The Untold Story of America’s Opioid Addiction

Jun 5, 2016

By Jeremy Samuel Faust

We learned Thursday that Prince died of an opioid overdose—specifically from fentanyl, a synthetic opioid often prescribed to people who have built up a tolerance to oral opioids. (Fentanyl is more potent than powerful drugs like OxyContin and is most commonly administered via a patch.) While the toxicology report has not yet been made public—and may never be—it’s possible that Prince, who had a reputation for living substance-free but also suffered from debilitating hip and knee pain, got his drugs from his doctor, not a dealer. Why would the legendary recording artist have been prescribed a drug that put his life at risk?

There’s no question that opioids are effective at managing certain types of pain. But American medicine has become far too reliant on the potentially dangerous drugs for the wrong reasons. About 15 years ago, hospital watchdog groups grew concerned that physicians were not taking pain management seriously enough. The solution to this perceived epidemic of pain in the early 2000s was opioids. These strong painkillers became the drug of choice as ibuprofen (the active ingredient in Advil, Motrin, and similar products) had fallen out of favor thanks to overblown concerns about the risks of internal bleeding.

Around the same time, pharmaceutical companies noticed a now infamous study from 1986 suggesting that opioids were less addictive than previously thought. The author of that paper has since publicly recanted its conclusions, calling the sample size of 38 individuals too small. But pharmaceutical companies used this small, now roundly debunked study to convince professional medical organizations, and eventually hospital regulators, that it was safe to give opioids to more patients.  Since the early 1990s, the annual number of opioid prescriptions has tripled. Opioid overdose deaths have quadrupled. Today, Americans consume 80 percent of the world’s (legal) opioids, despite accounting for less than 5 percent of the world population.

There’s no single villain in this story. Our dangerous embrace of opioids was the result of the entire medical establishment—including governmental, nonprofit, and pharmaceutical organizations—searching for an answer to the problem of pain. That problem is real: Managing pain, specifically chronic pain, is an essential part of any doctor’s practice. It is terrible to see people suffer and whenever possible and prudent, pain should be treated. And some of the players in this story were driven by real concern for patients’ quality of life. But others, specifically the manufacturers, were driven by crasser motives: the realization that they could make a fortune by pushing for wider use of prescription opioids.


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13 comments on “The Untold Story of America’s Opioid Addiction

  • This irony here is that physicians are prescribing opiods to people with chronic pain — which is to say they are giving them addictive drugs to which they’ll build a tolerance when they need long-term pain management — but if you go surgery and really need a good pain killer for just a few days, they’ll only give you paracetomal (i.e. nothing) and leave you needlessly in serious pain when these drugs would seem to be an ideal solution.



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  • @ NorthernVoice

    Yes, the pendulum will swing and I am afraid that those needing these medications will be shorted to stop the epidemic of those not needing them, those working multiple doctors and those building an unfilled tolerance to these drugs.



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  • Due to the removal of the medial cartilage in my right knee I’ve developed osteoarthritis in it. And I also have rheumatoid arthritis in my right hip; let’s face it, I’m a mess!

    But I live in the UK, and we have the National Health Service (NHS), and I would be astonished if any of its practitioners was to presribe opiates!

    Why would anyone do such a thing? Silly question really!

    Incidentally, I still can’t quite get my head round what Sarah Palin said about what Obama Care would result in; as far as I’m aware, the NHS has never set up any death camps; maybe that was what her Witch Doctor told her would happen, in order to relieve her of some funds?



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  • My dad lived with excruciating back pain for many years. His doctor refused to prescribe Fentanyl because he claimed it was too strong. The medication my dad was on was not effective and had the side effect of constipation which aggravated his back pain. He was constantly falling down and he had to start using a wheel chair. There were many days when he wouldn’t get out of bed. When he turned 90, he got a new doctor who prescribed Fentanyl patches. His life improved dramatically. He is now 93 and moves about on his own with a walker. Yes, he is probably addicted to the Fentanyl. But the three virtually pain-free years he has enjoyed have to be put in the balance. We go swimming together and he again enjoys going out to restaurants. I admit this is all entirely anecdotal, and no, I’m not a paid shill for Fentanyl. It just annoys me that a medication is only criticized without looking at the positive side.



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  • prietenul #4
    Jun 6, 2016 at 8:08 am

    When he turned 90, he got a new doctor who prescribed Fentanyl patches. His life improved dramatically. He is now 93 and moves about on his own with a walker. Yes, he is probably addicted to the Fentanyl.

    There are times when quality of life is more important than side-effects.

    With estimated life expectancy becoming more predictable, beyond a certain age, the longer term side-effects are unlikely to have time to develop into problems.



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  • NorthernVoice #1
    Jun 5, 2016 at 8:00 pm

    but if you go surgery and really need a good pain killer for just a few days, they’ll only give you paracetomal (i.e. nothing) and leave you needlessly in serious pain when these drugs would seem to be an ideal solution.

    When I had surgery following an accident about three years ago, the hospital (UK NHS) put me on a morphine drip, where I could press a button and get a shot on demand.

    I don’t like addictive drugs, so they took it away again when I had only used it three times in recent days.

    They then gave me Paracetamol when I went home, but I quickly discontinued that as well – simply by avoiding movements which caused pain.



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  • I have no doubt in my mind that paracetamol works on some pains. It is the only pain killer I can take that does not make my stomach ache more than the original pain. I have recently started using a gel Ibuprofen when the pains get too much. Paracetamol doesn’t seem to do much for back pain or sciatica. With sciatica, a few paracetamol and stretching of the calf usually does the trick within two or three days for me. With my lower back pain, paracetamol seems to take care of some of the associated pain of tightening muscles but does nothing at point. That I get relief from chiropractic cracking of my own back. This can take a good few days to achieve depending on how bad it is but if the surrounding muscles allow, laying flat and bringing one leg over to the opposite side, getting it just right, and…crack!….relief for a while, maybe days. When it was at its worst, just one circuit of Ikea meant I would disappear from site on a rug somewhere, or bed, crack, and I was good for another boringly slow twenty yards. Maybe back pains are too important to have a simple drug cut out the message and have a hotline to the brain?



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  • Olgun #7
    Jun 6, 2016 at 9:40 am

    I have no doubt in my mind that paracetamol works on some pains. It is the only pain killer I can take that does not make my stomach ache more than the original pain. I have recently started using a gel Ibuprofen when the pains get too much.

    Ibuprofen is an anti-inflammatory drug, so if the pain is being caused by a trapped nerve, an anti inflammatory drug may reduce the swelling which is putting pressure on the nerve, whereas a simple pain killer will just reduce or deaden the pain without freeing up the nerve.

    https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682159.html
    Prescription ibuprofen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints).
    It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.

    I get relief from chiropractic cracking of my own back. This can take a good few days to achieve depending on how bad it is but if the surrounding muscles allow, laying flat and bringing one leg over to the opposite side, getting it just right, and…crack!….relief for a while, maybe days.

    This sounds as if the physio-exercise could be manipulating a piece of damaged displaced disk cartilage, back into place reliving pressure on a nerve.



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  • Well said Alan [#5],

    There are times when quality of life is more important than side-effects

    This is, to me, what social policy on health really needs to be about.

    We’re all going to die – so saving lives can’t be the policy focus. But quality of life is something we can all get our heads round.

    Peace.



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  • Can anyone comment on how bad the heroin addiction problem is in Europe, Australia, Canada and elsewhere?

    I’m also wondering what treatment options exist that we don’t have here in US. Our rehabs were too few and inadequately run years ago and now with the explosion of addiction patients here, the system has become absolutely inadequate to deal with even a fraction of the patient load. Outdated and overloaded. Government response has been too little, too late.

    There is much blame here for how Drs have prescribed pain pills indiscriminately and created our addiction problem and big pharm is blamed for their predatory capitalistic sales of these pills but that’s not the whole story here. Many (most?) heroin addicts never came to their addiction through legitimate use of pain pills after injury or surgery. They just fell into the addiction from partying with other people who already were addicted. There is a strong common thought process in that crowd that other people get hooked but they themselves never really would.

    As much as I have complained about the AA program in the past, I have to give them credit for their insistence that the addict take responsibility for their own actions and stop blaming everyone and everything around them for their destructive party behavior. It’s not all black and white, I realize that, but blaming Doctors and big pharm may take the focus off the individual and undermine prevention programs.



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  • Olgun @ 7.

    “It is the only pain killer I can take that does not make my stomach ache more than the original pain.”

    I used to have the same problem Olgun, but now there are Gastro-resistant Naproxen tablets, and Lansopraxole capsules.

    This is beginning to resemble a hypochondriac’s self-help site!



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  • @ prietenul

    ‘It just annoys me that a medication is only criticized without looking at the positive side.’

    Thank you for that comment I feel exactly the same way. My wife suffers from anxiety and depression which is crippling for her. What has worked in the past is occasionally taking Diazapam (valium) when she needs to subject herself into a social situation, it takes the edge off and allows her to cope. Typically she’ll take a half tablet about 1/2 hour before some socially difficult interaction, she never takes tablets more than 2 days in a row. However, Because it is known to be addictive we cannot find a GP who will write a script for her. I have sat there and asked them to look up her records and confirm she has never abused the drug a bottle of 50 tablets lasts her over a year. But not luck, so she has been prescribed less ineffective drugs (for her) which have given (her) terrible side effects which take her months to wind back off. Yes drugs can and are abused, but like you I feel that should not be the reason why good drugs should not be used. Presumably they are concerned she could be doctor hopping, all the more reason why we should have a national register that pops up every time she is prescribed a medicine that way she should never be over-prescribed, she can buy as much bloody alcohol as she wants, she just can’t have something far more effective and they way she is using it, harmless.



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  • @LaurieB

    Can anyone comment on how bad the heroin addiction problem is in Europe, Australia, Canada and elsewhere?

    I’m not sure of the differences in stats, however what I have noticed is that the US has less regulation on legally advertising drugs. There is some of that here but much less. The US seems very pushy on its drugs. We will have adds for asprin etc. and adds asking to ask your doctor about quit smoking solutions but it doesn’t seem as blatant as it is in the US.

    Another factor is we have very good social welfare, I believe this may take some of the heat out of drug issues. From the outside the US seems to have more ghettoisation than Australia, here you can be unemployed, poor and you will get some government housing, rent assistance, dole. It’s a bit more generous than the US, were I teach we have multi-generational welfare dependence, and while this is a problem I’m never worried I’m going to come across a student with a gun or turf wars (we have the odd knife attack or more often threat which usually makes national news if that is any gauge). School shootings related to drugs or gangs are unheard of (I’ve been teaching for 20 years and have never heard of one in my state or even the whole country). We certainly have drug crime, we have murders over it occasionally bikie gangs, it just doesn’t seem that whole suburbs are that dangerous in the same sense that some areas of the states are. I’m sure it is the same for most of the US but that may give you an impression at least here in Australia.



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