Sunday, November 21, 2021

Dopesick, or Dead

It was recently announced that more than 100,000 Americans died from overdoses between April 2020 and 2021, which was about a 25% increase in a single year. About 70% were men between the ages of 25 and 54, according to stats reported in the New York Times.

The abrupt increase in a year is notable, of course, but the particulars of drug type within the increase is also important:

(Click to enlarge and you'll see the Fentanyl label on the graph's lower right area, accounting for the upswing in recent years.)

Fentanyl, which is more potent by orders of magnitude and is, reportedly, being mixed into other street drugs without users' knowledge, is clearly responsible for a lot of the increase in overdoses.

Why are people taking fentanyl? 

The other change that has happened in this trend line over more years than just the most recent one was the decrease in availability of Oxycontin. Its creator, Purdue Pharma — now bankrupt because of legal action — originally induced the demand for opioids across huge swaths of the country and when they were finally forced to stop their unconscionable, greedy acts, they left behind broken people who needed a fix.

And there was fentanyl, ready to take the place of Oxy. Here's a story that gives an example of how that goes.

According to this August 2021 Atlantic article,

Starting around 2010 or 2011, events converged in ways that made prescription pills less widely available. Law enforcement cracked down on pill mills, the maker of Oxycontin made the pill harder to crush, physicians tightened their prescribing practices, and more states created prescription registries to help identify people who were obtaining prescriptions by “doctor shopping” — that is, by seeking prescriptions from multiple physicians at the same time. Many people who abused pills turned to heroin, which was cheaper and easier to get. Several years later, illicitly sourced fentanyl, 50 times as potent as heroin, intensified the death toll.

Can you tell I've been watching Dopesick on Hulu? Yes, you can. Three episodes (out of eight) left.

From it, I've learned a few facts I never knew, and wish I didn't have to know:

  • There is a Drug Advertising Hall of Fame. (Well, that should make it easy to know who to lock up some day.)
  • Purdue's FDA approval basis and early marketing claim that less than 1% of people who used Oxycontin would become addicted came from a five-sentence letter to the editor in the New England Journal of Medicine. That letter was based on observational data of a small number of patients who were prescribed opioids for a short time while confined to the hospital.
  • The FDA reviewer who approved the "unprecedented" label for Oxycontin that allowed its over-prescription by doctors even though it was a Class 2 narcotic, went to work for Purdue within two years.

Watching Dopesick makes me realize how insulated I was and still am on a day-to-day basis from the effects of all this. But it's hard not to see that the destructiveness of drug abuse in rural areas and small towns plays some kind of role in our current political situation. People mourn what's lost and they're looking for someone to blame. The ultra-wealthy and corporations are spending big to point populist anger at everyone except the ones who are really responsible.

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