Regarding Opioid Abuse

Home >> Blog >> Regarding Opioid Abuse

             In recent years, the news 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). 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? I argue that 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 of 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 there are probably 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 is a profit before the interest of the individual type situation, especially because of the fee for service system that is in the United States.  This type of system can unfortunately incentivize doctors to order unnecessary tests and
procedures to generate more income (https://prognocis.com/what-is-fee-for-service-in-healthcare/).

            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 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. Capitalism can be a very good thing, but without some kind of regulation, many people, at least in the United States, seem to get carried away, and human values seem to go out the window.

            One part of a solution 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, 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). This can just contribute more to what is already a pill heavy culture in the United States, and it should be minimized or perhaps outright banned. In addition, corporate social responsibility should be a larger part of other educational programs and fields, such as the field of medicine. Doctors should also be monitored and supervised more in regards to what kinds of prescriptions they write and how often they write them. Finally, pharmacies should also be monitored and supervised more in how often they fill opioid medications for their customers.

                 While I do believe 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, 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 medications can have their place and they help a lot of people, however, it seems like 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 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 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, because I argue that it would take a large change in the mentality of a large part of the population. 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 today’s day and age, I feel like more people are trying to use less pharmaceutical drugs less and instead use 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, an important 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. 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.  Some additional reasons may be things like a culture that at least traditionally has been more about “live to work” as opposed to “work to live”, a culture that tends to be “sink or swim”, and a culture that is overly focused on money and materialism and often seems to put profits ahead of basic human values and the best interest of the patient, client, etc..  This needs to change.  

              Overall, I argue that some of the major contributors to the opioid epidemic are the profit over the 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.  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 argue that teaching corporate social responsibility and ethical business practices in universities and companies could also help to change the profit over the best interest of the patient type mindset that some people and companies seem to have.  I argue additionally, that a return to basic human values is very important as well.  One thing that can be helpful here is learning basic principles from spirituality.  This is not about some kind of religious/ritual approach. It is about basic human values such as kindness, compassion, and connection and a sense of belongingness with all of humanity and the whole world (Gurudev Sri Sri Ravi Shankar and the Art of Living Foundation). I argue that this can make a big dent in the the whole “profit over the best interest of the client, patient, etc.” situation.  Spirituality can also help people to shift their focus from a more outward obsessive type of pursuit of money and material possessions to try to find happiness, to something more meaningful and internal, because true happiness is inside of us, not outside of us (Gurudev Sri Sri Ravi Shankar and the Art of Living Foundation). However, at the same time, it is important to note that this does not mean that people can’t have a career or make money, or have friendships or relationships etc..  The problem is when people view these things as some kind of ultimate source of happiness and condition their happiness too much on these things.

              I also 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, more research should 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 argue that it would also help the situation if the US had at least some kind of adequate universal healthcare and better benefits for all employees such as paid family leave and a good amount of vacation and sick time.  Having better support systems in place to help those who are struggling and to help prevent people getting to the point where they are struggling, would be important as well.       

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/
  • Gurudev Sri Sri Ravi Shankar and the Art of Living Foundation
  • 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 
  •  
  • https://prognocis.com/what-is-fee-for-service-in-healthcare/

         Photo by Michael Longmire on Unsplash

Eugene Belilovsky

Scroll to Top