Mind and Body

Changing the narrative: it is not good drugs vs. bad people

Lessons learned in marketing Valium applied by Sackler family to OxyContin; roots of the opioid epidemic can be found in economic distress and family disruption; fentanyl in cocaine overtakes fentanyl in heroin as leading cause of OD deaths in Ohio; and mass incarceration remains major barrier to health equity

Image courtesy of Twitter feed from CityLab

The illustration from the CityLab story reporting on sociologist Shannon Monnat's new research.

By Richard Asinof
Posted 2/18/19
As more lawsuits and in-depth reporting reveal, the narrative pushed by the owners of Purdue Pharma, makers of OxyContin, keeps falling apart. Without an effort to address the economic distress as a root cause of the diseases of despair – drugs, alcohol and suicide, efforts to control the epidemic of drug ODs will fail.
When will there be a comprehensive database created in Rhode Island that combines the deaths from alcohol, suicide and drugs? What is the connection between toxic stress and epigenetic changes in the brain that correlate with a prevalence of substance abuse disorders? Which Rhode Island health insurer will endorse the use of non-invasive neuromodulation as a reimbursable treatment for migraines? What are the opportunities for research to track the use of fentanyl test strips in Rhode Island?
In the same way that big coal companies once ravaged Appalachia, the big drug companies ravaged the same population with opioids, exploiting economic distress and the breakdown of vulnerable rural communities. There appears to be a direct correlation to the breakdown of the middle class in the U.S., the decline of unions, the increase in health care costs, and the success of private equity debt financing as a corporate finance tool of consolidation.
How we choose to rebuild our economic strengths in Rhode Island – and the role of government in securing new companies to locate here – may demand a new kind of New Deal – one that invests heavily in green innovative technologies.
When it comes to the threat from climate change, we are truly in a national and global emergency.

PROVIDENCE – The front page story by reporter G. Wayne Miller in The Providence Journal on Sunday, Feb. 17, “Lawsuits put Sackler family under harsh spotlight,” provided details from the lawsuits against the Sackler clan and its role in the opioid epidemic through its family-owned firm, Purdue Pharma. The story, however, might have been improved if Miller had drawn on the reporting by Chris McGreal in his book, American Overdose: The Opioid Tragedy in Three Acts.

For instance, according to McGreal, Arthur Sackler, one of three brothers, who, as McGreal wrote, found a way to sell drugs by getting patients to ask for them: “But there was no denying Arthur’s commercial genius. He quickly grasped two key concepts in selling prescription drugs. One was to get doctors to sell them for him. In those days, patients had a respect for physicians bordering on awe, so if a doctor recommended a medicine, it was as good as sold. The other realization was that the way to make real money wasn’t to sell a drug to those who needed it when they would probably buy it anyway. The key was to push it on those who didn’t.”

Pushing Valium
According to McGreal, Arthur Sackler perfected the sales technique with a new tranquilizer in 1963, Valium, where the manufacturer, Roche, wanted to sell the drug without cutting into the market for another of its anti-anxiety pills.

Sackler, according to McGreal, solved the problem by inventing a new market, persuading Americans they had far too much stress in their lives and what they needed was a tranquilizer.

“Within a decade,” McGreal wrote, “Valium was the most prescribed drug in the country, as millions of people could apparently not get through the day without it. By 1978, it was selling more than two billion pills a year.”

[Valium proved to be addictive and very difficult to stop taking; the book, I’m Dancing As Fast As I Can, by Barbara Gordon, told the story of her attempts to stop taking Valium. The drug was also immortalized in the Rolling Stones song, “Mother’s Little Helper.”]

The same successful marketing techniques pioneered by Arthur Sackler in promoting Valium were then later used in the marketing of OxyContin.

New research by Shannon Monnat
A new working paper by Syracuse University sociologist Shannon Monnat and the Institute for New Economic Thinking challenges many of the narratives about what is driving the epidemic of opioid overdose deaths.

What Monnat’s research analysis found is that in both rural and urban communities, two key factors – economic distress and the supply of opioids – predict the rate of opioid deaths, according to a story published on Feb. 14 in CityLab.

“I really do want to push back against this cliché that addiction does not discriminate,” Monnat said, as quoted in the CityLab story. “The physiological processes that underlie addiction themselves may not discriminate, but the factors that put people in communities at higher risk are not spatially random.”

In the working paper, Monnat examined county-level drug mortality rates, according to the CityLab story. Two-thirds of these deaths involve heroin, fentanyl, and various prescription opiates. She focuses on non-Hispanic whites – a racial group that, as of 2016, has the highest drug mortality rate. After controlling for demographics, she finds that the average drug mortality rates are highest in large metro counties, and increased most since 2000. The rates decline the further one moves away from urban areas.

“What that means is that drug mortality rates aren’t higher in economically distressed places simply because they’ve had a greater supply of opioid prescribing there,” Monnat said, as quoted in the CityLab story. “There’s something about economic distress in and of itself that helps to explain the variation that we’re seeing across the country and the magnitude of the drug crisis.”

Fentanyl + cocaine in Ohio = 3,000 dead
In tracking the incidence of fentanyl in overdose deaths, Rhode Island may want to pay attention to the results from a study in Ohio, to focus beyond the illicit heroin supply.

In an analysis published in January by Harm Reduction Ohio, it found that the addition of fentanyl into the illicit cocaine supply had killed 3,000 Ohioans, and that most of the contamination was occurring at the street dealer and user level.

In 2017, for the first time, Harm Reduction Ohio reported, cocaine-fentanyl mixtures killed more people than heroin-fentanyl combinations.

Further, the study found that the fentanyl adulteration of the cocaine supply was occurring at the bottom of the supply chain, at the level of local dealers, street dealers and even users. The findings were based upon Harm Reduction Ohio’s analysis of crime lab data from the Ohio Bureau of Criminal Investigation to determine at what point in the supply chain fentanyl appears in cocaine. BCI has four state crime labs that analyze drugs confiscated by law enforcement.

Mass incarceration – a threat to health equity
As Shannon Monnat has said, America is not going to be able to arrest its way out of the current epidemic.

The Robert Wood Johnson Foundation recently published an article that put the issue of mass incarceration front and center as one of the major barriers to achieving health equity.

“With approximately 2.2 million U.S. adults and youth behind bars, the U.S. incarcerates many more persons – both in absolute numbers and as a percentage of the population – than any other nation in the world,” the article began, using a pull quote.

Mass incarceration, the article continued, “disproportionately impacts lower-income communities, communities of color, and persons with disabilities, creating a barrier to achieving health equity.”

People who are incarcerated face greater chances for chronic health conditions, both while confined and long after their release, the story continued.

“Mass incarceration’s reach extends far beyond the jail cell, impacting not only those behind bars, but their families, their communities, and the entire nation. Almost 10 million children have experienced having one or both parents incarcerated at some point in their lives – impacting their health and future opportunities. Within communities, mass incarceration disrupts social and family networks and economic development while across the country it consumes large portions of government budgets with negligible impact on crime rates.”

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