The Blame Game

Who’s to blame?

That’s the question rolling off of everyone’s lips as we hit the halfway point in the year 2017’s record breaking opioid epidemic. By the way, this epidemic does not only belong to 2017; it is shared amongst 2016, 2015, 2014, 2013, and 2012 as well.

So who’s fault is this epidemic? What direction should my finger be pointing, I wonder. With whom should I lay my guilt upon?

Should it be “Big Pharma”?

Companies like Purdue and other billion dollar pharmaceutical companies that proudly tote a license to kill in the form of FDA approval for several opioid analgesic medications utilized deceptive marketing practices to create an enormous demand for their precious medicinal gold. Since the creation of OxyContin in the 90’s and a few major lawsuits later, many would believe that the pharmaceutical companies are what triggered such staggering numbers of the addicted in this country.

In the spirit of instinctual response, my body feels the urge to lunge at the throats of these pharmaceutical executives, but once I allow higher thinking to surpass what Freud would describe as my “id,” I’m not sure I can blame them for this epidemic entirely.

Did they contribute to it in a major way? Sure, there is no doubting that. They did what major companies do best and capitalized on a market in the most disgusting possible way. They used deception, clever marketing, and common sense to push a drug that’s been abused for thousands of years disguised in pill/lozenge/patch/liquid-form onto the medical community. They saw an opportunity to make lots and lots of money, which, in the eye of a stock holder, is the only statistic that matters.

But hey…it’s not personal. It’s just business, right? There is no doubt that what the pharmaceutical companies have done over the past couple decades is deplorable, and without them, this epidemic wouldn’t be even close to what it is today. With that being said, they were the moss that added to the stone that was already rolling down hill. They aren’t the root of the issue, they just added a whole lot of kerosene to the fire.

Doctor Doom

I can’t discuss blame without mentioning the doctors that took the Hippocratic oath, yet seem to be more concerned with increasing the wait time in their waiting room than actually treating a patient. I feel the need to mention that what I’m about to say, in no way, describes all doctors. There are many doctors out there working with pure intentions and goals that benefit the greater good.

The doctors I’m bringing up here are the ones that went from owning a pill mill to a treatment center following the yellow brick road of currency.

Or the ones who claim they are treating pain with compassion by prescribing multiple month scripts of narcotic pain medications but fail to mention the addictive nature of these medications.

The mentality seems to be that it’s easier to manage the symptoms than treat the problem, but can we say they are the root of the opioid epidemic? Again, I feel they may be major contributors to the problem, but not the match that started the fire.

Commander in Chief, is it you?

The natural thing to do in blame the man in charge. Plain and simple, when things are going wrong, you look up the ladder to the guy on top.  For a while, President Obama was even blamed for milk spoiling too quickly.

In this case, tens of thousands of addicts die each year as we cry out to the government for help, yet the number of overdoses continue to rise month after month. Lots of talk and pretty words supported by kept hairstyles and regal suits are spoken, yet no major change seems to be occurring. The news stations report that this bill or that bill is being proposed, but it reminds me of the employee that draws circles on his desk all day to make it appear that he is busy; at the end of the day, there is little to show for his efforts.

The conspiracy theorist in me wants to blame money for the reason politicians aren’t making a real effort in this issue. As long as the politicians keep getting visits from lobbyists that line their pockets with dough, their agenda will never be pure nor will their efforts be thorough.

I also believe that they flat out don’t know what the solution to this problem is. They aren’t doing much about it because they don’t know how to fix the state of the nation. Rick Scott’s famous “listening tour” in Florida led to what? Thirty Million dollars? What is that supposed to fix? Not to mention, they are using that money to fund mostly Medication Assisted Therapy (MAT) based programs, which is a fine method of temporary harm reduction (if done correctly), but is most certainly not a long term solution to a nationwide epidemic.

They don’t know how to fix the problem because the problem can’t be solved at a governmental level. The problem is way too weaved in and out of daily life.

So what is the problem, in my opinion?

The Perfect Storm

Twenty years ago, when I was ten years old, technology was limited to TV’s, beepers, huge brick cell phones, and a Nintendo 64. The internet was in the early years of emergence and a tech boom was on the horizon. I would go outside when I got tired of playing Mario Kart and engage in a “house rules” variation of hide and go-seek with the neighborhood kids.

Suddenly, the tech boom arrived and within two, short decades we have been able to accomplish some of the most incredible things that as a ten-year old, I only dreamed of. Phones that give me access to all the information I could ever need and double as miniature television screens, websites that ship any item to my door with the click of a button, cars that can drive themselves, services that pick food up for me that I can order through an app, and so on.

Our heads are buried in our phones as we deny friend requests on Facebook from some guy in Bangladesh, scroll through pictures of our high school crush on Instagram, and send “snaps” we shouldn’t be sending on Snapchat.

It’s a new world, a world that offers a wide array of over-stimulation and over-simplification. The issue with that is, from an evolutionary stand point, humans weren’t ready for the world we live in today. Generationally, we’ve been endowed with the ability to adapt to challenging situations. A stressor appears and as we get through it we build new neural pathways learning to adapt to that particular type of stressor. In today’s world, though, many of the common challenges we’ve adapted to as a species have been very quickly taken away. Now, add the constant stimuli of social media, all knowing google searches, and apps that can accomplish anything, and our brain doesn’t know what to do with itself once a stressful event occurs. We’re being coddled and suffocated at the same time!

Now, working simultaneously with the tech boom as it emerges, the creation of new psychiatric medications begins trending. You have a feeling you don’t like? There’s a pill for it now-a-days. Suddenly, we find ourselves waist deep in a social norm that states “Have a problem?…Pop a pill and that problem goes away instantly.”

The Root Cause

You see, the opioid epidemic wasn’t created by the pharmaceutical companies, over-zealous doctors, or a lack of governmental attention. It wasn’t even the Mexican cartels that flooded our streets with potent heroin as well as the synthetic versions of it. The problem was simply exacerbated by all of them! The epidemic started before them on a societal level. Essentially, what I am saying is, they all struck right at the perfect moment when American society was at it’s most vulnerable state.

Think of society as a match and the pharmaceutical companies, doctors, government, and cartel as gasoline. The match is lit then thrown near a barn full of hay. Now the flame from the match would have just burned out near the barn and no harm would have been done, but then here comes the gas covering the entire barn as it splashes near the match eventually igniting the entire barn up into flames.

It’s no secret that the generation known as “millennials” are being hit the hardest by the opiate epidemic. Hundreds of 20-somethings die every day from accidental overdose. It’s also no secret that during these so called “millennials’” life span is when the tech boom and normalizing of psychiatric intervention occurred. The generation that gets so highly criticized for unfounded entitlement, poor work ethic, and an inability to cope with life’s difficulties are being killed off by deadly substances. But it’s not their fault, they…we were born into this.

Some have adapted better than others but as a majority, the millennials are struggling because they weren’t equipped to handle such rapid changes of this magnitude. No one was. They are the ones who were born into and began growing up in one world, and then suddenly, with the snap of a finger, found themselves living in another.

An instant gratification society has been created, fostered by the perfect mix of technology, medications, and clever (yet evil) businessmen and women. The ideal breeding ground to spawn addicts has been formulated and we are living in it!

So what now?

Well, now…now we find hope. Hope that as this generation ages, it catches up, at an evolutionary level, to the “world of rapid growth”. We slowly begin to holster the hoses that are spewing gasoline on this fire by better regulating the pharmaceutical companies and medical community. We educate the nation on the dangers of opioids, benzodiazepines, amphetamines, marijuana, alcohol, etc... And things eventually normalize. What goes up, must come down…right?

Or, on the other hand, we chalk up this generation as a loss and begin focusing our efforts towards the generations after us. We can hope they are born well-adjusted, learn from their predecessor’s mistakes, and find new ways to cope with life. We all know the two-year old that can work an iPad like a champ already. Maybe, they are simply being born better equipped than we could ever be.

The reality is that as treatment center owners’ and operators we must adapt our therapy to this ever-changing population. The National Institute for Health is currently working with a number of private partners to help adapt Substance Abuse Disorder treatment to meet the current needs of today’s addict. The inclusion of overdose reversal training, opiate specific therapies, and new non-addictive treatments for pain are a step in the right direction.

Realizing the pessimistic undertone in my saying that we “chalk this generation as a loss,” I want you to understand I’m half-joking. I don’t think this will be an easy task to change the way we treat those struggling with substance abuse disorders. We basically will need to evaluate all of our current treatment modalities and throw out what isn’t working. With that being said, though, I feel as if with proper clinical expertise, adaptive treatment teams, long-term community support, and an innovative focus, people can still achieve long lasting recovery in today’s times.

Like I said…now we find hope.