A perfect storm of blame: human nature and the opioid crisis

Perhaps the greatest transgression in deconstructing any crisis is the sin of pride. Journalists write righteous articles chronicling the devastating aftermath as if doing so somehow obscures the fact that they didn’t catch on in the first place while it was happening. Politicians legislate the tail end of the issue in a self-congratulatory posturing of getting at the truth while never bothering to examine the source of the matter. And the real players in the orchestra pit—the ones fiddling away at their respective parts in pursuit of their passions—are tone-deaf to the collective disaster they are creating

Here is the sad fact: when it comes to crises, humans seek to cast blame rather than admit that the source of crises is found in our nature. That’s right: we are born to generate crises—and we are all to blame—yet we proudly act as if the fault lies elsewhere. Such is the case with the opioid crisis.

Let’s start with the easy explanation: It’s Big Pharma’s fault. The articles continue to come out demonstrating Purdue Pharma’s rigorous promotion for their brand, OxyContin, as being a “less addictive” drug than other opiates. It’s human nature to advocate for your goods. And it’s easy to believe why this may be true. The time-release technology of OxyContin tablets creates a slower uptake of the drug, thereby avoiding the “rush” of other opiates—a craving that abusers seek. Now it appears that Purdue was aware of the abuse potential but continued to push hard for sales. That’s irresponsible. But Purdue isn’t Big Pharma. It’s an isolated example in an industry that more often produces some great answers to peoples’ suffering from illness. So is it Purdue’s fault? Well, it is and it isn’t.

It’s the FDA’s fault, then. The FDA, as it does with all regulated therapies, negotiated with Purdue Pharma on what’s called a “label.” A label is the fact sheet that is set in stone when talking about what the product can and cannot claim. In order for Purdue to make the claim that OxyContin is “less addictive” that other opiates, it must—by law—have studies to prove it. Purdue didn’t do such studies. And the line in the label that the FDA co-wrote is this: Delayed absorption as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” “Believed to reduce???” What is the U.S. Opioid EpidemicThe FDA shouldn’t have allowed such a line without clinical trials proving the claim. That’s irresponsible. Who knows what the FDA assumed. Could it be that they thought that physicians would use the drug in clinical practice and see for themselves? It’s human nature to make such an assumption, as the medical credo is “first do no harm.” So is it the FDA’s fault? Well, it is and it isn’t.

It’s the doctors’ fault, then. They are the learned intermediaries preventing patients from doing harm to themselves by taking drugs they shouldn’t be taking. The problem is that for most patients with intractable pain, OxyContin and other opioids are the only practical alternative. If you’ve been in a car accident or fractured a vertebrae or incurred an injury where the pain is excruciating and chronic, you are going to want to manage the pain by any means necessary. (What do you hope a doctor gives you after a painful procedure?) Physicians face a Hobson’s choice: either treat with medicines that are insufficient to abate the pain and are non-addictive, or use opioids, which are effective yet addictive. What would you do: let people suffer or take away their pain? It’s human nature to relieve suffering. Now some doctors criminally violate their position by doling out opioids such as OxyContin to people without legitimate medical conditions. That’s irresponsible. But for the overwhelming population of doctors, they were only giving patients what they thought was in their best interests. So is it the doctors’ fault? Well, it is and it isn’t.

It’s the patients’ fault, then. Many take the drugs not to get high but rather to feel normal and pain-free. But others ignore the doctor’s directions and take them more often than they should. It’s human nature to take your own pain away. And then there are the people with legitimate pain who hoard opioids and sell them to people who want to get high and, in turn, become addicted to them. It’s human nature to anesthetize the burdens of life’s challenges with pills or booze or whatever. It’s also irresponsible. So is it the patients’ fault? Well, it is and it isn’t.

And so on.

Law enforcement will bring Purdue Pharma and pill-mill doctors to justice. Politicians will vote some inane legislature that will only make matters worse, like jailing addicts or preventing the sale of opioids as a class. Journalists will write exposés on the “epidemic” that’s taken hold of our society in pursuit of admiration. And the rest of us not in intractable pain will shake our heads at the weakness of those who are addicted to OxyContin and other opioids. It’s human nature to prejudge those unlike you. But none of these measures will resolve the crisis. In fact, the more that people assign blame, the more heated the crisis becomes.

As time goes on, maybe Big Pharma will come up with better solutions. Or maybe a non-medical industry will invent a safe way to manage severe, chronic pain. Or maybe, as a society, we institute better programs for addiction and less judgment of addicts. Or maybe politicians will allow other untried substances, such as marijuana, to be studied for their analgesic properties (if any). Or maybe none of these will occur and everyone will continue to point fingers at other parties. It’s human nature to abhor change.

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