All the talk about rising oxycodone prescriptions in the UK causing a middle-class heroin crisis is gold-plated baloney.
This article originally appeared on VICE UK
Over the last few weeks, newspapers have been handing out grim tidings about the steep rise of the powerful prescription drug oxycodone in Britain. Better known by its brand name OxyContin, Oxy, or Hillbilly Heroin, the opioid painkiller that has devastated America is about to reap narco-havoc here too, according to the Times and the Daily Mail.
What the papers did was to dutifully repeat a warning—issued by the consistently clueless Tory think-tank the Center for Social Justice (CSJ)—that rising oxycodone prescriptions in the UK could well lead to "a middle-class heroin crisis." I'm sorry to disappoint all those entrepreneurial Scouse and Pakistani heroin trafficking outfits out there already drooling over the latest copy of Super Motors magazine, but this is gold-plated baloney.
And here's why.
First, the figures: As the CSJ points out, oxycodone was prescribed more than a million times in England last year—an increase of more than a third since 2010. Questions over the rise of this drug in Britain, now being used by an estimated 100,000 people, go to the heart of how we manage pain, and what pain actually is.
In 1979, a respected group of health experts known as the International Association for the Study of Pain met up to decide what the medical definition of "pain" was. The result—a guiding light for health services around the world—was published in their in-house journal, Pain.
"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage," it said. It wasn't just saying pain is the physical yelp you get when you drop a brick on your toe. It's also about emotion. What's more, it accepted that a medic's understanding of pain can be reliant on a patient's description.
The industry of pain is huge. And if there is a land of pain, look no further than the richest country on earth and the world's keenest consumer of corporatized opium: America. In 2013, 207 million prescriptions were handed out for opioid painkillers such as oxycodone.
What opioids such as morphine, codeine, oxycodone, and fentanyl are meant to treat is physical pain, such as backache, cancer-related pain, and post-operative pain. But aggressive marketing and propaganda aimed at patients and doctors—chiefly at the hands of Purdue Pharma, the makers of OxyContin—led to massive over-prescribing, especially in rural areas where some doctors turned to painkillers as a cure for all, which is how it gets its Hillbilly nickname.
Purdue promised America it had invented the first non-addictive opioid painkiller. The same had been said of heroin by its German inventors a century ago. Instead, people discovered that, by scraping away the waxy coating with a razor, you could crush and snort it and get a heroin-like high. Available from your local doctor—who was probably being paid a bonus for handing out Oxy scripts—it became the most popular recreational drug in America after weed. It became massive.
By 2010, half a million Americans were abusing OxyContin and 16,000 were dying each year of opioid painkiller overdoses. Its clean-cut image and easy availability made it the favored tipple of celebrities like Courtney Love, Winona Rider, Heath Ledger, Philip Seymour Hoffman, and Michael Jackson. By this time, Purdue had already agreed to pay out $600 million—one of the biggest ever lawsuits in America—for misleading the public about OxyContin's addictive potential.
When the American government got a hold of the runaway Oxy train, restricted prescriptions and pressurized Purdue to make a tamper-proof pill, many of those who had become addicted to Oxy moved over to street heroin, which by 2012 had become cheaper. Hence the rise in heroin use in America and fear in the UK that oxycodone begets heroin.
Per head, consumption of opioids in the UK is currently similar to that of the USA ten years ago. So are we heading for an oxycodone-fuelled heroin epidemic, as the CSJ and British media speculate?
I put the question to the UK's expert on painkillers, Dr. Cathy Stannard, a consultant at Frenchay Hospital in Bristol. She wasn't having any of it. "To infer that an increase in oxycodone prescribing in the UK will lead to an increase in heroin use makes three or four utterly fallacious assumptions. It's a massive leap of very tenuous logic."
She explained that Britain's medical system and its drug scene are very different to America's. Over here, doctors and patients are far less exposed to the pressures of Big Pharma and prescribing is better managed. Despite falling in recent years in Britain and rising in the US, heroin use remains much more prevalent over here.
America has five times the general population of Britain, but only twice the number of heroin addicts. The prices reflect this, with the average price of a gram of heroin being $60-90 in Britain compared to $200-450 in the US. With the added presence of free methadone for drug users in treatment and the wide availability of low-cost street valium pills, there is nowhere near the kind of demand by British drug users for opioid painkillers as there is in the US. With the exception of Tramadol, opioid painkillers are very low down the list of abused street drugs in the UK.
Oscar D'Agnone, medical director at CRI, the UK's biggest drug charity which treats 17,000 drug users, says oxycodone doesn't register high on his radar.
"Very few of our clients are on Oxy—probably less than 1 percent," he says. "We sometimes get people referred to our services who were initially put on this drug for pain management but who then started using it to keep their emotional pain in the background, to keep their emotions stable, in the same way people use valium. A much bigger problem with us is Tramadol and codeine."
"To infer that an increase in oxycodone prescribing in the UK will lead to an increase in heroin use makes three or four utterly fallacious assumptions. It's a massive leap of very tenuous logic" – Dr. Cathy Stannard
In 2012 there were 31 deaths in the UK linked to oxycodone, a fraction of the thousands who die as a result of the drug in the US each year and far less than deaths from Tramadol.
Dr. Stannard's concern over a rise in oxycodone prescribing in the UK is not about Britain mirroring the US—rather, it's to do with how a drug is being use to numb people without actually curing them.
"Most of the rise in opioid prescribing here is for long-term chronic pain, such as back pain, which is part of the human condition. Many people have it. Sadly, however, opioids are neither an easy nor necessarily effective solution to the problem. The failure rate for the treatment of long-term back pain with opioids is about 100 percent."
Dr. Stannard told me that prescription opioids such as oxycodone could lead patients "down a one-way street" of using the drugs as an emotional buffer, regardless of whether they are alleviating physical pain. She says the patients most at risk of opioid-related harms are those with mental health or substance use disorders who have greater odds of both being prescribed opioids and getting them in harmful high doses.
"People may feel better taking these drugs because they temporarily relieve pain, but they can end up using them to deal with difficult thoughts and emotions. They find oxycodone can make life less painful, emotionally," she continues. "Perception of pain is influenced by thoughts and emotions. For some people, as the pain from their original injury becomes a minor problem, opioids will distance people from unpleasant thoughts and experiences. But as a result they become more remote from their feelings."
So what do these drugs feel like? Why do they drag people in? Because they all are derived from the same plant as heroin—the opium poppy—opioid painkillers have the renowned "cotton wool" effect on the user, of dulling physical and emotional pain. Opium, sometimes called God's Own Medicine, has been used in this way since the dawn of civilization.
The root cause of the prescription drug epidemic, especially in the US, was perhaps not back ache or neck pains, but the need to avoid or mollify bad feelings. The drive to become medicalized is not just about opioid painkillers.
Cathryn Kemp ran into a wall of opioid painkillers when she was diagnosed with pancreatitis in 2004. After a series of operations she was prescribed morphine, then oxycodone for three years and, finally, fentanyl. "[These things] saved my life because I was in so much pain I was on the brink of suicide. But while they temporarily relieved my pain, I became dependent on them.
"It was such a relief not to feel pain. The oxycodone made me feel relaxed, like sinking into a warm bath. Because your body is good at metabolizing opioids, you need more of them to get the same effect. So my dose went up, but the pain never actually went away. It made my life bearable.
"Painkillers for me was all about feeling normal, to feel like everything is OK with the world, have a warm glow. I was relaxed in a way I'd never been before. It was a feeling of being in touch with the divine."
Are we sleepwalking into a fuzzy oblivion? Is the pain industry beast medicalizing citizens to such an extent that people are gravitating to a state of swapping real life for being comfortably numb?
"We thought the big problem with these drugs was addiction. Now we realize the problem is with patients who take them and basically opt out of life," one medical expert told the New York Times reporter Barry Meier, who has written two books on America's OxyContin disaster.
Meier found that, "while opioid painkillers do work for some patients, when workers are treated with high doses of opioid drugs fairly soon after these injuries, it's the leading predictor for them not coming back to work for long periods of time, or ever. These drugs are not just blocking pain receptors so you don't feel pain. These drugs are depleting people of energy."
The root cause of the prescription drug epidemic, especially in the US, was perhaps not back ache or neck pains, but the need to avoid or mollify bad feelings. The drive to become medicalized is not just about opioid painkillers. In Britain, these are dwarfed by the use of anti-depressants, of which 53 million prescriptions were dispensed last year.
In short, none of the conditions exist in the UK—in terms of healthcare and the existing illegal drugs market—for the OxyContin epidemic to occur here among either middle-class or seasoned drug addicts. With no OxyContin epidemic, there is no heroin epidemic.
Perhaps, as a society, by expecting our emotional or physical pain to be numbed on demand, we have lost our ability to cope without the use of drugs. In 1974, the Austrian philosopher Ivan Illich, a massive critic of Western medicine, warned of what he called society's " medical nemesis."
"It now seems rational to flee pain rather than to face it, even at the cost of addiction," said Illich. "It also seems reasonable to eliminate pain, even at the cost of health. It can be argued that the total pain anesthetized in a society is greater than the totality of pain newly generated. Only the recovery of the will and ability to suffer can restore health into pain."
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