Motivation, Memory And Related

motivation, memory and related circuitry.” (2011) In recent years, the Opioid Epidemic has become a prominent issue in America. Since the 1990’s, the amount of deaths caused by opioid overdoses is rapidly increasing, thus making this a social issue rather than an individual problem. (The New York Times, 2017) Because so, the Opioid Epidemic is creating pressing consequences, such as creating an economic burden, breaking families apart, and causing intervention from the government. In attempt to ameliorate this social crisis, the government has put emphasis on drug abusers and dealers, thus making drug possession one of the main reasons for incarceration. (PEW Research, 2018) PEW researchers argue that despite the effort, there is no decrease in the amount of deaths caused by opioid overdoses. (2018) In other words, this highlights the fact that the opioid epidemic is something bigger than drug deals and use. Rather, the opioid epidemic is a societal issue induced by institutions such as medical physicians, pharmaceutical companies, and the government, and their failure to take part of the blame for the crisis, thus causing individuals of lower socioeconomic status to be used a scapegoats, overall illuminating the need for change within the stereotypes of addiction, and reform in healthcare approaches for opioid addiction. Literature review

Opioids are a drug prescribed primarily for chronic pain, and work closely with opioids receptors in the brain, in order to regulate pain and dopamine levels. (The New York Times, 2017) This makes them highly addictive because when taken, the drugs reward their abuser with a dopamine rush, leaving him or her needing more to satisfy their needs. (The New York Times, 2017)

In 1986, medical physicians, Russell K. Portenoy and Kathleen M. Foley published research firmly stating,

“We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse,”

thus introducing the disillusionment that opioids are generally safe and have no real connection to addiction. (1986) According to Andrew Kolodny, this lead to a gradual, then eventually rapid increase in the use of opioids to treat chronic pain, when opioids were originally utilized for cancer-related pain at the time. (2015) The use of opioids gained momentum with Purdue Pharma’s introduction of Oxycontin in the 1990s. (Kolodny, 2015) To encourage the long-term use of opioids, Purdue Pharma funded educational programs and campaigns in order to persuade medical professionals and the public that opioids should be used more aggressively in healthcare. (Kolodny, 2015) In addition, Portenoy advocated that opioid addiction is not the same concept as,”physical dependence,” which was claimed to be,” clinically unimportant,” thus easing the public into the idea that addiction to opioids is not as big as it seems. (1996) Despite the exaggerated and insufficient campaign proposed by Purdue Pharma, physicians began to prescribe opioids more and more, thus allowing people to become dependent on them; this influx of drugs became the catalyst to what the opioid epidemic is today.

By 1999, 86% of opioids prescribed were for non-cancer related reasons. (Liu, L., Pei, D. N., Soto, P., 2018) By 2012, physicians prescribed 81% of patients with opioids, which is triple the amount of patients prescribed than in 1999. (Centers for Disease Control and Prevention, 2017 ) “In 2016, health care providers across the US wrote more than 214 million prescriptions for opioid pain medication,” according to Centers for Disease Control and Prevention. (2017) This hike in prescribed opioids is a result of,”a lack of education and misinformation, leading to overprescribing and a tendency to focus on ineffective strategies,” rather than advising patients with other remedies to deal with pain. (Manchikanti, 2012) Wilson M. Compton, Maureen Boyle, and Eric Wargo claim,” it is clear that overprescription of these medications over the past two decades has been a major upstream driver of the opioid abuse epidemic,” thus citing that medical practitioners, and their practice of overprescribing are one of the main instigators of the opioid epidemic. (2015) In the documentary, Warning: This Drug May Kill You, all victims of addiction used prescribed medication such as Vicodin or Oxycontin as a gateway, or introduction, drug to heroin.(HBO & Pletz, 2017) Despite having an opioid dependency and history, victims in the film such as Stephany and Wynne, were still prescribed opioids to treat pain (that was often self- inflicted), which ultimately led to their demise.(HBO & Pletz, 2017) Coincidentally, studies reveal that physicians are paid by pharmaceutical companies, thus unveiling the correlation that the higher prescription rates physicians have, the higher payoff they receive from pharmaceutical companies. (Kressler, A., Cohen, E., & Grise, K., 2018) Furthermore, Aaron Kressler, Elizabeth Cohen, and Katherine Grise coherently found that physicians found within the highest 0.1% percentile of opioid prescribers were 95% more likely to receive a payment, and that in 2015, 48% of physicians received payment from pharmaceutical companies. (2018)

According to a research done in Boston, Massachusetts by Benjamin Bearnot, John F. Pearson, and Jorge A. Rodriguez, the highest concentration of discarded needles used for heroin was found in neighborhoods with younger, wealthier populations. (2018) In addition, the white population has a higher rate of opioid overdose than the Black/ Hispanic population. (Gramlich, 2018) Although it may seem that these two statistics have no relationship, they indeed show a commonality: access to health care. The ongoing opioid epidemic is unique to the United States due to the structure of the healthcare industry. Unlike other countries, in order to have medical health coverage, Americans must seek insurance companies by themselves, usually through employers or the government, thus causing the health care insurance industry to become a monopolizing business model. (Amos, 2017) In fact, insurance companies encourage physicians to prescribe opioids to treat pain because,” its extremely low cost.” (Shactman, 2015) Not only so, private insurance companies do not even aid in combating opioid addiction by omitting medication for opioid addiction in their healthcare plans. (Lopez, 2018)

Discussion

This idea that drug dealers and opioid addicts are solely to blame, or even the perpetrators of the epidemic, is false. Using the functionalist perspective, the Opioid Epidemic has a function within society. The obvious manifest function of opioids is to heal individuals who feel immense pain, and allow them to live life pain-free. But, the evidence presented reveals institutions such as Purdue Pharma, insurance companies, and even medical practitioners, are utilizing opioids as a money multiplier, rather than caring for the well-being of the patients. On the contrary, this allows for the latent function of creating more jobs. For example, if opioid consumption is high, pharmaceutical companies would need more pharmacists to synthesize the drugs,more delivery workers to distribute the drugs and so on. But, on the other hand, this influx of opioids creates pressing dysfunctions within society. Because of this addiction that the opioids cause, social structures such as education and families suffer. Less people attend higher education, or even dropout of high school because opioid addiction. Families are broken apart, with family member either leaving the family or tragically dying, due to this fixation on opioids. Yet, all these institutions disregard the dysfunctions and still encourage the use of opioids due to their cost effectiveness and conveniences.

Pharmaceutical Companies: Deceiving Data

Pharmaceutical companies are notorious for their capitalist mindset, which is shown through their methods (such as campaigns or even television commercials) of selling drugs, that could heal people, at higher prices. Companies, especially Purdue Pharma play a big role in perpetuating and furthering the Opioid Epidemic. Kolodny emphasizes that not only do they supply the opioids to physicians, but they also deceive physicians, and even the public, into believing that products such Oxycontin or Vicodin are not as addictive as they claim to be. (2015) When Purdue Pharma introduced Oxycontin in the 1990 using a campaign, the information they used to support the idea that Oxycontin is not addictive was insufficient and not accurate due to the lack of long term studies on the drug. (Kolodny, 2015) Rather, they utilized chronic pain as a means of making the product look desirable and safe. This elucidates the commercialization of drugs roots within pharmaceutical companies, and their greediness. By paying physicians based off how much opioids they prescribe, pharmaceutical companies are comparable to slim tea companies that pay celebrities to endorse their products, which overall confirms that drugs are just a product and commodity to them, rather than a life-saving necessity.

Physicians’ Prescribing Methods

The Overprescribing Crisis Because of miseducation originating from pharmaceutical companies, (Manchikanti, 2012) physicians grew to the idea that opioids can heal chronic pain without harm.With this evidence, it is strongly suggested that physicians are overprescribing opioids. Specifically, in Warning: This Drug May Kill You, Wynne, a woman with a great,loving childhood, three children, and a supportive husband, becomes addicted to opioids after being prescribed Oxycontin and Vicodin to treat pain after her caesarean section. (HBO & Pletz, 2017) Although it may seem that she just lost control, the fact is she was continued to be prescribed with opioids repeatedly, despite her history of addiction. Physicians continued to feed her addiction, failing to examine her past. (HBO & Pletz, 2017) Wynne’s daughter angrily asserts,

“That was probably the most anger I could feel ever because she’s been to that

hospital, easily, fifty times. They’ve seen her there unconscious, had to like pump her

stomach so many times, and yet she comes in there and they leave her with more [opioids],”

(HBO & Pletz, 2017) which reveals that hospitals and physicians do not even take into account individual’s addiction disease. Rather than looking at the patient holistically, they assess solely the problem that is in front of them, because of its convenience; while this may fix the problem short-term,in the long-run, it allows individuals to take advantage of the factory-like hospital setting. And if this is not sufficient enough, the correlation between the amount of deaths due to opioid overdose and amount of opioid prescriptions a year reveal an upward, strong trend, (Centers for Disease Control and Prevention,2017) overall supporting the claim that overprescription of opioids is a leading factor in the opioid epidemic.

Stereotyping The stereotype of a heroin or any other opioid abuser is a poor, lower class minorities. However, demographics reveal that young, white, wealthier populations have a higher chance of being opioid addicts. (Bearnot, Pearson,& Rodriguez, 2018) (Gramlich, 2018) This discrepancy exists because of the false stereotype that minorities or people of lower socioeconomic class are more likely to be addicts. Physicians then become wary of prescribing opioids to people who are minorities or come from a low socioeconomic background. This stereotype influences physicians to prescribe opioids more towards individual who do not fit into that stereotype, thus allowing people who are white, who are younger, and who are wealthier to have a higher risk of becoming addicted to opioids.

Corrupt Insurance Companies

On that note, people who are white or wealthier are also susceptible to opioid addiction simply because they are more likely to have health care insurance. Because universal healthcare does not exist in the United States, privately owned healthcare companies exist and decide policies, partnerships with medical companies, etc. Because so, health care within the United States is more of a business. Similarly to pharmaceutical companies, health care insurance companies try to earn the most money they can, which they do by encouraging the use of opioids within hospitals. Because of their,” extremely low cost,” (Shactman, 2015) insurance companies praise the use of opioids rather than remedies such as physical therapy, which is more expensive and takes longer to complete. This reveals that insurance companies are just as much to blame for the opioid epidemic. In addition, privately owned insurance companies fail to provide coverage for opioid addiction treatments or medication. (Lopez, 2018) Because so, either individuals cannot afford to become sober, or become stress in trying to pay for treatment for opioid addiction, thus making them more likely to return to abusing opioids. (Lopez, 2018) Conclusion

There is overwhelming evidence that institutions such as pharmaceutical companies, physicians, and healthcare insurance companies within the United States are perpetrators of the ongoing Opioid Epidemic. This predisposed notion that drug dealers, people of color, or individuals from poorer neighborhoods are the only ones who are fueling the opioid epidemic must be debunked, because it is simply untrue. But more importantly, rather than focusing on who is to blame for the opioid epidemic, the United States needs to focus on building a strong rehabilitation and support system for opioid addicts. Rather than leaving addicts to deal with their addiction by themselves, having the support they need, can bring them out of the shadows. People need to remember, that at the end of the day, addiction is a disease that needs support and time to heal.