Pain Management

In some ways, this is the most important and difficult subject I’ve written about since I got here.  Unfortunately, it’s also the one I feel least qualified for.  Even during a global pandemic, America’s epidemic of opioid addiction remains one of the country’s gravest, most intractable problems.  In terms of deaths, it’s on a scale with COVID, but over a longer period.   At least 500,000 people died in the US from opioid overdoses between 1999 and 2019 and the Centres for Disease Control (CDC) suggest it could be as many as 850,000.  But the statistics for something so shrouded in stigma, secrecy and prone to multiple interpretations are bound to be unreliable.  Unsurprisingly, the number of opioid attributed deaths has risen sharply over the last year, with COVID adding to what are sometimes described as “deaths of despair”. 

We all experience physical and emotional pain during our lives.  It’s part of the human condition.  I’ve had my share, but I’ve never suffered from the kind of acute, chronic physical pain that was, ostensibly, the original reason for the widespread prescription of newly coined medical opioids in the US from the turn of the 21st century.  That said, of course, people have been taking medicinal pain killers for far longer and some of the substances that are now considered dangerous drugs, like heroin, were once widely available to anyone who could afford them.  Arguments about liberalisation and decriminalisation rage on.  But I’m sure if my life was dominated by pain, I’d be looking for something to relieve it too and part of the appeal of prescription opioids is that they’re legal and – initially at least – carry the respectability of the medical profession. However, this veneer quickly erodes under the pressure of profiteering and addiction.

I was determined to learn more about America’s opioid crisis during my Fulbright Fellowship because it seems to me that otherwise, you can’t fully understand what’s going on here.  I turned to an excellent, but harrowing, book, American Overdose by Chris McGreal (published by Public Affairs, 2018).  There are others, but Mr McGreal was one of the first writers to identify the prime culprits for the opioid epidemic, big pharmaceutical corporations, most notoriously Purdue, owned by the Sackler family. The wealth of these corporations is staggering and the comparatively modest fines some have received for their role in the opioid epidemic haven’t changed that. 

It is bitterly ironic that, as they continue to make mega-profits from selling opioids, those same drug pushers are currently striving to thwart attempts by the Biden administration to exert at least some control over their pricing policies.  These corporations, who no doubt profess to believe in the divine power of the market, are refusing to allow the government to negotiate the price of prescription drugs, which are, as a result, significantly more expensive in the US than elsewhere.  There are constant TV commercials by the drug companies at the moment, scare-mongering that restricting their profits will deprive sick people of the drugs they need.

As McGreal meticulously describes, this kind of emotional blackmail was Big Pharma’s stock in trade when prescription opioids were unleashed on an unsuspecting and vulnerable US public.  Advocates for the new drugs insisted they would cure “an epidemic of untreated pain”, without leading to addiction and that denying them to people infringed their right to a pain-free life.  This is where several potent features of American society converge – the notion of rights, free choice, ill-health, privatized health care and powerful drug companies (and their legions of lobbyists).  It’s also another reflection of the appalling institutional failure of the American political establishment.  McGreal relates how, as the evidence of the damage opioids were doing accumulated, politicians (many receiving funding from Big Pharma) and the State either failed to intervene, or actively facilitated the drug companies.  Again, it’s a horrible, predictable twist that some of the same politicians who turned a blind-eye to the opioid crisis, are now trying to sabotage policies that would relieve some of the conditions that lead to addiction, in the form of the Build Back Better agenda. 

Consumption used to be an alternative name for tuberculosis, but today in the US, it also describes the culture around health.  The drug companies bombard viewers with strategically placed TV commercials for all manor of drugs, the only country (other than, surprisingly, New Zealand) that allows the practice.  They’re an extraordinary 21st century equivalent of the 19th century travelling medicine shows that roamed the Old West selling miracle cures.  The idea that it’s possible to buy good health is firmly ingrained.  This connects with the opioid addiction epidemic because one of its key dynamics is over prescription.  In some cases, as American Overdose details, this is the result of unscrupulous doctors and pharmacists cashing-in on people’s desperation.  But it also reflects a system in which pressure is deliberately built by Big Pharma for patients to demand certain drugs. 

Some of these issues have manifested during COVID, in the form of a deep distrust of the political and healthcare systems. However irrational it may appear from the outside, with the way opioids and other prescription drugs have ravaged some US communities, it’s understandable that some are skeptical about an officially authorised and aggressively promoted vaccine. There are other ways the underlying state of the nation’s health disastrously intersect. I’ve read accounts of research showing that people who’ve become reliant on opioids are less likely to survive on a ventilator if they suffer severe COVID. There’s also a political dimension in the overlap between COVID, opioids and Trump support in some areas (I sometimes wonder if gun ownership and violence are also part of that Venn Diagram, but I haven’t seen anything to confirm that).

The thing that usually gets left out of this discussion (to the extent there is one), is why so many Americans struggle to get through their daily lives without recourse to powerful, mind and body changing narcotics. Certainly, there’s a cynical corporate machine that’s exploiting people’s pain in exactly the same way as a street-corner drug pusher (although many have pointed out the contrast between perceptions of and legal responses to, drug use between urban African-Americans and others). But like the crack-epidemic, addiction feeds on poverty despair and toxic capitalism and that’s the thing America doesn’t really want to talk about.

Here’s what one child in West Virginia wrote about her experience of opioids:

“This is a picture of me and my daddy and my little brother. I love my daddy so much. Then the next week daddy died from taking drugs. I cried and cried. I miss my daddy. I want to hug and kiss him every day. It is very sad when kids don’t have their daddy to play with now. I still cry when I think about my daddy.”

Chris McGreal continues:

“By then (2017), West Virginia had placed more than six thousand children in foster care because of opioids and moved others out of the state because of lack of resources to look after them. Its Bureau for Children and Families expects the number to increase for years to come, with all the consequences that has for the next generation.” (American Overdose, p283)

There’s the rub. COVID may, or may not, be waning. Prescription opioids and the industry around them, are not.

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