement of the approach to medical data collection, so overprescription and abuse can be better monitored. That’s a step in the right direction, but what does it do for current addicts? Y’know, the ones it’s okay to stigmatize? If you ask me, little. And wouldn’t it be okay to stigmatize them? The state says they deserve jail time, assault, and theft. The government is never wrong, is it? It’s not like they have a profit motive for driving people to victimless crime.
Sarcasm aside,what can be done? Rat Park gives us some insight. This study highlights the reality that it isn’t always the drug that causes addiction, but the circumstances. Rats that had a better environment abused heroin less and reproduced more. But this insight is incomplete. Nobody argues the results should be binned, but many rightly argue that they should be included in fuller analyses. Read this, and try to click all the links, for more info.
But the issue seems clear. Decriminalize nonviolent offenses, like those associated with drug use, and put the money associated with drug criminalization into infrastructure renewal and jobs programs. Treat people like people, and not stigmatized numbers in a future bank ledger. The medical industry and government need to put people over profits. Until they do, people will continue to die, and money will create an unstoppable cycle of destruction and social collapse.
A Socialist Rebuttal by Stephen Shenfield
I would like to pick up one of the important points made by this writer – namely, the apparent trade-off between relieving pain and preventing addiction. Now that doctors are finally exercising greater caution in prescribing opioids there is rising concern that people suffering pain may not receive adequate treatment. ‘Many people can’t get the meds they need’ and face a Hobson’s choice between enduring their pain and resorting to street drugs.
Non-addictive (non-opioid) painkillers such as ibuprofen and acetaminophen (tylenol) have long been freely available, but evidently they are not powerful enough to relieve certain kinds of pain. A trade-off does therefore exist. However, there is nothing inevitable about it. As others have argued, it is a product of the widespread legal prohibition of marijuana, even for medical purposes. It is also a product of past neglect of research into alternative types of non-addictive painkillers.
Such research is now underway. In August 2018 it was reported that scientists in the United States and Japan had successfully tested a new pain-relieving compound on 15 rhesus monkeys. The compound, known as AT-121, acts both on the mu opioid receptor to suppress pain and on the nociceptin receptor to reduce addictive and other harmful side effects (such as itching and respiratory problems). It is claimed that AT-121 achieves the same level of pain relief as morphine at only 1/100 of the dose.
Even allowing for a measure of hype in the publicity surrounding this research and the fact that as yet there have been no reports of testing of the new compound on human beings, it does seem to represent a big improvement over opioids. Of course, it may not be available to patients for some time.
Why was research of this sort not conducted earlier? It has been sorely needed for decades and could have prevented enormous suffering and averted the current crisis. One major factor in the delay must surely have been the dissemination of lies about the supposedly non-addictive character of opioids by pharmaceutical companies and by corrupt doctors in their service.
Another question. Is it inevitable that so many millions of people should need relief from acute and chronic pain? A well-grounded answer would require analysis of the multiple sources and varieties of pain, but clearly there is great potential for sharply reducing the incidence of several phenomena that account for an enormous amount of pain – road accidents (replace cars by mass transit, reduce working hours of truck drivers), work accidents and occupational diseases (prioritize workers’ safety), sports injuries (play safer sports), cancer (crack down seriously on pollution), etc.
And underlying all the other questions. How sane is a society that entrusts its vast technological capacity and productive power to tiny cabals of avaricious ‘werewolves and vampires’? How long is it going to be before we have finally had enough of their abuses? When are we going to bring the productive forces of society under the democratic control of society and put them to use in the public interest?