With his trademark blend of humor, brutal truth and outrage, John Oliver educated America about its deadly opioid epidemic on his HBO show Last Week Tonight, laying much of the blame for its origin at the feet of the pharmaceutical industry.
And with valid reason.
Several decades ago, doctors reserved opioids primarily for end-of-life pain, fearing the addiction risk they presented to patients. Opioid painkillers are a chemical cousin of heroin, after all.
But in the 1990s, when a push began for a more aggressive response to patient pain, the pharmaceutical companies answered with opioids, claiming their addictive potential had been overblown and that in reality only about 1% of users developed problems. That statistic, Oliver noted, came not from verified research, but was plucked by the pharmaceutical companies from a letter to the editor in the New England Journal of Medicine.
Purdue Pharma led the pack with its opioid OxyContin, which was vigorously marketed to the medical community along with free samples, misleading testimonials and swag such as a plush toy gorilla. “And I must say, Purdue,” Oliver noted, “this is the perfect choice of mascot because much like a gorilla, OxyContin might seem appealing but if you’re not careful, it will tear your f—ing life apart.”
By the year 2000, physicians were writing almost 6 million OxyContin prescriptions annually. Doctors loved having a quick and easily solution for pain at hand. Patients loved the relief the pills brought.
The problem, of course, was that despite what the marketing claimed, the opioids remained wildly addictive. But when proof of this began to pile up, doctors on the Purdue payroll responded by putting forward an alternate theory: OxyContin users weren’t addicted. They were experiencing “pseudo addiction,” which was described as “relief-seeking behavior mistaken as drug addiction.” That explanation, Oliver noted, is like Chipotle saying, “Have you heard about this fascinating new thing called pseudo diarrhea?”
In 2007, Purdue and three of its executives were ordered to pay a combined $634.5 million in fines for lying to the public about OxyContin’s addiction risk and its abuse potential.
Damage Control and Beyond
These days, 250 million prescriptions for opioids are written every year. That’s more than enough for every adult in the U.S. to have a bottle of pills.
We’re now trying to clean up the damage and get the genie back in the bottle, Oliver noted. The Centers for Disease Control and Prevention, for example, has called on doctors to default to alternative, non-opioid methods for pain relief, such as physical therapy, whenever possible, and to prescribe as low a dose and as little of the drug as possible when it can’t be avoided.
But the new era of restrictiveness has had unintended consequences. Heroin is now cheaper and easier to get than an opioid painkiller prescription, and that’s led many to turn to heroin as a substitute. In fact, about 75% of those addicted to heroin started with prescription opioids.
So now, not only do we have a prescription painkiller epidemic, Oliver explained, we have a heroin epidemic as well. And the statistics are terrifying: An estimated 2.6 million people age 12 or older were addicted to prescription opioids or heroin in 2015, and the drugs are involved in more than 30,000 U.S. deaths annually.
That means any solutions must take into account those already suffering. “We can’t just work to prevent future addicts,” Oliver said. “We’re going to need to do more to help the millions that already exist.”