I don’t think I buy Laudan Aron’s explanation for the opioid epidemic in the United States, as expressed in her post at RealClearPolicy. In essence she blames it pharmaceutical companies and their diabolically effective advertising campaigns:
he sharpest increases in opioid use began in 1996, exactly one year after Purdue Pharma introduced OxyContin, an extended release form of oxycodone. Purdue Pharma’s activities culminated in a policy decision to make pain the “5th Vital Sign” to raise awareness about identifying and treating pain in clinical settings, along with the help of smiley faces for pain rating scales. Many groups and organizations were on board: the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards, The Joint Commission (which accredits hospitals), as well as pain patient groups. But there was no central coordinating entity paying attention to the effects of these changes on community or population health, or to possible unintended consequences.
I don’t deny that there’s been an enormous increase in the use of opioids or that companies have advertised them or that straight to consumer advertising of pharmaceuticals places stresses on physicians. I’d add another explanation: the increasing treatment of patients as customers. “Give the Lady What She Wants!” is a perfectly good slogan for a department store but not for physicians. In states that have tightened up on prescription painkillers (like Florida) the rate of opioid abuse has gone down, too.
Attitudes probably play a role as well. Emotions, including agitation, emotional pain, regret, and sorrow, used to be thought of as normal, ordinary parts of life rather than something to be medicated away.
The linked article seems to be a rejoinder to the earlier article on that same site, in which a pro-drug-legalization proponent confessed that the rise of opioid addictions and fatal overdoses challenged the author’s belief that expanding personal freedom would not have much cost. There appeared to be two responses: (1) the author’s suggestion of better education on the dangers of addiction and taxes on drugs to fund addiction treatment, and (2) the claim that doctors and the medical industry create the demand either through perverse economic incentives, corruption or the legitimizing imprimatur of a doctor’s prescription. Drug regulation versus drug de-regulation models.
I find both responses ludicrous in their own way, and as to doctors driving demand, I believe (a) addictive drugs are addictive, (b) doctors prescribe to the symptoms, and (c) when doctors don’t provide pain relief, addicts switch to heroin.
I think the only reasonable response is that drugs should only be decriminalized to the extent their physical harm is relatively minor like marijuana.
PD:
It makes no sense – none at all – to treat an addict like a criminal. Yesterday I made a berry crumble (lots of cheap berries at Costco and they were getting old in the fridge) knowing that I would consume most of it. It’s not an addiction, but it’s similar in that it is hard to control and not great for you. (3 sticks of butter in the recipe.)
Self-destructive, compulsive behavior. Now, explain how it would make anyone’s life better if in response to my crumble SWAT had kicked in the door, shot my wife’s dog and dragged me off to prison, all to save me from the consequences of my shameful need.
We have an excellent real-world model for dealing with addiction: cigarettes. No one has to be arrested, no one has to be shot, no one has to go to prison. We educated people on the health issues around cigarettes, we made it harder for kids to get them, stopped advertising, passed some second-hand smoke laws and then we let it be. The result? Rates of cigarette use are dropping like a rock. Cigarette smoking in high school kids is a third of what it used to be, and if you don’t start in high school you don’t start, period.
Cigarettes are as addictive as opiates and kill a hell of a lot more people, and yet, despite the fact that tobacco has the full array of lobbyists and pet politicians and a huge media presence stretching back to Bogie and Bacall, we won the fight against tobacco. Cops and courts and prisons have absolutely no place in this. This is a public health issue made infinitely worse by efforts to “treat” it with prison terms.
Amen. And don’t forget employer drug testing policies or that you can be prosecuted for driving under the influence of narcotics without having even one drink. Plenty of disincentives already without jail for possession.
I think you are correct that treating the patient like a consumer is part of the issue. We see the same problem with over prescribing of antibiotics. Also, let us not forget that the industry actually lied about some of their studies showing the drugs had low addiction potential and some executives went to jail for that. On Florida, I would wait tot see what happens. They have decreased prescriptions by a little over 1%, but they started as one of the states with the highest rates to begin with.
PD is correct that addicts just go shopping. Easy to do since we have no way to surveil narcotic prescriptions and abuse with our many individual practitioners and hospitals. Had dinner Friday night with a group including a young, female internist. She works in coal country where Oxy (and other drug) use is endemic. She gets many people coming in and demanding drugs and they often get threatened. Her office staff all carry.
Steve
Dave,
Off-topic, but I saw this on Twitter and thought of you:
https://twitter.com/CuteEmergency/status/691334907130306560
Looks like our car on any given day.