If you’re like me, you’ve probably heard something about an opiate epidemic in the United States. But if you’re like me, you might have no idea how bad that epidemic really is. More than a quarter of a million Americans have died from overdoses in the last 15 years, and the problem is getting worse. And yet many of us know nothing about it.
I’ve heard bits and pieces about the problem in various places. As the candidates for the 2016 election have made appearances in various towns, people have asked about the heroin epidemic–and that’s part of the problem, because it’s not really a heroin epidemic per se. As an opiate, heroin certainly plays a role, but prescription drugs are at least as common as heroin, if not more common. And notably, the prescription pad is generally where this epidemic originates.
Hooked by the Prescription Pad
Doctors writing prescriptions are probably to blame for one of the more odd and interesting aspects of this epidemic: It’s running rampant through communities of white Americans, particularly middle-class and upper middle-class whites, but is much less problematic in communities of color. That runs counter to stereotype and past patterns of drug addiction1, and experts point to racial stereotype and bias as the likely explanation.
Put simply, doctors are statistically less likely to write opioid prescriptions for black patients. Studies suggest that doctors worry about black patients becoming addicted or selling their prescription drugs on the street. White patients trigger no such concern, and many critics believe doctors have been much too quick to prescribe opiates for white patients. In effect, racial bias has shielded the black community from a devastating epidemic.
In response to the perceived over-prescription, a movement arose to limit or stop opioid prescriptions entirely, but this is partly blamed for pushing Americans hooked on prescription opioids like vicodin and oxycontin toward illegal opioids like heroin. VICE recently ran a good piece about the consequences for patients with chronic pain who believe they need opiates. When their doctors refuse to continue the prescription, many turn to illegal drugs. Some simply suffer through the limitations of daily pain; others commit suicide.
A personal aside here: In 1995, I fractured a vertebra in my back, and my physician at the time wanted to send me home with a 30-day morphine prescription. A nurse cautioned my parents that at the end of a month I would be a “screaming addict,” and so my parents balked and instead I got 30 days worth of enormous ibuprofen tablets. One more reason to appreciate their judgment.
Life in the Bubble
I finally woke up to the severity of America’s opioid problem thanks to The United States of Anxiety, a joint production of WNYC and The Nation magazine. I highly recommend the podcast, which not only touches on the addiction issue, but other matters of race and class that have led the US to the situation we find ourselves in today.
One of the points made on that program is about the way we today live within “echo chambers,” physically and intellectually isolated from those who differ fro us, and how that can create a bubble in which we are unaware of issues affecting other communities. I’ve long recognized that phenomenon in politics, but the idea that it would lead to a hidden epidemic killing hundreds of thousands of Americans is startling.
One expert points to the fact that the epidemic has been ongoing since about 2001, and yet President Obama barely mentioned it until 2015. The reason, he suspects, is that the President himself is in a bubble, and he just didn’t know about it.
That’s astounding, and immensely problematic. But it’s hard for me to be too judgmental, when I myself had no idea.
On this same subject I’d also highly recommend you check out an episode of the NPR podcast Embedded, which takes listeners inside an HIV outbreak in Indiana linked to abuse of the prescription opioid Opana. It’s pretty dark, but as I listened I found myself questioning whether drug companies are deliberately producing presciption opioids with the intent of addicting users.
- The crack epidemic of the 1980s, for instance, was generally seen as a black problem, but the use of cocaine (of which crack is just one form) was consistent across all races; white people just tended to use powdered cocaine more frequently than crack. The way this particular epidemic was represented in the media is another illustration of the way race shapes the way Americans perceive reality. ?