Dear America: The Opioid Epidemic Is Not New, But Thanks For Caring

Earlier today, we brought you Goldman’s latest on America’s opioid epidemic in which the bank outlines the possible implications for the labor market (and for the US economy more generally) of America’s affinity for prescription painkillers.

In the introduction to that post, we mentioned a letter we received earlier this week from a reader whose take on the opioid epidemic is eye-opening to say the least.

We don’t have any way of knowing how accurate the following is. But given what we do know about how long it usually takes for the mainstream media and the government to recognize a problem and given how often those problems are misdiagnosed once they’re finally recognized, we’re willing to go out on a limb and say it sounds pretty spot-on to us…

**********

Dear H,

America is finally waking up to the opioid epidemic.

Great.

Now if only everyone (including the government) weren’t two decades late.

I can’t speak for the whole of Appalachia, but I what I can tell you is that in the late 90s and early 2000s there was already an epidemic in some parts of the region.

All of those things everyone is suddenly talking about – you know, Vicodin, Percocet, OxyContin, fentanyl, etc. – yeah, that’s old news in some parts of Appalachia. And, I’d wager, it’s old news to a lot people in other parts of the country that have been dealing with this for going on two decades.

Vicodin, seriously? You want us to think you know something about this and you’re calling it Vicodin? Come on, man. They were “tabs” and then later they were “hydros.” Oxycodone, seriously? They’re “percs.” OxyContin has always been “oxy” – plain and simple on that one.

High schoolers were stealing these from family-owned drug stores back in 1999 and handing them out at parties in Appalachia. Let that sink in. They were so readily available and easy to get ahold of that people were literally giving them away in makeshift baggies made from the bottom of cigarette pack cellophanes. You’d throw five or six in there and seal the top by melting the plastic with a lighter.

Again, these little gift packs were free. This was before anyone even figured out there was enough demand to warrant slapping a price on them. And indeed, by giving them away, demand was created out of thin air as an entire class of high school kids suddenly realized that class was a lot more fun if you’d just eaten a couple of tabs.

Oh, and as for all those stories about fentanyl you’re reading, well, guess what America? Kids in Appalachia were riding around licking fentanyl suckers back when Nelly was still at the top of the Billboard.

And it wasn’t just opioids. There was plenty of Xanax and any other benzodiazepine you wanted. In fact, “benzos” were so easy to get that no one even bothered with anything but “totem poles” – that would be the strongest Xanax they made. In other words, you didn’t have to “settle” – as it were. The strongest version was just as readily available as anything else.

And don’t forget about tramadol. You didn’t know about tramadol did you? Yeah, turns out Ultram is highly addictive and do you know what else? You can eat a lot of more of those without dying than you can opioids and the street value at the time was only $0.50 each versus $1 a milligram for tabs, percs, and oxys.

The problem with all of this is that those high school students eventually grew up (well, the ones who didn’t die and there were more than a few who did).

And around the same time they all graduated, a thriving black market developed for all the drugs listed above. Prices went up. Suddenly it wasn’t kids stealing from their parents’ pharmacies anymore. It was young adults getting to know older people with legitimate prescriptions. And those people quickly figured out just how lucrative a business this could be.

It got shadier and shadier from there.

The medical community tried to curb addiction with something called Suboxone – you’ve probably heard of it.

Well guess what? People got hooked on it too and before you knew it, the orange Suboxone wafers that dissolved under your tongue were going for $30 each on the street. Worse, an entire racket grew up around the clinics that gave out the Suboxone prescriptions. It was just legalized drug dealing. Walk in, pay at the counter, say you’re an addict, and boom, you’ve got a Suboxone prescription. The only choice you had to make then was whether to become a Suboxone dealer or a Suboxone addict. You can probably guess what most people chose.

This, friends, describes the experience of an entire demographic that was unlucky enough to be in high school in Appalachia from 1998 to 2002.

So please, America, do that group of people a favor, will you? Spare them the stories about how you know what’s going on and how much you really care. Because so far you haven’t done shit and it’s been damn near 20 years.

Oh, and please stop explaining how you’re doing a bang up job arresting Mexican cartel leaders. Because putting “El Chapo” behind bars isn’t going to do a single goddamn thing to keep prescription pills out of people’s mouths.

**********

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2 thoughts on “Dear America: The Opioid Epidemic Is Not New, But Thanks For Caring

  1. I don’t know about Appalachia but this rings very true here in Ontario. Lots of kids did them when I was younger including close friends. I saw the price of 80mg OxyContin go from 10$ to 160$ over the span of roughly 5 years. And those fentanyl patches? Yeah, those went from free to 20$ to 400$ over a similar time frame. Could be way higher now, I’ve got no clue since I haven’t spoken to any of those people in years. I am no stranger to prescription drug recreational use (abuse?), but there is no fucking way I would touch these things for fun (even if they are the proverbial ‘king’). Oxycodone is on par with heroin for potency, but the much higher bioavailability means you can eat or snort it to reach similar effects to heroin injection (ignoring the ‘rush’).

    But anyway, the spotlight on the ‘opioid epidemic’ is probably due to illicit fentanyl coming in from China. Problem with heroin is you still need to smuggle it in by bricks cause your neighbors would probably notice a field of poppies growing in your yard. Now take fentanyl, where you can put an amount equal to a standard sugar packet and make about 50,000 doses (yes you read that correctly; no BS).

    When you start fucking around with a drug where a grain of sand gets you high but 5 grains of sand kill you, you are bound to get some media attention (and a shit ton of overdoses to go with it). Although prescription opioid overdoses are more common, people are typically less shocked. Less shock = less media attention.

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  2. And to exacerbate the enormity of this catastrophic health problem plaguing every strata of life, add this to the picture:

    “Of the 115 million prescriptions written for these painkillers each year in the United States, 60 million are for adults with mental illness, according to the researchers.

    “Despite representing only 16 percent of the adult population, adults with mental health disorders receive more than half of all opioid prescriptions distributed each year in the United States,” study lead author Matthew Davis, assistant professor at the University of Michigan School of Nursing, said in a university news release.

    “Prescription opioids include drugs such as OxyContin and Vicodin. Widespread use of opioids for pain has led to an epidemic of addiction in the United States. Forty lives are lost to prescription drug overdose every day, according to the U.S. Centers for Disease Control and Prevention.

    “Study co-author Brian Sites said that “because of the vulnerable nature of patients with mental illness — such as their susceptibility for opioid dependency and abuse — this finding warrants urgent attention to determine if the risks associated with such prescribing are balanced with therapeutic benefits.” Sites is an anesthesiologist at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

    “About 39 million Americans have been diagnosed with a mental illness. Among these people, more than 7 million (18 percent) are prescribed opioids each year. In adults without mental illness, just 5 percent are prescribed opioids, the study authors said.

    “The researchers said the link between mental illness and opioid prescribing is particularly concerning because mental illness is also a major risk factor for overdose and other opioid-related harms.

    “The study is scheduled to be published online July 6 in the Journal of the American Board of Family Medicine.”

    http://www.medicinenet.com/script/main/art.asp?articlekey=205159

    I was unable to find the study at the current issue page of the Journal of the American Board of Family Medicine, perhaps one of you can: http://www.jabfm.org/content/current

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