I tried my first opioid drugs a few weeks ago. First it was Hydrocodone. Then a few OxyContin. Then a dose of morphine.
There were no memorable highs as a result. The opioids that are causing a national health crisis became my friends as I battled the excruciating pain of a kidney stone — my first experience enduring unbearable pain. Those powerful pills were legally — and very carefully — administered in a hospital setting to help me through three painful days of waiting for the stone to pass.
Thankfully, the pain disappeared once the stone was removed surgically, and that ended my intake of major league drugs.
The path from pain relief to a drug-induced, life-threatening high is frighteningly simple. A patient suffering from a chronic condition is prescribed a pain reliever like the drugs mentioned above. Unfortunately, for too many, the pain source doesn't disappear with a 30-minute medical procedure as mine did — and neither do the opioids.
It was coincidental that my opioid experience occurred in the middle of doing research for a public forum on the opioid crisis set for Sept. 7 at St. Petersburg College where I administer programs to inform the public. That research raised my awareness of the benefits and hazards of these ubiquitous pills. And it brought a whole new awareness of pain — my own, and that of those other 999,999 Americans annually suffering chronic pain who need help getting through a day.
How opioids became the go-to drug for pain — and a national epidemic — can only be described as bizarre. It involves a letter to the editor of the New England Journal of Medicine published in January 1980, followed six years later by release of a study of 38 non-cancer patients who were treated for pain with opioids. The letter, signed by two researchers at Boston University Medical Center, reported that only four of 11,882 patients treated with opioids for pain developed an addiction to them. The 38-patient study, by a doctor at Memorial Sloan Kettering Cancer Center, reported that only two of the 38 patients treated with opioids became addicted.
The conclusion drawn from these studies: Opioids are safe. Said the Sloan Kettering researcher: "Opioid maintenance therapy can be a safe, salutary and more humane alternative" to surgery or less effective pain relievers.
Literally, this is what many say broke doctors' resistance to prescribing opioids for pain: A one-paragraph letter to the editor of a medical journal, and one doctor's study of 38 patients. That's how skimpy the research was back in the 1980s and '90s.
Well, there was this one other additional factor that helped seal the deal with opioids for pain treatment. The Joint Commission, an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States, published a book in 2000 that was required reading for doctors. That book cited studies that claimed "there is no evidence that addiction is a significant issue when persons are given opioids for pain control." And, it pooh-poohed doctors' concerns about addiction side effects as "inaccurate and exaggerated."
Guess who sponsored the book? Purdue Pharma.
Bingo. Purdue Pharma, the same 124-year-old Stamford, Conn.-based pharmaceutical company that in 1992 produced — wait for it — OxyContin. According to Forbes, OxyContin has generated the majority of Purdue's $35 billion in sales, and in 2015 put the company's owners, the Sackler family, at No. 16 on Forbes’ list of richest U.S. families (net worth $14 billion).
I'm not saying Big Pharma is to blame for the opioid epidemic. But others do. The attorney general of Ohio, one of the states hardest hit by the opioid crisis, filed a lawsuit in June against a number of pharmaceutical companies, including Purdue, accusing them of sponsoring million-dollar marketing campaigns that "trivialize the risks of opioids while overstating the benefits of using them for chronic pain." At least four other jurisdictions have filed similar suits.
Holding the pharmaceutical companies legally responsible for this opioid crisis may not be as far-fetched as it seems. The litigants are using the precedent set by attorneys general in the '90s to take down Big Tobacco for its cover-up of the hazards of smoking.
Then there's the China factor. The Chinese are responsible for manufacturing a great deal of the deadly fentanyl and carfentanyl opioid analogs that are responsible for the overdose tsunami.
So, to sum up the blame game for the opioid crisis: It's lousy research. It's blasé doctors. It's Big Pharma. It's China. It's American consumers' wimpy aversion to pain. All of the above.
So what are the solutions? Look to the Sept. 7 forum "The Drug Epidemic: How Opioids Became a Death Machine" from 6 to 8 p.m. at SPC's Seminole campus to provide additional insights into not just causes of the crisis but also its effect on the local community. Information can be found at http://solutions.spcollege.edu. It's free, but advance registration is requested.
David Klement is director of the Institute for Strategic Policy Solutions at St. Petersburg College and a retired journalist. He wrote this article exclusively for the Tampa Bay Times.