A few weeks ago, my husband and I lost a friend to an opioid overdose. He was not the first person we knew who died from an overdose, but he was perhaps the closest. And while I am still working through the five stages of grief (denial, anger, bargaining, depression and acceptance), the anger I have been feeling has been particularly intense. Probably because deaths by overdose are senseless.
Our friend was not alone. There were an estimated 100,306 drug overdose deaths in the United States during 12-month period ending in April 2021, according to the Centers for Disease Control and Prevention, with “an increase of 28.5% from the 78,056 deaths during the same period the year before.”
Highly addictive opioids include prescription drugs like oxycodone, and addictions can lead to the use of heroin. Opioids can be effective at managing acute pain, for example after surgery or when used with compassionate care, such as with late-stage cancer patients. Opioids were never appropriate for treatment of chronic pain due to their highly addictive nature.
The opioid crisis began in the 1990s as clinicians were instructed to pay close attention to pain management and as new pain medications were manufactured and marketed. Purdue Pharma introduced OxyContin, claiming it had features that made it nonaddictive and thus safe to use as a chronic pain solution. Other pharmaceutical companies introduced similar products.
The safety claims were mostly false, and many patients became addicted to the pills. Heroin traffickers seized on the opportunity to provide (and profit from) cheaper alternatives that quickly got desperate people hooked. Heroin purportedly features a more intense high. Fentanyl is a synthetic opioid that is 80 to 100 times stronger than morphine and far more potent than heroin. It is also easier to overdose on fentanyl. The National Institute on Drug Abuse reports that 80% of people who turn to heroin started with prescription opioids first.
After we learned of the loss of our friend, I felt anger but also indignation. Most times when I experience this level of anger, I try to convert that into passion and look for ways to tackle the issue.
Starting from the top down, I found myself outraged at the role Purdue Pharma played in this public health crisis. Purdue’s directors knew that OxyContin was being misused but continued to promote it. Back in 2019, Purdue filed for bankruptcy as lawsuits piled up by the thousands accusing the company and its owners, the Sackler family, of being partially responsible for the opioid epidemic.
Just a few weeks before my friend lost his life, the Sacklers and Purdue reached a settlement with a group of states that had long resisted the company’s bankruptcy plan. This settlement will funnel billions of dollars from the Sackler family fortune into addiction-treatment programs nationwide. While the deal is a step, the Sackler family has yet to acknowledge any wrongdoing or personal responsibility.
While it is important to acknowledge that chronic pain is a difficult medical problem that causes suffering, our medical establishment has yet to keep up with this public health crisis. At this level, my ire rests with the medical providers who continue to overprescribe opioids. Provider education can help in this arena. Alternative therapies and treatments should be encouraged, researched and paid for by the companies that created this problem.
There are many treatment options available for people already addicted. Some studies link Medicaid expansion and access to treatment. There are two pieces of good news coming out of Missouri. Missourians voted in 2020 to expand Medicaid, and the state finally joined the Prescription Drug Monitoring Program in 2021. (Washington state’s Prescription Monitoring Program, also known as Prescription Review, was created in 2007).
For days after we learned of the news of our friend, my husband and I kept wondering: What did we miss? How could we have helped? I experienced a profound sense of disappointment in our friend’s family and other friends for not recognizing his physical and emotional pain and offering help. I admit that I am mad at him too for leaving us too soon.
The roots of the situation can be traced back to the decline of the working class, especially in rural communities, and the erosion of families and communities. Perhaps the hardest work our society needs to do is rebuilding our communities. The implications of this work can extend well beyond the opioid crisis. I personally look forward to pursuing this endeavor, in memory of my friend.