I just finished reading the great, albeit incredibly depressing book Dreamland by Sam Quinones. The book outlines what had been a silent epidemic of opioid and heroin addiction that has and is actually concentrated amongst middle class whites.
The CDC estimates that between 1999 and 2016, 200,000 people died of an overdose on prescription opioids. Many more died from heroin and as Dreamland notes, as many as 80 percent of those addicted to heroin started off as prescription opioid users.
It started with the "pain revolution" where many in the medical establishment were trying to liberalize the use of opioids for those with chronic pain. The concern, of course, was addiction. But then came a one paragraph letter to the editor in The New England Journal of Medicine in 1980 by two doctors, Porter and Jick, who had no intent of proving anything. It read in its entirety as follows,
"Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction."
No serious person could think that one doctor relaying his experience in a controlled environment should count for much if anything. But this became the rationale (excuse?) to open the flood gates on prescribing OxyContin and other opioids en masse. Pretty soon, this paragraph was being referenced as a "landmark study" and was cited over 600 times in medical journals.
Perdue Pharma lead the way in basically prescribing different versions of heroin to people, often for relatively minor injuries. More and more got hooked. Then Mexican drug cartels, particularly from one small town named Jalisco started created franchises of sorts all over the United States. This match made in Hell pushed the opioid scourge throughout middle America.
Things may finally be turning, hopefully. There have been several large lawsuits against Perdue Pharma and others and doctors are becoming more careful about prescribing these drugs. President Trump has also declared the opioid epidemic a public health emergency. But the malice and stupidity that allowed it to get this far are truly incredible.
"Every day is a new life to the wise man."
The Righteous Mind
Star Slate Codex
Consulting by RPM