Pain and Pleasure – The opioid crisis in the U.S. turned into an epidemic. It all started with OxyContin and its marketing campaign by Purdue Pharmaceutics
About human fragility– U.S. facing unprecedented opioid crisis – all eyes on Fentanyl
It is all over every kind of platform. Newspapers frontpages, major news websites headlines, international coverage – but also foreign affair ministries, global news outlets, the DEA and the Council on Foreign Relations’ online pages. Everybody seems to be talking about Fentanyl. And with good reason. A drug up to fifty times more powerful than heroin, Fentanyl is the undisputed star of the opioid crisis – an epidemic that is killing more than anything else in the U.S. – and in the U.S. more than anywhere else: deaths associated with opioid overdoses all over the world combined do not get close to the U.S.’s.
Either to consume it, produce it, smuggle it, or fight against it, everybody seems to be chasing Fentanyl – but the history behind the opioid crisis goes far back in time, leading to the relationship between pain and pleasure, the intuition of a pharmaceutical company, and a ruthless marketing campaign. Underlying human fragility when it comes to addiction.
The scale of the U.S. opioid crisis – number one death cause for the 18-45s since 2019
Starting in the early 2000s, the U.S. opioid crisis has reached unprecedented levels of threat but spiked in recent years. Since 2019, indeed, opioids have become the leading cause of death in the eighteen-to-forty-five demographic. Death tolls topped eighty thousand casualties in 2021 but did not stop there, picking at 109,000 in 2022, according to the Centers for Disease Control and Prevention (CDC) most recent available data. Most overdoses are associated with the use of synthetic drug Fentanyl. According to medical journal The Lancet, data are expected to keep rising. The number of opioids-related deaths are in fact lowering the nation’s life expectancy.
The opioid epidemic is affecting the country in economic terms as well. The U.S. Congress Joint Economic Committee found that in 2020 alone the crisis cost the government one point five trillion dollars – or seven percent of that year’s GDP. Data include healthcare costs to treat overdoses as well as funds allocated to the efforts for fighting illegal fentanyl traffic and more.
U.S. opioid crisis: geopolitical implications and Fentanyl poisoning
According to the Council on Foreign Relations, quoting sources like the DEA, the supply chain of Fentanyl and, increasingly, of Fentanyl precursors, involves a number of foreign nations, problematizing international relationships that are already tense. Most of the illegal Fentanyl that gets on U.S. streets, indeed, seems to be manufactured in China, shipped to Mexico and finally smuggled across the county’s northern border. Most recently India also emerged as a relevant precursor manufacturer. Making Fentanyl a relevant actor in the geopolitical arena as well.
It does not end there – of course, U.S. domestic affairs are affected too. Tackling the fentanyl crisis has become an absolute priority for the Biden administration and we know fentanyl has been a topic of discussion in the majority of recent U.S.- Mexico meetings. As Biden tries to use economic sanctions as a weapon against people and companies linked to cartels, Republicans went as far as proposing for U.S. troops to enter Mexican territory to «impose order» – likely turning Fentanyl into an argument of dispute in the upcoming presidential elections.
Marketing, big pharma and OxyContin – roots of the U.S. opioid crisis and human fragility
Though Fentanyl is center stage today, the opioid crisis began with a different drug: OxyContin, by Purdue Pharmaceutics. The history behind the U.S. opioid epidemic we are witnessing today has gained traction thanks to recent Hulu and Netflix series Dopesick and Painkillers. Both series indeed tell the story of the Sackler family, their company Purdue Pharmaceutics, and how they managed to make billions by generating an epidemic of addictions so wide it is still – and increasingly – affecting Nord American society almost three decades later – creating and nourishing a human fragility that seems unstoppable.
Purdue Pharmaceutics started commercializing OxyContin, a drug based on semi-synthetic opioid Oxycodone, in 1995. Since its launch, OxyContin – or simply Oxy, as it became to be known – was falsely advertised as the first opioid drug ever invented that could cure pain without causing addiction.
How Purdue Pharmaceutics increased opioid consumption to make profits
Richard Sackler is the main person from the Sackler family associated with the beginning of the opioid addiction epidemic. After co-inheriting the company, he followed the footsteps of the previous leader figure in the family, his uncle Arthur. Richard’s billionaire revenue plan started from an intuition: that mixing marketing and big pharma could result in a goldmine – and he turned out to be right. He began using marketing strategies from the choice of the name. OxyContin, chosen to be consumer-oriented, after holding a series of thorough focus groups.
He did not stop there. As shown in an early scene from Painkillers, Sackler wanted his drug to fit in the gap between pain and pleasure: «all of human behavior» says Matthew Broderick who stars as Sackler in the Netflix drama, «is comprised of two things: Run from pain, run towards pleasure». OxyContin became the way to go from one to the other. No need for running either – all you had to do was swallow a pill.
Oxy was not only heavily advertised, but pushed in hospitals and clinics through the tireless, aggressive work of a sales team motivated by mind-boggling salaries. The perfect capitalistic storm. Purdue Pharmaceutics’ failure to properly inform their clients about the drug’s risks, such as addiction and overdoses, ultimately resulted in doctors prescribing it for all kinds of pain, in the belief that it was a perfectly safe solution to contrast discomfort. Far from revealing its actual side effects, the company went as far as inventing a previously nonexistent definition, «severe episodic pain» to justify the prescription increase. Opioid-related deaths skyrocketed – and so did Purdue Pharmaceuticals’ turnover.
From OxyContin to Fentanyl – developments of the U.S. opioid crisis root in human fragility
The issue with OxyContin is that the body gets easily accustomed to the substance. It is tricky: opioid-based painkillers work perfectly, at first – getting rid of the pain, either chronic or from a trauma, like nothing else will. Yet, after a while, patience started to notice OxyContin wasn’t as effective. To make it work again, Purdue Pharmaceutics suggested increasing the dosage, guaranteeing there was no danger in doing so. As it turned out, this, however, created a vicious cycle rooted in human fragility that brought people to assume more and more of the drug – thus becoming addicted.
This is where it gets even trickier. With time, either Oxy addiction gets so bad that Oxy is no longer enough – or doctors would stop prescribing it, after noticing it did in fact create addiction, even though Purdue Pharmaceutics kept saying it did not. At the beginning of the crisis, addicted and unable to get more, patients, or users, started to look for it illegally, or assume it in improper ways – snorting or injecting it for a more powerful effect. People also turned to other substances, especially heroin. This loophole created a parallel, dark market for opioids.
Fentanyl is a synthetic opioid, up to fifty times stronger than heroin, commonly used in hospitals for anesthesia or prescribed to cancer patients to fight strong chronic pain caused by the sickness. Yet, illicit use of the substance is spiking, in a new and deadlier wave of the U.S. opioid crisis. Most of illegally sold Fentanyl is clandestinely produced, with no applicable medical use. Since it is cheaper than other opioids to produce but way more powerful, Fentanyl is often sold as Oxy or heroine without users’ knowledge, making it more likely to overdose. The majority of the 100,000 U.S. deaths a year related to the opioid crisis are associated with Fentanyl.
Institutional response to the U.S. opioid crisis – Naloxone and the human fragility
Among the most powerful tools to fight opioid overdoses, including those induced by Fentanyl, is Naloxone. Naloxone is an opioid antagonist, widely used in the U.S. to reverse the effects of opioid overdoses. The crisis got so severe that some States, starting from the state of New York, created programs to train police forces to administer Naloxone on the field, without having to wait for first responders. Depending on what form it is administered, Naloxone can reverse opioid overdoses effects in two to ten minutes.
This solution does not however fail to present with additional issues: as reported, among others, by photographer Philip Montgomery in his work American Mirror, reversing the overdose too often as far as the solution goes. Rarely followed by any social help – saving the victim just so that they can get to the next dose. As the available data make abundantly clear, the opioid crisis, feeding on human fragility, is here to stay: the U.S. society should step up and find more complex solutions to such a complex and pervasive epidemic. A good starting point may be switching from a profit to a care-oriented society.
OxyContin
Is the commercial name of oxycodone, a semi-synthetic opioid drug, first synthesized in Germany in 1916. Commercialized in the U.S. starting from the 1970s, it contributed to sparking the opioid epidemic.
