Regarding Opioid Abuse

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In recent years, the news seems has become more and more filled with stories about the abuse of opioids in the United States. There is also good reason for this as according to the Los Angeles Times, there are approximately 400,000 people in the United States who have died as a result of opioid overdoses since 1999 (Healy, 2019). In addition, according to the Los Angeles Times, about 1.7 million Americans are currently addicted to prescription opioids and about 652,000 Americans use heroin, of which about 80% are thought to have started on that road through the misuse of prescription narcotics (Healy, 2019). I argue that if these figures are indeed true, then it is quite troubling. The big question in this situation seems to be how this country ended up in this situation and what to do about it? In my view, the answers are a combination of factors.

            One of the factors that I argue has led to this situation is the tendency for companies, pharmacies, and doctors in the United States to put profits ahead the interests of the patient. I am not saying that this is the case for all companies, pharmacies, and doctors in the United States, but I would argue that there are many who do put profit ahead of the interests and welfare of the patient. A well-known example of this is the case of various tobacco companies who according to the American Lung Association, were found to have been covering up the health risks that are associated with smoking and were targeting children with these products for decades (American Lung Association, 2019).  In addition, according to the American Lung Association, the major tobacco companies were found to have “Concealed and suppressed research data and other evidence that nicotine is addictive (American Lung Association, 2019). This sounds very familiar when compared to the situation at hand with opioids.  In addition, another example is that according to USA Today, there are tens of thousands of surgeries that are performed each year by doctors that patients don’t actually need (Eisler and Hansen, 2013). Again, I argue that at least a part of this a profit before the interest of the individual type situation, especially because of the fee for service system that I would argue is still very prevalent in the United States, where medical workers are paid for every procedure they do.

      In my view, these are all indications of a cultural phenomenon where profit comes first and the best interest of the client/patient comes after. Again, I am not saying that all corporations and individuals behave in this way, but I do argue that there are many corporations and individuals in the United States where this kind of mindset is present. While in my view there are similar phenomena that exist in other countries as well, I argue that it is more pronounced in the United States. Sometimes, it seems that if left unrestrained, capitalism in the United States could lead to some very terrible things. I would argue that capitalism can be a very good thing, but that without some kind of regulation, many people, at least in the United States, seem to get carried away.

            One part of a solution, in my view, could be implementing stronger regulations on the pharmaceutical industry, requiring them to provide more education to people on the dangers of certain substances, and making corporate social responsibility a larger portion of education for the people studying the field of business and those already working in the field of business. Also, I argue that there should not be heavy marketing of pharmaceutical drugs on television. According to the BBC, The United States and New Zealand are the only two countries in the world where advertising of prescription drugs is allowed on television (Amos, 2017). I would argue that this just contributes more to what I see to already be a pill heavy culture, and I believe it should be minimized or perhaps outright banned. In addition, I believe that corporate social responsibility should be a larger part of other educational programs and fields, such as the field of medicine. I believe that doctors should also be monitored and supervised more in regards to what kinds of prescriptions they write and how often they write them. Finally, I argue that pharmacies should also be monitored and supervised more in how often they fill opioid medications for their customers.

            While I do think that pharmaceutical companies, doctors, and pharmacies should undergo changes, I argue that part of the current problem with opioids has to do with the mindset of patients as well. In particular, in my view, there seems to be a strong culture of medication in the United States. There seems to be a pill for everything and people sometimes just seek out pills, when in reality they may not be necessary. Of course I believe that pills have their place and that they help a lot of people, however, I would argue that in many cases, people in the United States like to look for a quick fix. It seems to me that sometimes people think that just taking a pill could fix all the problems in their life.

In addition, I would argue that this kind of mindset applies to many doctors in the United States as well.  As an example, according to the BBC, there was a study done in 2016 which compared the rate at which American doctors and Japanese doctors prescribed opioids and the result was that Japanese doctors treated acute pain with opioids 47% of the time, as compared to 97% in the United States (Amos, 2017). So overall, I would argue that in the US, many people seek out pills that they may not necessarily need and visit doctors that are also very willing to prescribe these medications that the patient might not necessarily need. I am not saying that this happens in all situations, but I do think that there are many situations where a patient just wants a quick fix with a drug and the doctor is willing to write a prescription for the drug, whether or not the patient really needs it, or will even benefit from it.

           This aspect of the problem is a little more difficult to solve, in my view, because I would argue that it would take a large change in the mentality of a large part of the population. I argue that pharmaceutical drugs certainly have their place and help a lot of people, but at the same time, I would argue that many people take them who do not really need to and most likely experience unpleasant side effects to one extent or another. I would argue that to some extent, there have been some changes to the general mindset of the population in regards to their consumption of pharmaceutical drugs. In my view, nowadays, more people are trying to get off of their pharmaceutical drugs and using other therapies and coping skills to deal with their problems.

             A third aspect to the problem of the opioid addiction situation could be that people in the United States could be feeling more depressed and stressed than before and might thus be more inclined to try to self-medicate with opioids.  According to Psychology Today, in a recent study, more than 10% of the people in the study had depression that was function impairing during the last 12 months and approximately 20% of the people in the study had at some point in their lives experienced depression (Rubin, 2018).  In addition, according to Psychology Today, depression was almost twice as common in women as compared to men (Rubin, 2018).  While it seems to be pretty commonplace to hear on the news about how common depression is in the United States, in my view, the question is whether it has increased in recent times. According to Psychology Today, the rates of depression that were found in the recent study are higher by at least 50% as compared to the rates from the study performed about ten years earlier (Rubin, 2018). 

   The other question here is whether the increase is a result of a change in methodology regarding diagnosis or whether there is a true increase in the incidence of depression (Rubin, 2018). Interestingly, according to Psychology Today, an increase in the prevalence of depression is supported by other studies that show increases in indicators of depression and suicidality and that even if some of the increase has a relation to the methodology used, that it still seems that a growing number of people are struggling with depression (Rubin, 2018).  Another interesting aspect to this is that according to Psychology Today, the investigators from the recent study found that other problems were common for people struggling with depression (Rubin, 2018). Specifically, some of the other problems that investigators identified were substance use disorders and anxiety disorders (Rubin, 2018). Additionally, some of the things mentioned by Psychology Today were that 58% of people with lifetime major depressive disorder had substance use disorder, which included alcohol and nicotine disorders as well as others and that 37% had an anxiety disorder (Rubin, 2018). Again, an interesting question here is that if depression really has been increasing in recent times, what are the reasons for this?. I would argue that if depression really has become more common in the United States, that the reasons for this are quite complicated. In my view, perhaps some of the reasons are that there are some serious problems with health insurance in the United States and that employees, for the most part, don’t seem to have good benefits that are available to people in many other developed countries, such as paid family leave, and a good amount of vacation time and sick time. 

              Overall, in my view, some of the major contributors to the current opioid epidemic are the profit over interest of the patient mindset of some pharmaceutical corporations, doctors, and pharmacies. Additionally, I would argue that the mindset of the general population regarding the use of pills for most things also contributes to this situation. Finally, I would argue that it is entirely possible that depression has been increasing in the United States and that this has also contributed to the current opioid epidemic, with people perhaps trying to self-medicate and eventually just getting addicted. In my view, some of the things that can be done to try to remedy the situation are stronger regulation of pharmaceutical companies, doctors, and pharmacies. In addition, I would argue that teaching corporate social responsibility and ethical business practices in universities and companies could also help to change the profit over patient interest mindset that some people and companies seem to have. Also, I would argue that reducing or eliminating marketing for pharmaceutical drugs on television and educating people about other therapies to replace or reduce pills, could also be helpful. Additionally, I would argue that more research needs to be done to try to determine why more people in the United States are struggling with depression, if indeed that is the case.  Finally, I would argue that it would also help the situation if the US had universal healthcare and better benefits for all employees such as paid family leave and a good amount of vacation and sick time.     

 

References

  • American Lung Association. (2019, January 29) (Last updated). The Gavel that Unraveled the Tobacco Industry: 10 of the Most Appalling Facts about Tobacco Company Misdeeds from the Famous Federal Court Ruling.  Retrieved from: https://www.lung.org/our-  initiatives/tobacco/reports-resources/sotc/by-the-numbers/10-appalling-tobacco-facts.html
  • Amos, O. (2017, October 25). Why opioids are such an American problem. Retrieved from: https://www.bbc.com/news/world-us-canada-41701718
  • Eisler, P. and Hansen, B. (2013, June 19). Doctors perform thousands of unnecessary surgeries.  Retrieved from: usatoday.com/story/news/nation/2013/06/18/unnecessary-surgery-usa-today-investigation/2435009/
  • Healy, M. (2019, September 18). Who’s to blame for the nation’s opioid crisis? Massive trial may answer that question. Retrieved from: https://www.latimes.com/science/story/2019-09-17/opioid-lawsuit-who-is-to-blame
  • Rubin, E. (2018, August 9). Depression in the United States—an Update. Retrieved from: https://www.psychologytoday.com/us/blog/demystifying-psychiatry/201808/depression-in-the-united states-update  

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Eugene Bel
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