America's Exploding Oxy Epidemic

By Maia Szalavitz 06/17/11

America is certainly afflicted with a huge opiate problem, but you won't get the real story in the media. As the White House prepares to launch a billion-dollar anti-Oxy war, here are some rarely reported but crucial facts about who gets addicted—and why.

The price of OxyContin. Photo via

Egged on by the nation's media, the Obama administration seems keen to start a full-fledged nationalpanic over prescription painkillers. In April, the nation’s drug czar, flanked by the heads of the DEA and FDA, announced a major new law-enforcement initiative at a much-discussed press conference where he designated the widespread use of prescription painkillers like OxyContin an “epidemic” and a “crisis” comparable to crack in the ’80s and heroin in the ’70s.

But while it's true that prescription drug abuse has increased by 20 percent since 2002, with some 28,000 deaths by OD in 2007 alone, the roots of the painkiller problem are widely misunderstood.For the most part, opioid addicts are seen as victims of greedy doctors and profiteering pharmaceutical companies. In reality, however, most painkiller addictions don’t start in doctors’ offices, and it’s actually impossible to become addicted “by accident.”

 So why does the media insist on blaming physicians and Big Pharma? For one thing, because greedy pharmaceutical companie and unscrupulous physicians have been responsible for a lot of bad things things. But the persistent myths that pervade the coverage of this epidemic pervade because real-world addiction doesn’t always fit into the neat narratives preferred by journalists and politicians.

1. Most painkiller addicts were never pain patients.

Reporters love to tell the story of the poor pain patient who got hooked on Oxys because he just couldn’t stop taking them after an accident or surgery. This tear-jerker is catnip to liberals who view the pharmaceutical industry as dedicated to exploiting innocent patients by bribing their doctors to overprescribe their expensive (but potentially addictive and dangerous) brand-name drugs. And since drug companies so often live down to their bad image, it’s easy to overlook cases that are not so black-and-white.

To make matters worse, this storyline is also beloved by addicts seeking to elude responsibility: “It’s not my fault! And it was an accident! My doctor and Big Pharma did it to me!”

But as one Florida newspaper found out to its embarrassment, the “accidental addict” narrative is rarely the full story. The man they’d featured under that headline as a doctor’s victim didn’t begin his life of crime because of pain treatment—he had a prior cocaine-dealing conviction.

However unwittingly, the Orlando Sentinel had indeed chosen a representative opioid addict: like their former coke dealer, the vast majority of people addicted to prescription painkillers were addicts before they ever “asked their doctor”—as pharma’s TV drug ads suggest—about OxyContin.

One study of some 28,000 found that 78% of people in treatment for Oxy addiction had never—not once—received a legitimate prescription for the drug!

One study of some 28,000 found that 78% of people in treatment for Oxy addiction had never—not once—received a legitimate prescription for the drug!

And 80% of OxyContin addicts, according to research by the National Institute on Drug Abuse, have also taken cocaine. By contrast, in the general population over age 12, just 15% have even tried coke.

Unless you want to believe that pain patients are so delighted by their medical Oxy buzz that they went out and found themselves cocaine dealers, a more parsimonious explanation is that people with pre-existing addictions sought doctors to get opioids. It wasn’t the doctor or pharma that done it.

2. Most pain patients given opioids for chronic pain never become addicted.

I’ve written here before about the distinctions between physical dependence and addiction—put simply, people who are physically dependent on certain substance have a physical need for those substances to function normally, while addiction is compulsive use despite negative consequences.

People who take opioids daily for a month or more will inevitably develop physical dependence. But contrary to conventional wisdom, dependence has little to do with addiction, which is almost exclusively driven by a person’s psychological relationship with the drug. This is why, for example, although some blood pressure medications can cause potentially deadly withdrawal symptoms, no one robs their grandmother to get more of them.

People who are dependent on—rather than addicted to—painkillers can easily get relief by tapering off the drug. Indeed, many pain patients go through withdrawal without even realizing that that’s what’s causing their “flu.” If you aren’t psychologically attached to the drug, kicking opioids is not the gothic ordeal portrayed in so many movies.

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Maia Szalavitz is an author and journalist working at the intersection of brain, culture and behavior.  She has reported for Time magazine online, and is the co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered, and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids. You can find her on Linkedin and  Twitter.