The Sentinel series helped set the template for what was to become the customary narrative for reporting on the opioid crisis. Social worker Brooke Feldman called attention to the prototype in 2017:
Hannah was a good kid....Straight A student....Bright future. If it weren't for her doctor irresponsibly prescribing painkillers for a soccer injury and those damn pharmaceutical companies getting rich off of it, she never would have wound up using heroin.Feldman, who has written and spoken openly about her own drug problem, knows firsthand of the deception embedded in the accidental-addict story. She received her first Percocet from a friend years after she'd been a serious consumer of marijuana, alcohol, benzodiazepines, PCP, and cocaine.
Indeed, four months after the original "OxyContin under Fire" story ran, the paper issued a correction: Both the handyman and the executive were heavily involved with drugs before their doctors ever prescribed OxyContin. Like Feldman, neither man was an accidental addict.
The story, of course, was the one about the accidental addict. But to what purpose?
Some reporters, no doubt, simply hoped to call attention to the opioid epidemic by showcasing sympathetic and relatable individuals — victims who started out as people like you and me. It wouldn't be surprising if drug users or their loved ones, aware that a victim-infused narrative would dilute the stigma that comes with addiction, had handed reporters a contrived plotline themselves.
Another theory — perhaps too cynical, perhaps not cynical enough — is that the accidental-addict trope was irresistible to journalists in an elite media generally unfriendly to Big Pharma. Predisposed to casting drug companies as the sole villain in the opioid epidemic, they seized on the story of the accidental addict as an object lesson in what happens when greedy companies push a product that is so supremely addictive, it can hook anyone it's prescribed to.
Whatever the media's motives, the narrative does not fit with what we've learned over two decades since the opioid crisis began. We know now that the vast majority of patients who take pain relievers like oxycodone and hydrocodone never get addicted. We also know that people who develop problems are very likely to have struggled with addiction, or to be suffering from psychological trouble, prior to receiving opioids. Furthermore, we know that individuals who regularly misuse pain relievers are far more likely to keep obtaining them from illicit sources rather than from their own doctors.
In short, although accidental addiction can happen, otherwise happy lives rarely come undone after a trip to the dental surgeon. And yet the exaggerated risk from prescription opioids — disseminated in the media but also advanced by some vocal physicians — led to an overzealous regime of pill control that has upended the lives of those suffering from real pain.
To be sure, some restrictions were warranted. Too many doctors had prescribed opioids far too liberally for far too long. But tackling the problem required a scalpel, not the machete that health authorities, lawmakers, health-care systems, and insurers ultimately wielded, barely distinguishing between patients who needed opioids for deliverance from disabling pain and those who sought pills for recreation or profit, or to maintain a drug habit.
The parable of the accidental addict has resulted in consequences that, though unintended, have been remarkably destructive. Fortunately, a peaceable co-existence between judicious pain treatment, the curbing of pill diversion, and the protection of vulnerable patients against abuse and addiction is possible, as long as policymakers, physicians, and other authorities are willing to take the necessary steps. (...)
Many physicians... began refusing to prescribe opioids and withdrawing patients from their stable opioid regimens around 2011 — approximately the same time as states launched their reform efforts. Reports of pharmacies declining to fill prescriptions — even for patients with terminal illness, cancer pain, or acute post-surgical pain — started surfacing. At that point, 10 million Americans were suffering "high impact pain," with four in five being unable to work and a third no longer able to perform basic self-care tasks such as washing themselves and getting dressed.
Their prospects grew even more tenuous with the release of the CDC's "Guideline for Prescribing Opioids for Chronic Pain" in 2016. The guideline, which was labeled non-binding, offered reasonable advice to primary-care doctors — for example, it recommended going slow when initiating doses and advised weighing the harms and benefits of opioids. It also imposed no cap on dosage, instead advising prescribers to "avoid increasing dosage to ≥90 MME per day." (An MME, or morphine milligram equivalent, is a basic measure of opioid potency relative to morphine: A 15 mg tablet of morphine equals 15 MMEs; 15 mg of oxycodone converts to about 25 mg morphine.)
Yet almost overnight, the CDC guideline became a new justification for dose control, with the 90 MME threshold taking on the power of an enforceable national standard. Policymakers, insurers, health-care systems, quality-assurance agencies, pharmacies, Department of Veterans Affairs medical centers, contractors for the U.S. Centers for Medicare and Medicaid Services, and state health authorities alike employed 90 MME as either a strict daily limit or a soft goal — the latter indicating that although exceptions were possible, they could be made only after much paperwork and delay.
As a result, prescribing fell even more sharply, in terms of both dosages per capita and numbers of prescriptions written. A 2019 Quest Diagnostics survey of 500 primary-care physicians found that over 80% were reluctant to accept patients who were taking prescription opioids, while a 2018 survey of 219 primary-care clinics in Michigan found that 41% of physicians would not prescribe opioids for patients who weren't already receiving them. Pain specialists, too, were cutting back: According to a 2019 survey conducted by the American Board of Pain Medicine, 72% said they or their patients had been required to reduce the quantity or dose of medication. In the words of Dr. Sean Mackey, director of Stanford University's pain-management program, "[t]here's almost a McCarthyism on this, that's silencing so many [health professionals] who are simply scared."
by Sally Satel, National Affairs | Read more:
Image: uncredited
[ed. Finally, a voice in the wilderness. Relatedly, I'd like to see a more nuanced discussion on the topics of dependency and addiction. The author (like everyone else) assumes anything addictive is unquestionably bad (especially if it's something that makes you feel good). If you need insulin, are you dependent and an addict? Of course, but who would deny insulin to a diabetic, and what's the difference? How might the world look if people had a steady and reliable supply of medications, for whatever reasons? Couldn't be much worse than it is now and might solve a lot of social problems. RIP Tom Petty and Prince.]
