America has a pill problem. According to the Mayo Clinic, nearly seventy percent of Americans are on one or more prescription drugs, and about twenty percent regularly take more than five. Blame it on Big Pharma’s unique relationship with the media. America is one of only two countries in the world that allows drug manufacturers to conduct direct-to-consumer advertising. The other is New Zealand.
All of this advertising has helped to create a pill-popping culture that’s always on the lookout for the next big wonder drug, and for a worrying number of Americans, that wonder drug seems to be hydrocodone, an opioid marketed under the names Vicodin and Lortab, among others. Despite accounting for only five percent of the world’s population, Americans are responsible for ninety-nine percent of the world’s hydrocodone consumption.
Opioids are chemically similar to the street drug heroin, and can be just as addictive. Both are based on opium: a drug derived from the seed pods of Papaver somniferum, a species of wild poppy. According to Opium: A History by Martin Booth, the plant was probably first cultivated in ancient times somewhere in the Middle East or Asia Minor. Regardless of where it first came from, opium and its derivatives can now be found just about anywhere.
Here in the United States, more people died in 2014 from overdoses of opioid painkillers than from any illicit street drug — some 19,000 in all. In reality, the line between street drugs like heroin and prescription drugs looks like a very steep slope. Addicts sometimes turn to heroin when their prescription drug sources dry up, and communities that have problems with one often have problems with the other. Sam Quinone’s book Dreamland is a shocking look at this hand-in-hand relationship.
According to the National Institute on Drug Abuse, prescriptions for opioids have grown dramatically in recent years. There were 76 million such prescriptions in 1991 and almost 207 million in 2013. While almost all of the states have systems in place to monitor the number of opioids prescribed by doctors, not all of them have safeguards to prevent addicted patients from visiting multiple clinics to get the drugs they need. There is no national database, meaning there’s little preventing addicts from traveling over state lines to get their prescriptions filled. (Of course, for some tech-savvy addicts, scoring opiates can be as easy as checking their spam folders. Check out Joshua Lyon’s memoir Pill Head for a look into this hidden world.)
The lack of effective oversight regarding opioids has paved the way for so-called “pill mills”: fly-by-night clinics where unscrupulous doctors prescribe the drugs to addicts and dealers with little to no therapeutic pretense. Criminal operations like these can be just as brutal as any street-level drug cartel. Physicians at one of the biggest, the Florida mega-clinic American Pain, regularly wore guns under their lab coats according to John Temple’s book American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic.
In recent years, Florida and other states have enacted laws aimed at cracking down on these kinds of clinics with varying degrees of success, but controlling the availability of opioids will probably take a coordinated response on a national level. Nationally tracking opioid prescriptions would certainly be a good first step, as would reevaluating how we educate young doctors about pain management and addiction, along with encouraging more frank and open discussion between doctors and their drug-dependent patients.
Addressing America’s pill problem will also require that the pharmaceutical industry accept its own culpability. Recently, the American Medical Association called for an end to all direct-to-consumer drug marketing, but without action from congress, the drug companies aren’t likely to do this on their own.