Dopesick Resurrects an Opioid Narrative That Is ‘Neat, Plausible, and Wrong’

It takes two and a half minutes TrailerFor the Hulu Miniseries DopesickThis could be enough to revive the myth behind America’s failed opioid policy. Non-medical drug users are driven to deadly and dangerous black market drugs. This policy stigmatizes and causes pain patients to despair, anguish and suicide.

This miniseries is based on Beth Macy’s 2018 powerful article Buchen DopesickSam Quinones 2019 book, and. Dreamland, validated policymakers who subscribe to the false narrative that America’s overdose crisis is the direct result of doctors over‐​treating their pain patients with opioids and turning them into “addicts.” Although I don’t have the opportunity to watch the entire series yet, the trailer clearly shows that it is about “good versus evil”: deceitful executives from pharmaceutical companies manipulating compassionate doctors who care deeply about their patients and exposing them to dangers that could lead to addiction. Doctors like myself who have published research about opioids should be concerned by the lack of nuance.

State and federal policymakers were convinced they had identified the root cause of the opioid overdose crisis. They embarked upon a coordinated effort to decrease prescriptions of opioids in the hope that this would stop the rise of overdose deaths. Per 100 people, prescriptions of opioids have increased. DroppedFast 50 percent increase in overdoses since 2012. Nearly simultaneously, overdose rates have risen from approximately 40,000.To be released in 2012. 93,0002020

The trailer’s viewers see Purdue’s pharma sales reps instructing them, “These magic words: ‘less that 1%’ are your most effective talking points.” Then, a series of sales representatives repeating the phrase “less than 1%” to different doctors encourages them to give opioids to patients. Dramatic music accompanies an investigator saying, “Purdue continues to lie about the drug’s safety—to doctors, patients, and the FDA.” DopesickMacy was the executive producer for this miniseries. statesThese scenes are not exact, but are drawn from extensive research.

At least 2 Cochrane Systematic ReviewThey meet the highest standards StandardsMedical research has shown that addiction rates to long-term opioids in chronic pain patients with non-cancer conditions (e.g., cancer) are around 1%. Nora Volkow (National Institute on Drug Abuse) and Thomas McLellan (National Institute on Drug Abuse) are the only ones to do so. SubmittedIn the New England Journal of MedicineIn 2016, it was discovered that opioid prescribing is unpredictable and does not lead to addiction, “unlike physical dependence or tolerance.” Addiction occurs in only a small percentage of persons who are exposed to opioids—even among those with preexisting vulnerabilities.”

One problem with the misleading narrative is that people tend to confuse physical dependence and tolerance with addiction. The two are very closely connected. Long-term use of many drugs can lead to physiologic adaptation. This means that higher doses are required in order to achieve the desired results. Sudden withdrawal may cause severe, sometimes even fatal, withdrawal reactions. High blood pressure, among other ailments, can be treated with beta-blockers. Sudden withdrawal could prove fatal. However, no one would call people who have hypertension and are on beta blockers for many years “beta-blocker addicts”. Tolerance and dependency can also be caused by many other drugs such as antidepressants or antiepileptics. On the other side, addiction is defined as compulsive use despite adverse consequencesIt is possible to. Addiction can be described as a compulsive behavior disorder. It is often associated with preexisting psychological comorbidities and early developmental traumas.

This narrative fails to mention that overdoses continued growing long before OxyContin was approved by the Food and Drug Administration in 1996. Researchers at the University of Pittsburgh provide clear evidence that overdoses from non‐​medical drug use have been growing The rate of growth has been exponential since the 1970sDifferent drugs are more prevalent among overdoses at various points in the time.

The media reported that white middle-class Americans were becoming more addicted to prescription opioids. Policymakers have stuck with the story.

Macy writes in her book that “Americans account for 4.4 percent” of all opioids consumed. Doctors were encouraged (correctly) to treat the problem. OpiophobiaThis led to them neglecting pain and more prescriptions were written. In turn, this meant that more prescription opioids could have been diverted to black markets. H.L Mencken famously said, “there is always a solution to every problem—neat, plausible, and wrong.” The idea of blaming the drug companies and doctors for the overdose epidemic seemed reasonable. There are many powerful stories such as those in DopesickAnd DreamlandThese solutions were fuelled by such people. Jacob Sullum, Michael Schatman and I highlighted this in the Journal of Pain ResearchIn 2019, the government has released data No evidence has been found to support any type of correlation between the number of opioids prescribed and the non‐​medical use of opioids or of opioid addiction.

Certain doctors, pharmacists and other healthcare professionals used their licenses and degrees to cover the lucrative business of drug selling. However, doctors who treat pain patients shouldn’t be blamed for doing so. BlameDrug prohibition The powerful incentive of prohibition is to CorruptDoctors, pharmacists and sales representatives for drug companies who are looking to make a living from the underground trading.

The main victim of this crime is, at the end of it all, a pound of flesh. Dopesick The Sacklers’ Purdue Pharma won’t stop overdose rates from rising. The majority of non-medical drug consumers have moved away from prescription painkillers that are more dangerous and diverted. There were 93,000 deaths from overdoses in 2020. 70,000 were opioid‐​related, 83 percent of which involved illicit fentanyl. Prohibition has fueled the black market which meets very effectively demand. 

Based upon a neat, plausible, and wrong narrative, policymakers cast in stone the then‐​controversial Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain—United States, 2016This was done to make clear that the CDC did not intend to establish “settled science” but rather general guidelines to assist practitioners.

The CDC was aware of misinterpretation of and misuse of its 2016 guidelines. advisoryApril 2019. In April 2019, the agency declared in December 2019. PlannedIt will be updating its guidelines. FDA hosted a meeting to update its guidelines.Workshop for the public“I asked last August if the evidence for dosing with morphine milligrams equivalents supported my hypothesis.

Just recently, the Drug Enforcement Administration lowered production quotas of all prescription opioids. Sixteeth year in a rowWhile doctors fearlessly undertreat chronic pain, they also abruptly stop prescribing medication to patients who have had a positive and productive life.

Unfortunately, patients in pain are often the true victims Victims of the false narrative, with documented increases in mental anguish and suicide from untreated or under‐​treated pain. Suicides number in the top ten. VeteransThe Veterans Health Administration has reduced opioid use and the prices of prescriptions have risen dramatically.

The COVID-19 crisis has taught us a lot. That biological science is not always settled and often nuanced. And that simple explanations can sometimes be wrong. Hulu has released a miniseries to try and ignite passions about the misguided opioid policy.