Over the years, stories of addiction to painkillers in the United States have become increasingly common. From 1999 to 2018, almost 800,000 people died of overdoses, and in 2017 alone, there were 70,237 deaths, double the number of 10 years earlier.
To understand how it all began, we need to take a step back. Although cancer cases in the United States remained stable from 1995 to 1999, the number of deaths from the disease fell steadily during the same period. In those years, cancer treatments became more effective, and kept more people alive. However, there was a price to pay: patients had to deal with long and painful therapies. Meanwhile, in an economy whose expansion had been based on industry for decades, it was hard to find adults who didn't have some form of ailment. The life expectancy of the middle class was lengthening enormously, but it was often accompanied by unbearable pain.
In 1996, a US pharmaceutical company, Purdue Pharma (which belonged to the Sackler family) introduced a new opium based painkiller. It went by the name of OxyContin. Drugs derived from opium are the most powerful and effective painkillers in circulation: they block pain by acting on the brain’s receptors, but above certain doses they also cause a sort of euphoria, and if used regularly, they lose effectiveness and are addictive. Several similar drugs soon hit the market. The pills worked, but their effectiveness rarely lasted the 12 hours promised on the box, and even though these drugs required a prescription, many Americans began to take more than they were prescribed.
A national discussion then began to emerge about the lack of attention doctors were paying to this issue. Newspapers repeated that doctors underestimated patients' pain, and that opiates were safe. This media frenzy helped make doctors more sensitive to the issue, but it also persuaded them that they could prescribe these drugs without worrying about it. This was the trigger for the perfect storm: a new sensitivity of public opinion, strong pressure from the government, and a shift in the health conditions of millions of people at a time of great economic development in the second half of the twentieth century.
By the turn of the new millennium, American cities were flooded with billions of opiate-based pain pills, and hundreds of thousands of people became addicted to them. Before long, getting these drugs became easier because certain people realised there was money to be made, and doctors started writing fake prescriptions. Pharmacies did the same. The black market for drugs was thriving, it was highly organised, and it was everywhere. Even the drug cartels understood that there was money to be made, so they too jumped on the bandwagon, and flooded American cities with another opium derivative, heroin, which was much cheaper than painkillers.
American doctors have always been more likely to prescribe painkillers to white people than black people, because of a prejudice that leads them to believe that black people are more likely to abuse drugs. The result of this prejudice was that 90% of the people who started using heroin in the United States after 1980 were white, despite the stereotype of the black addict.
The death toll from drug abuse was the highest the country had ever seen. So much so that from 2016 to 2018, for three consecutive years, life expectancy in the United States decreased rather than increased. This hadn't happened since 1915-18, when World War I and the Spanish flu killed millions of people around the world.
Today things are beginning to change. In August 2019, the pharmaceutical company Johnson & Johnson was sentenced in Oklahoma for the misleading advertising of its opioid-based painkillers, and had to pay a settlement of $572 million for describing their products as safe and necessary, despite being aware of the related risks. Every US state has already been hit by, or is in the process of having to pay similar reparations. Meanwhile, drug abuse still remains very high. In 2018, the number of people who died of overdoses in the United States decreased for the first time in thirty years. The latest budget laws approved by Congress have allocated tens of billions of dollars to train doctors and health personnel, to set up structures to help curb the epidemic, and to give cities and states more effective tools to get things under control. The US public has become more sensitive to the issue: it is now impossible to discuss the country’s financial crisis and its consequences, or for that matter the nation’s deindustrialization and the conditions and needs of the middle class, without talking about the opioid crisis.