Cleaveland: A home-grown humanitarian crisis

The rosy economy offers oportunities to fix or work on social issues, such as the proliferation of opioidsr.
The rosy economy offers oportunities to fix or work on social issues, such as the proliferation of opioidsr.

Imagine an infectious disease that killed 190 Americans every day with no evidence of subsiding. The president would likely declare a national emergency. We would expect mobilization of every health-related agency of federal and state government to address the outbreak. Public and private laboratories would direct their efforts to find a cause and a cure. Physicians and nurses would deploy to treat victims in the hardest-hit regions. The media would relentlessly track the fatalities and the efforts to find a solution until a vaccine or medication was perfected that would end the outbreak.

photo Dr. Clif Cleaveland

Addiction and deaths related to drug overdoses represent a man-made, noninfectious epidemic that annually takes a growing toll of wrecked or terminated lives.

Recently released data for 2017 reveal more than 70,000 deaths occurred from drug overdoses, a 9.6 percent increase from the previous year. Opioids accounted for more than 47,000 of those deaths with a sharp increase in fatalities related to synthetic opioids - fentanyl and car-fentanyl. An estimated two million Americans are addicted to opioids.

An estimated 14,000 Americans died from cocaine overdose among the five million who used the drug during 2017.

About 10,000 Americans died from use of methamphetamine and other stimulants. Some deaths resulted from mixtures of multiple drugs and alcohol.

Countless family members and friends suffered from the deaths of loved ones. Prompt intervention by first responders and emergency department staff prevented many thousands of additional drug-related deaths.

"Dopesick: Dealers, Doctors, and the Drug Company that Addicted America" by Beth Macy is a searing investigation of the epidemic of addiction and deaths related to opioids. The sustained rise in addiction began with the introduction and aggressive promotion of oxycontin (OC) in the late 1990s. The manufacturer claimed that the new opioid was less addictive because of a sustained-release formulation. Physicians received gifts and other inducements to prescribe OC. Representatives of the manufacturer earned large bonuses for promoting the drug.

Some physicians, oblivious to the risk of addiction, over-prescribed OC for injuries and other painful conditions. A few physicians engaged in criminal dispersal of the drug to individuals who would resell the tablets at great profit.

Individuals who became addicted to OC would pay large premiums to purchase the drug on the black market. They would crush tablets to inject the drug intravenously. When this supply failed, they often turned to heroin. An addicted person might steal or become a distributor to fund their habit.

Warnings from community physicians who began to see serious addiction from OC slowly gained traction. In 2001, the Drug Enforcement Administration began monitoring the distribution of OC.

Use of OC relentlessly spread from rural to suburban to urban populations. Civil suits were filed against the manufacturer, which fought each charge vigorously. A federal suit in Virginia charged the manufacturer with mislabeling OC to minimize the risk of addiction. A settlement in May 2007 required the manufacturer to pay $600 million in fines and three of its executives to pay $34.5 million for fraudulent marketing of OC.

Macy weaves in the stories of addicted people and the loved ones who used every resource at their command to rescue a son or daughter from the grips of OC and heroin. One tragedy unfolds after another. Relapses are frequent after inpatient and outpatient efforts at rehabilitation. Private, inpatient care depletes the finances of families. States and communities vary in quality and availability of addiction services. We celebrate the occasional conquest of addiction.

"Dopesick" offers invaluable insights into a deeply, troubling, largely uncontrolled epidemic of opiate addiction. The book presents a challenge to each of us to mobilize the resources to prevent new cases and to provide effective rehabilitation for people caught in the deadly grip of opioids.

Contact Clif Cleaveland at ccleaveland@timesfreepress.com.

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