This week, John Oliver featured Opioid addiction on his Emmy Award winning show, Last Week Tonight. The story, which got lots of Twitter love, brought to light how prescribing practices and pharmaceutical advertising have contributed to the current opioid epidemic. Pharmaceutical companies have paid more than $634 million in damages for misleading marketing. But the opioid epidemic continues to run rampant – in the US and globally – and pain killers are, ironically, killing us.
When my son, who was 15 years old at the time, had outpatient surgery for a broken ankle, the discharge team insisted that OxyContin be included in his discharge packet. “No thank you” was not an acceptable response from us. If we didn’t take the meds, we would have to sign a document declaring ‘treatment refusal’. So with 20 OxyContin in hand, we headed home – Really? 20 OxyContin? Never taken, they continue to sit in my medicine cabinet…
1. What are Opioids? Opioids are drugs that are prescribed for pain relief. They work by reducing the intensity of pain signals reaching the brain. They also affect the parts of the brain controlling emotion. Drug names that you might recognize include Vicodin (hydrocodone), OxyContin, Percocet (oxycodone), morphine, and codeine. They are miracle drugs for pain relief, but they are highly addictive and have become a devastating public health crisis.
2. Scope of the problem. An estimated 15.5 million people depend on opioids globally, and the burden is particularly high in North America, eastern Europe, and southern sub-Saharan Africa. Around the world, opioid overdose kills 69,000 people annually. More than 2.1 million people in the United States suffer from substance use disorders related to prescription opioid pain relievers.
3. How did this happen? According to the National institute on Drug Abuse, the key causes at a population level are: 1) A drastic increase in the number of prescriptions written and dispensed; 2) Greater social acceptability for using medications for different purposes; and 3) Aggressive marketing by pharmaceutical companies.
4. Too much and not enough. Ironically, while over-prescribing of pain medication has led to an opioid epidemic in the US and other high-income countries, supply of opioid analgesics in most of the world remains far below what is required to address the legitimate medical needs of patients with moderate to severe pain. Clearly we need medications effective in pain management, but we need to consider alternative, less addicting medications as well as polices that promote pain control and reduce risk of addiction.
5. Unintended consequences in fighting the epidemic. Methods to reduce abuse have failed. Several companies have developed crush-resistant pills to prevent snorting, but this led to a dramatic spike in melting and injecting the pills, which in turn led to an increase in HIV infection because of sharing needles. Technological solutions aren’t a silver bullet, and the underlying problem eventually needs to be addressed.
John Oliver cracks some good jokes about constipated dogs and sped-up grandparents, but more importantly, he’s bringing to the forefront a problem that is both tragic and needs to be addressed. “It won’t be cheap, it won’t be quick, and it won’t be easy,” he says. Isn’t that the story of mental health? It’s not cheap, quick or easy. The alternative is to continue losing millions of loved ones as a result of not acting.
