As this article from The Guardian notes, there’s a lot of finger-pointing going on at this point in the opioid epidemic. Blame-shifting, you might call it. Some of this is intended to lay the ground for legal action. Hard to fault the plaintiffs, but juries are unpredictable.

It’s true that our current opioid epidemic sprang from a misguided effort to increase use of opioids in the treatment of chronic pain. That effort was clearly self-serving on the part of Big Pharma, who are always in search of ways to increase profit margins. But it also represented some legitimate complaints by pain patients and the physicians who treat them. Those were the folks who moved politicians and bureaucrats with passionate appeals. I would once have said that involved some bad science, but now it appears that nobody bothered to investigate the science at all.

Pill mills played a role, and those were never intended to be more than outlaw ventures — consequences be damned. It’s the sort of phony clinic that pops up when regulation is lax and independent practitioners predominate. There were plenty of rural communities that were¬† already in need of medical services. Unfortunately, the pill mill’s only purpose was to push opioids. Its customer base quickly grew beyond pain patients, to include the addicted.

Opiates have been around for thousands of years. Many important surgical procedures were made possible only because opiates were available to manage pain. As we found new ways to administer them — such as with the invention of the syringe in the mid-19th Century — the medical professions became a steady source of opiates for patients who became thoroughly dependent on them.

Among those were Civil War veterans. I’ve read that at one time, most US physicians, however small their practice, maintained at least one opiate user on morphine. Physicians of the time weren’t opposed to that. To them, it was just the practice of medicine.

But other elements within society objected, motivated by fear that opium smoking, popular among Asians, would spread to the West. The early 20th Century saw new legislation designed to suppress opiate use. It was very much a law and order strategy, and with our modern perspective, we can see the flaws in that far better than our ancestors could.

Once the laws changed, those opiate-dependent patients were instantaneously turned into outlaws. In some respects, they remain so, even today.

Still, it seems obvious to me that the underlying problem is the nature of opiate drugs. For all their benefits, they carry risks. Always have, always will. The new opioids are far stronger than their predecessors, and the accompanying risks are dramatically greater.

Yes, it’s possible to abuse heroin. But when you’re addicted, it’s probably more correct to say that addiction is abusing you. And will continue to do so if allowed. In a way, that means everyone is at fault, and no one.

Not that I expect this awareness to put a stop to the effort to fix blame. We’re far too fond of that.


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