Can the US end its addiction to painkillers?

Politicians are finally talking tough on an opioid abuse epidemic. But they may lack the will to fully kick the habit.

Oxycodone has a high abuse potential and is prescribed for pain relief [Education Images/UIG via Getty Images]

New York, United States – Quitting isn’t easy. Just ask Kasey Kearney-Argow.

She kicked prescription painkillers and other drugs six months ago. But in the back of her mind are euphoric memories of opioid stupors and the knowledge that a doctor nearby will write a prescription any time she asks.

“They didn’t ask me too many questions because I’ve been in three car accidents and I have extremely bad migraines due to my neck pain, so I can get Percocet whenever I want,” Kearney-Argow, 23, told Al Jazeera, referring to a strong pain reliever that can also give a high.

“Even if that wasn’t true and I told the doctor that, they would prescribe it to me anyway. It’s too easy to get any opiates down here.”

As a bullied, bereaved and shy teenager in New Jersey, Kearney-Argow started using cannabis, ketamine and the types of powerful painkillers that doctors prescribe to cancer victims but have increasingly been doled out for lesser ills.

Once she was hooked, injecting heroin became a cheaper route to the same buzz. Her weight fell to 43kg and she dropped out of college. A clinic in Florida has helped to straighten her out. She kept the tattooed rock chick look, but now has a steady job and plans to start modelling.

She is not unique. According to the US government’s Centers for Disease Control and Prevention (CDC), opioid abuse is an “epidemic”. The number of overdose deaths involving opioids – including some strong painkillers and heroin – nearly quadrupled between 1999 and 2014.

Every day, 78 Americans die from such overdoses, often when pills are mixed with alcohol or sleep aids and users pass out and stop breathing. In April, the music icon Prince, 57, joined this statistic after an accidental, self-administered overdose of fentanyl.

US doctors have prescribed ever-more opioid painkillers since the 1980s, but lawmakers are finally waking up to the problem. US President Barack Obama’s budget request for 2017 includes $1.1bn in new funding to expand treatment to all opioid addicts who want help.

“The only way we reduce demand is if we’re providing treatment and thinking about this as a public health problem and not just a criminal problem,” Obama said when launching his plan in March.

So far, none of the bills passed by Congress includes enough cash, but this may change before the mid-July summertime recess. Campaigners warn that bitterness between the two parties in an election cycle could kibosh a much-needed deal.

Even with a breakthrough, former politician Patrick Kennedy, a scion of a Democratic dynasty who published a warts-and-all tale of his own battle with addiction, called A Common Struggle, warns that it’s too little, too late.

“Neither the president nor Congress wants to treat this as the disease that it is,” Kennedy told Al Jazeera.

“Every single family in America is touched by this illness. Every single family is worried about a family member being affected by this illness, and if we want to make fundamental change, we need to change everything.”

Kennedy has teamed up with Newt Gingrich, a Republican who hopes to be running mate to presumptive nominee Donald Trump in the 2016 presidential vote, and others to campaign for better treatment via the charity Advocates for Opioid Recovery.

READ MORE: Mindful addiction recovery 

They say addiction is a sickness for which users need levels of treatment akin to sufferers of diabetes, cancer and other diseases. Only half of them receive drugs such as buprenorphine and naltrexone which help reduce cravings and the risk of an overdose.

Spending a little more on treatment would yield huge savings down the road, with fewer addicts filling courthouses, jails and emergency rooms, said Kennedy. He should know. He has seen the dark side of the pill bottle.

“I have lived experience. My brain was absolutely addicted to these opiates. I had to be [an] inpatient on a number of occasions to get detoxed and I dealt with all of the ancillary issues of humiliation, arrest – a lot of things that come with this,” he explained.

“Fortunately it wasn’t death, but it could’ve been.”

Opioid crisis 

It does not top the agenda in the 2016 White House race, but both Trump and Hillary Clinton, the presumptive Democratic nominee, have addressed the opioid crisis – not least because it blights New Hampshire, Florida, Ohio and other battleground states.

Clinton says addiction is a “disease, not a moral failing“. She calls for more treatment, re-training of doctors and putting fewer non-violent users behind bars. Trump says a “beautiful wall” along Mexico’s border will stop banned substances reaching the US.

At heart, this is a complex problem. America has divergent policies on narcotics. For decades, it led a global war on drugs. But times have changed. A handful of states now allow recreational weed use for adults. California is poised to follow suit.

Hard drugs such as heroin are banned, but opioid painkillers have lawful uses. Such drugs as oxycodone and hydrocodone were once reserved for the acute pain of those recovering from car crashes and surgery, and those getting palliative care for Aids, cancer and other killers. 

But drug firms began marketing painkillers more aggressively and, thanks to some research supporting their wider use, doctors followed suit. Soon, they were doling out Percocet and Vicodin when teenagers got their wisdom teeth yanked out.

READ MORE: Drug addiction in the US 

Despite clinical names, the pills are highly addictive and even short courses can leave users hooked. They stimulate receptors in the brain to produce a strong pain-numbing effect, while also lessening the anxiety and depression that can accompany pain.

Nowadays, ever more opioid painkillers are prescribed and consumed. Clinicians wrote nearly a quarter of a billion opioid prescriptions in 2013 – enough for every American adult to have their own bottle of pills, the CDC says.

America’s fee-for-service health model incentivises giving patients what they ask for. Repeat prescriptions mean more business for doctors. Hospital patients leave better feedback forms when doped up on opiates.

So-called “pain clinics” have popped up in some states, dispensing pills to just about anyone who asked. Dealers drove to Florida’s many clinics to stock up and re-sell back in Kentucky, West Virginia and elsewhere. Costing $1 per milligram, addicts can easily blow through $150 a day.

The typical addict is poor, white and single. As such, the pills were dubbed “hillbilly heroin”, which users like to grind up and snort. State and federal officials have clamped down on overprescribing and “pill mills” by training doctors and in the courts.

In 2007, Purdue Pharma, the maker of the painkiller OxyContin, paid a $634m fine for misrepresenting the drug’s addictiveness. In December it reached a $24m settlement with Kentucky after the state claimed Purdue cost it “an entire generation” to OxyContin.

Results have been mixed. Many addicts were forced to switch to heroin – which is cheap and readily available – to feed their cravings, leading many users to needles. Desperate addicts have even tried getting high from anti-diarrhoea pills.

“Instead of being hooked on OxyContin, it’s much cheaper to buy a bag of dope,” Paul Pellinger, who helps run Recovery Unplugged, the Florida-based clinic where Kearney-Argow kicked her habit via musical therapy, told Al Jazeera.

“That’s why the people who were once hooked on the pills are now hooked on heroin.”

He blames the opiate epidemic on a profit-hungry healthcare system that plays into the vulnerabilities of mollycoddled American millennials, who use soporific drugs to ease worries over joblessness and college debt.

Another patient, Gene Lewis, is a case in point. As a teenager in Greenford, a rust belt Ohio town, he fell into a group of weed-smoking, pill-popping friends who saw shuttered steel mills and few opportunities around them.

He has been clean for eight months and now runs a call centre in Florida. Things are looking up for the 25-year-old, but he has little faith in lawmakers turning the tide on an addiction problem that tears through users “like a tornado”.

“We should make it a lot harder to get them [pills]. But I’m sure they make a lot of money off giving people those medications,” Lewis told Al Jazeera. “They’ll give you Vicodin for getting a tooth pulled out. That’s enough to start somebody on the wrong path.”

Follow James Reinl on Twitter: @jamesreinl

Source: Al Jazeera