by Comprehensive Staff
By Miguel Messina, Vice President, Substance Use Disorder Treatment Services
In reflecting about the opioid crisis and the epidemic of drug use in the US, I wonder what went wrong and why situations such as this happened. It is always easy to scapegoat an issue by blaming those who are harmed and who suffer the most (that is, blaming the addicted person) rather than looking for answers in places that might create confusion, anger or grief. What is becoming clear to me is that just as with any epidemic or crisis (natural or human-made) this crisis is going to have to take its course. While all of us are running around, wanting to change the law, creating awareness, producing more medications, and asking for help from our federal government, the damage caused by the proliferation of prescription drugs is done. It will continue to have an impact for years and generations to come. People are going to die, be incarcerated, or live the rest of their lives in agony. There are those who will find the help they need and make changes for the better. Indeed, changing the law, public education, and prevention, education for medical providers, facilitating more treatment, and removing stigma are all reasonable measures to prevent future epidemics of any drug. Changing our view about the way we consume substances is essential, as well as the way we alleviate our problems with medications.
I would like to share what some experts might consider the causes of the present epidemic, which rest on social and economic determinants. To start, one can explore eroding economic opportunities and a lack of evolving abilities to transcend social and environmental problems such as poverty, geography, access to healthcare, access to education, proper nutrition, and recreation. These determinants are well studied and understood in the public health research. Unfortunately, they are not as well appreciated by policymakers and practitioners. This lack of acknowledgment is recognized by our emphasis in “curing” problems rather than addressing and resolving the contributing factors of the problem.
Another interesting factor is the process by which pharmaceutical companies have been able to market a product with no research or studies supporting its benefits nor policies holding the maker of the product responsible (for example, the ability to introduce a narcotic as a product deemed safe for consumption). When the commercialization of healthcare and opportunistic marketing are combined with dangerous off-label use, physician’s kickbacks, lucrative speaking fees, and lobbying for an unregulated system, the result is a drug called OxyContin. Now we are addressing the problem with the prescription drugs, by cutting addictive individuals from the drug of choice, and marginalizing them to the streets to seek and find a lower grade opioid; hence, longevity of the crisis is extended and in many cases, new crises are created.
In this short commentary, I am hoping to add to the ongoing dialogue regarding our current opioid epidemic. Perhaps the intention is to describe that the reasons and motivation behind a situation like ours is a combination of opportunity, money, lies, and ignorance, along with an existential need to avoid the pain, anxiety, and discomfort of living. I also hope that the next time we encounter a person addicted to any drug, especially to a prescription drug, that we hold our judgment and think about what other factors have contributed to this person experiencing this problem and this suffering, daring to look beyond what is visible.