Opioid Nation

Scene from Nurse Jackie

Scene from Nurse Jackie

Opioid Nation

Anne Timms considers America’s Problem with Prescription Drugs

“More Americans die every year from drug overdoses than they do in car crashes”, as President Obama pointed out, grimly, in an address to the nation in September. The picture this paints is one of a drug-crazed nation, awash with dangerously addictive substances gobbled down like sweeties by irresponsible users. If the statistics regarding the level of opioid addiction in the USA are to be believed, it’s not much of an exaggeration. Here in Britain, we think we know what opioid addiction looks like. It’s an underground problem, affecting only those who are willing to illegally source their mysterious powders, pills, and liquids. Think of an opioid addict and it’s likely that you’ll picture a hollow-eyed, trembling, criminal type who lives huddled in doorways and keeps dubious company. However, it was not these kinds of people to whom President Obama was referring. America’s problem is not one of illegal drugs, but of legal ones – handed out by doctors, no less, and taking thousands of lives each year. “…most of these deaths aren’t due to drugs like cocaine or heroin – but rather prescription drugs”, the President continued. How on earth did the USA get itself into this situation? What has caused their perilously close relationship with prescribed opioids? And why on earth are they taking so many medicines in the first place?

Medicated Nation

Americans take more medicated drugs than people of any other nation – and pay through the nose for them while they’re at it. In all fairness, this is partially because they’re not a particularly healthy bunch of people. Everyone knows that America has a major problem with obesity. Obesity produces a lot of health conditions which in turn require a lot of medicines. Then there’s the fact that, like most developed nations, America has a high population of elderly people. The older you get, the more prescribed drugs you tend to require. However, this doesn’t entirely explain the astonishing prevalence of prescribed drugs in medicine cabinets across the United States. It’s estimated that 70% of Americans are on a course of prescription medication at any one time, and 20% of visits to American doctors result in a prescription for powerfully addictive opioid analgesics. By contrast, the number of people on prescription meds in the UK is around the 47% mark, of which opioid prescriptions account for a very small fraction. Conditions which a Brit would either ignore or struggle through – headaches, sniffles, and so on – would have an American racing for an instant chemical fix. It’s ostensibly a strange phenomenon, considering that Americans pay an awful lot for visits to the doctor and prescribed medicines, while our NHS is free and our prescription charges low. So what’s going on?

Big Pharma?

A lot of accusatory glares have been levelled at that increasingly demonized entity known as ‘Big Pharma’. It is perhaps not surprising that a healthcare system based almost entirely upon profit should give birth to companies which advertise and push their product. It’s often posited that big, corporate manufacturers of opioid painkillers have worked hard to get their drugs prescribed for relatively minor ailments, resulting in an enormous upsurge both in opiod prescriptions and in the number of people who think that they need such things. As a result, the taking of powerful drugs, and a total belief in permanent bodily perfection has become normalized within American culture to such a degree that not even a minor headache will be countenanced. In Britain, we’d think that scoffing a potently addictive opioid for a hangover is not only palpably stupid, but pathetically weak to boot. In America, it’s normal – and pharmaceutical advertising may well have something to do with this. Some people certainly think so. Last year, the city of Chicago and two Californian counties brought lawsuits against a range of pharmaceutical companies in which they claimed that said companies had knowingly and deceptively encouraged the prescription of opioid analgesics for conditions in which they were not needed, thus contributing to the public health crisis that is the prescription drug addiction epidemic. Several of the complaints have been dismissed (others remain under investigation), but the allegations have stuck in the public’s mind. An increasing number of sources are even bringing up the fact that opioid painkillers are frequently a gateway to the insalubrious world of heroin addiction, and pointing the finger at ‘Big Pharma’ over the recent upsurge in American heroin usage.

Attitudes And The FDA

In truth, it may well be a lot more complex than simple corporate greed (isn’t it always?). Part of the problem is American culture in general. Americans are a ‘quick fix’ nation, and they like things to be as powerful as possible. They don’t believe that the good enough is ever good enough – aspiration towards perfection is an American value. The way this translates into their attitude to healthcare is that any physical imperfection must be eradicated immediately. If this is pain, it must be dealt with with the strongest and most effective painkiller going – opioids. Plenty of Americans believe that if a drug is prescribed by a doctor, it must be safe – and thus slip easily into addiction through the simple process of taking a bit more than they should because it’s a ‘bad day’ for pain. There’s no denying that opioids feel good, so why wouldn’t one slip an extra Vicodin or Zohydro every now and again – particularly if it was given to you in the first place by a doctor, who surely knows what’s good for your health? Then there’s the fact that America’s drug regulatory body, the FDA, is relatively toothless. This stems from deregulation in the eighties, when the FDA was stripped of many of its powers in order to speed up the approval process for drugs which could help AIDS sufferers. From this undoubtedly worthy cause stemmed a culture in which drugs could be easily pushed out onto the American market without undue interference from the FDA.

What Can Be Done?

Arguments are currently raging back and forth within the USA. Some people want ‘Big Pharma’ to be brought to heel, and curbed with regulations. Others point out that pharmaceutical companies produce a lot of very necessary medicines, and the onus should be on stopping people from stumbling into addiction through education. A combined approach would seem to be the most rational – but the fine details of this will take a long time to percolate through the vitriolic and politically-charged American healthcare debate. In the meantime, Americans will continue to pop pills, and will continue to die as a result.

ANNE TIMMS is a freelance writer who has worked in the healthcare industry

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