A major epidemic in America, which seems to me to have received rather less publicity than its scale would warrant, is the dramatic increase in the number of deaths in the country from overdose of prescription opioids. In 2010, for example, there were 16,500 such deaths, more than four times as many as at the turn of the century. This century so far more than 100,000 people in the United States have died from overdoses of prescription opioids.
Mostly these drugs were prescribed for various kinds of chronic pain, for which they are singularly ineffective. What, then, accounts for their prescription in ever-larger quantities? It is unlikely that the American population is several times more pain-afflicted than it was a few years ago. Moreover, the drugs are not new—very similar drugs have been available for a long time.
There are, it seems to me, three main factors. First, drug companies have pushed their products enthusiastically, using the kind of advertising that busy or gullible doctors all too often fall for. Open any medical journal and you will find advertisements for these products, the ad industry having long since found means of lying without actually telling untruths.
Then doctors are only too pleased to be able to prescribe something or other in order to bring consultations to a quick end, and thus see more patients than if they linger. Doctors these days are not allowed as they once were knowingly to prescribe harmless placebos, so they have to prescribe something that they think might conceivably work (such as a painkiller for pain), even if it is potentially dangerous and overall does more harm than good. Patients with chronic pain, or who say they have chronic pain—not always the same thing—are moreover difficult and demanding, and without a prescription a single such patient could easy take up the doctor’s morning or afternoon. As literary theorists would put it, a prescription brings “closure.”
Finally, there are the patients. It is not usual to say anything against patients, of course, because—ex officio, as it were—they are suffering from something, otherwise they wouldn’t be patients. Even people who fake illnesses, provided they do it long and consistently enough, are now said to be suffering from an illness (it isn’t easy to escape, evade, or even avoid the compassion of the medical profession). True, the great medieval physician, Maimonides, prayed that he would never see in a patient anything other than a suffering human being; but he practiced more than 700 years ago, and patients—or at least some of them—have changed since then.
Quite apart from the fact that many doctors have felt threatened, or even been attacked, by patients of the opioid-enthusiast type, patients are less willing than ever before meekly to accept a doctor’s advice that, say, an opioid would do them no good. If patients don’t get what they want these days, they complain not merely to higher authority, if there is one, but on the Internet, that great magnifier of intemperance and instrument of cowardly revenge. A good doctor for such types is one who does exactly what they want him to do, like a butler or shop assistant. The patient is the customer and the customer is never wrong.
The result has been catastrophic, if the deaths of more than 100,000 people count as a catastrophe. Dishonest drug companies, careless, supine and cowardly doctors, and egotistical patients who will not take no for an answer have between them caused an epidemic that, had it been attributable to a bacterium or a virus, would have caused widespread panic and calls for all the research resources of modern medicine to be brought to bear upon the problem.
This hasn’t happened: Why not? Part of the reason, surely, is that the victims of the epidemic are also the cause of it, or at least willing participants in their own disaster. A death from opioid overdose is not something that, in the vast majority of cases, happens to the victim like a thunderbolt from the sky. In many if not most cases, he will not have taken the medicine as prescribed, he will have lied to the doctor to manipulate him, and so on and so forth. Of course, our ideology these days says that lying to doctors is itself either a disease or at least a symptom of a disease; but the still, small voice of common sense prevents the population from accepting it in its entirety. Hence its indifference to the problem.
Considering how much of a share the medical profession has in the blame, its response has been muted, to say the least, perhaps from a guilty conscience—or so I should like to believe. It often seems as if the arcana of rare diseases are of more interest to it than the deaths of scores of thousands of its patients by overdoses of the drugs it has negligently prescribed.
However, a couple of weeks ago an article in the New England Journal of Medicine did tackle the question. That is the good news. The bad news is that it was written by what President Bush (H.W., that is) would no doubt call “those folks” down at the National Institute on Drug Abuse, an organization that might be defined as that criminal conspiracy to extract money from Congress for its own ends by pretending and propagating the view that drug addiction is a chronic relapsing brain disease, for which the solution is—yes, you’ve guessed it—medical treatment, above all with drugs.
The NIDA seems to me like a financial adviser who bankrupts his client and then tells him that, now more than ever, he needs financial advice. First doctors create millions of addicts with their wretched prescriptions, then they tell them that they need treatment, because now they have a disease—they are persons with (yes, with) addiction! The sheer gall of it! I’ve known more honest confidence tricksters. At least they didn’t write articles in trade journals.
However, the world has ever been a wicked place and personally I’m glad of it: for without easy targets like the NIDA, what would we scribblers do?
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