One can read this as a thorough and engaging sociological account of why and how we continue to fail as a society to ‘deal’ with addiction. Fisher builds up a picture of Churchill’s ‘Those that fail to learn from history are doomed to repeat it’, but it’s more complicated than that, of course, as he takes pains to delineate in his multidisciplinary complex analysis. He manages to stay calm despite the anger one can feel behind some of his words as he describes the failures of the US.
He details the behaviour of doctors who are complicit in the addiction process, not to mention the pharma companies. I can’t speak for the US, but in other parts of the world it is often the local pharmacist who educates the unwitting potential addict presenting an unnecessary script provided by a doctor whose motives must be questioned. I had a friend a while back who broke his ankle in Melbourne and when he gave his script to the local chemist, the reaction was something like this: you know that’s a highly addictive opiate and you don’t need anything like that for your condition. Errrm, no he didn’t. A dozen years ago I presented such a script to a pharmacy in Geneva and although it was filled, it was with the greatest of reluctance and I more or less had to promise not to use it….a promise I kept.
What Pharma like Purdue has learned from history is that to repeat history is to fill their coffers. Doctors fill their appointment books and create any amount of work for their associates. Lesson: if history is to be changed, it will be by people who need it to change.
From The House Hearing THE ROLE OF PURDUE PHARMA AND THE SACKLER FAMILY IN THE OPIOID EPIDEMIC, Chairwoman Maloney’s opening statement.
For too long, justice has been out of reach for millions of American families whose lives have been ravaged by our Nation’s
opioid epidemic. For decades now, parents and family members have watched with broken hearts as their loved ones struggled with opioid addiction.
Since 1999, nearly half a million lives have been cut short by opioid overdoses in the United States alone. These lives were taken from us too soon. They were taken unnecessarily and they were taken unfairly. For each life lost, there have been many other family members–aunts, siblings, children, and loved ones–left to pick up the pieces.
And right there in the middle of all this suffering was Purdue Pharma, the manufacturer of a highly addictive prescription painkiller, OxyContin. This company played a central role in fueling one of America’s most devastating public health crises. Purdue has generated more than $35 billion in revenue since bringing OxyContin to market.
Purdue has been owned by the Sackler family since 1952. The Sackler family has profited enormously from the OxyContin business. Since bringing this painkiller to market, the family has withdrawn more than $10 billion from the company. Purdue has now admitted that after it got caught in 2007, after it pled guilty and paid a fine, it continued to commit crimes for another decade, like nothing happened.
Documents obtained by our committee by the Department of Justice and by state attorneys general say that members of the family were directly involved with the day-to-day operations of the company. And they launched an incredibly destructive, reckless campaign to flood our communities with dangerous opioids.
At the behest of the Sackler family, Purdue targeted high-volume prescribers to boost sales of OxyContin, ignored and worked around safeguards intended to reduce prescription opioid misuse, and promoted false narratives about their products to steer patients away from safer alternatives and deflect blame toward people struggling with addiction. And most despicably, Purdue and the Sacklers worked to deflect the blame for all that suffering away from themselves and on to the very people struggling with the OxyContin addiction.
Yet despite years of investigation and litigation, no member of the Sackler family has ever admitted to any wrongdoing, taken any responsibility for the devastation they caused, or even apologized for their actions. In their settlement with the Justice Department, Sackler family members admitted no liability.
I believe it was appropriate that Purdue pleaded guilty to criminal charges because that’s what it was, a crime. It was a crime against the American people. And with all the evidence that the Sackler family was directly involved and produced criminal actions, they were pulling the strings in fact, they should not escape accountability for these criminal actions this time around.
Today, for the first time, two members of the Sackler family, David Sackler and Kathe Sackler, will be testifying publicly before the American people about their role in the opioid crisis. They held senior positions in the company and on the board of directors. As these documents shows, they placed their insatiable thirst for personal wealth over the lives of millions of American families they destroyed.
It is my hope that today’s hearing will give the American people, including the scores of victims who have had their families shattered, an opportunity to hear directly from those responsible for these atrocities.
Next there is the role of politicians and law enforcement, sometimes working against each other, but more often in alignment. Here Fisher explores the racism of addiction. For two hundred years Americans have been sold the notion that non-white people are addicts seeking out (never mind that they are forced to by the very system defining them) horrifying illegal drugs which turn them into fiends, while white people merely have ‘habits’. In the case of the former, prohibition has often been seen as the way to deal (so to speak) with the problem. In the case of the latter….it isn’t even a problem, not really. Ask Purdue. Unexpectedly for me, Fisher shows us that white US citizens are at least as badly off, with their constant supplies of highly addictive but legal ‘medications’ as are non-white citizens who buy and use on the street.
Another layer again shows how hard ‘learning from history’ can be, and that’s the research industry’s role. From the scientists searching in the body to the psychologists investigating the mind, a couple of hundred years has left us without the simple explanations and solutions we would definitely prefer. That is probably the case even if we take into account that it is an industry, with the lack of objectivity that likely accompanies it. Inadequate methodology, axes to grind, theories to prove.
What makes this book incredibly human, and far from the coldness of sociology, is that the author is himself an addict and he tells his story of his fall and his continuing recovery. As Fisher is a medical doctor who chose to specialise in psychiatry and ethics, he is able to combine knowledge with experience to tell us….well, in the end, less than we might have hoped for. Perhaps I should say less than I hoped for as I would have liked to have answers that I could apply to myself and I did not find them. But given that he hasn’t even found his own answers, I can scarcely blame him for not giving me mine.
He must have thoughts about the relationship between addiction and the internet/social media/phones. I hope that’s for the next book. And, having read just before this one, The Expectation Effect, it’s hard not to wonder what relationship there may be there, both placebo as treatment and nocebo as exacerbating, which further complicate an already exceedingly tangled web.
Highly recommended.