WASHINGTON, DC – OCTOBER 21: Deputy U.S. Attorney General Jeffrey Rosen announces that Purdue Pharma LP has agreed to plead guilty to criminal charges over the handling of its addictive prescription opioid OxyContin during a news conference at the Justice Department on October 21, 2020 in Washington, DC. (Photo by Yuri Gripas-Pool/Getty Images)
Alarming statistics indicate a sharp uptick in opioid-related deaths in 2020. About 90,000 people across the country died from drug overdoses in 2020, up nearly 30% from 2019, when overdose deaths were the leading cause of death in Americans under 50.
Tennessee is far above the national average, with overdose deaths jumping 45% in 2020. Full numbers from the CDC show a country struggling to chart a path forward in a crisis that doesn’t have easy solutions. COVID-19 safety measures have strengthened addiction factors like isolation and economic instability and made treatment scarcer and harder to administer. In the coming years, an effective response will include a fundamental reconsideration of the healthcare system and social context that made the opioid epidemic possible in the first place.
My dad was prescribed opioids sometime in the late 1990s or early 2000s, information that I will never get. He had a history of alcoholism, critical information for any primary care provider. After surgery for a herniated disc, my dad’s official diagnosis became chronic pain. The solution was pain management. He referred to the regular prescriptions of OxyContin as “Medicine for my back,” blurring his addiction with medical advice. I don’t know where or how he sustained a steady supply of pills.
The 64,000 deaths in the US attributed to overdose in 2016 doesn’t include him. He died of a traumatic brain injury suffered after falling down the concrete stairs of the warehouse where he lived. I don’t know if he was drunk or high when he fell. I assume he was. He was houseless at the time and without regular income, presiding over a failing business, divorced, and estranged from his two college-aged kids.
Statistics tell an incomplete story of the opioid crisis. Data is collected when individuals have contact with reporting systems, like emergency services and hospitals, usually during an overdose. Overdoses are the tragic extreme of a crisis of isolation, stigma, and mental and physical health, a crisis playing out in real time across the state and country. It is much harder, perhaps impossible, to capture a complete picture: families who worry, calls going to voicemail, the disappearing money, missing hours and days, all the ways drugs ripple through the capillaries of a community.
The other major development this year that has defined the opioid crisis has been a suite of lawsuits, agreements, and settlements determining the liability of the crisis’s principal architects. With every case, more documents and information suggest that opioid manufacturing, marketing and distribution took place with full knowledge (or willful ignorance) of the potential human consequences.
Purdue Pharma, the multi-billion-dollar drug company built on OxyContin (a reformulation of morphine), appears near a $3.4 billion-dollar settlement for its role in flooding the country with pills. Purdue was founded and is owned by the now-infamous Sackler family, whose members served as the company’s chief executives until 2017. The family’s total wealth is estimated at $11 billion. A week ago, state attorneys general, including Tennessee’s Herbert Slatery, reached a deal around $26 billion with manufacturer Johnson & Johnson and three major opioid distributors.
When and if they settle, these billions will no doubt go towards supporting widely available and easily accessible Naloxone, a life-saving medicine that can save an individual experiencing an overdose. They might help fund community-based mental health resources or medication-assisted addiction treatment, two components of many successful recoveries. Tennessee might see up to $500 million from a single settlement, a boost for the state’s relatively new and vastly under-resourced opioid response.
This overwhelming focus on liability—of the executives who orchestrated an addiction epidemic and made off with the profit, the distributors who turned a blind eye, the doctors who claim not to know better—will save many lives and help rebuild communities. It should not be confused for justice. Real justice for the billions of prescriptions sold as ‘healthcare’ and the families like mine where pills became a household staple would start with an acknowledgement of wrongdoing by those who did wrong. The Sackler family, who sold addiction to millions of people and, adhering to a disciplined legal defense, has yet to admit wrongdoing. The doctors who wrote prescription after prescription. The lawmakers who blocked and continue to hinder access to healthcare for all Tennesseeans regardless of their ability to pay.
The opioid epidemic has laid bare a healthcare system that makes people sick. It revealed the perverse incentives that result when we task profit-seeking drug companies with healthcare delivery. While organizers and lawmakers push for a modern healthcare system that would provide free and accessible care to everyone, a shifting stigma around opioid addiction and drug use must clearly center drug users as victims.
Punitive measures taken against drug users continue to make little sense in addressing addiction, often consigning users to forced withdrawal and increasing the risk of overdose post-incarceration by as much as twelve times. This will take constant reminders that addiction takes a lifetime of treatment and strong support systems. A full understanding of addiction includes recognizing symptoms of addiction as a lack of healthcare. An informed understanding of addiction is required for any state or local response to associated crises like houselessness, mental health, and unlivable economic conditions.
One of the last times I heard from my dad was in an email. He told me he’d hit his head and wasn’t feeling well, but wouldn’t get it checked out. He didn’t trust doctors or hospitals. They were too expensive and they didn’t help. I do not blame him for that.
Over the past twenty years, the largest corporations in America have addicted millions of people, disproportionately poor and rural, to opioids. As we plunge deeper into crisis, and overdose deaths hover at twice what they were in 2015, the American healthcare system has done little to earn that trust back.
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