In the US, the use of opioids has now overtaken road traffic accidents as a leading cause of death.
In the 1980s, the rise of the hospice movement in the UK highlighted the fact that many cancer patients were dying in pain. To manage pain caused by advanced cancer at the end of life, strong painkillers — opioids — are often required. With careful titration many side effects can be avoided, and pain well controlled. That led to a more humane approach to end-of-life care. Further studies suggested that opioids were also beneficial in the management of chronic pain. At the same times, the idea was gaining that pain should not just be accepted. More patients asked for more pain relief. Later studies showed irrefutably that for many patients suffering chronic pain opioids were not useful.
But pharmaceutical companies are driven by the need to make a profit, even despite evidence and human need. Using the flawed initial studies companies, including those manufacturing the opioid oxycontin, encouraged widespread prescribing of opiods for patients with chronic pain. They claimed that oxycontin was less likely to be addictive because it was a slow release preparation. The company producing oxycontin, and three executives, were found guilty of criminal charges in 2007 because of such misleading claims, and had to pay over $600 million in fines. But opioid prescriptions had already become more common.
Patients who are already impoverished and depressed are less likely to manage the additional burden of chronic pain, or to cope with the help from physiotherapy and psychology which can manage it better. Even if opioids do not relieve the pain, they may cause pleasant side effects such as sedation, though ever-increasing doses will be required to maintain this effect. Then a physical dependence on the drugs develops, leading to severe withdrawal effects if it is withdrawn.
The Sackler family own the pharmaceutical company that manufactures oxycontin. They have a reputation for philanthropy, and have sections of museums, libraries and galleries named after them. Early in February, a “Shame on Sackler” protest at the Guggenheim Museum in New York attracted media attention with a rain of fake prescriptions falling on empty pill bottles rolling across the floor.
More needs to be done: we need a system of health and social care based on human need, not on the profit motives of pharmaceutical companies. Treatment of chronic pain should be evidence based and managed holistically. We need a civilised society where employers promote health, and help people to continue in employment when they are impaired by pain. And we need museums, libraries and art galleries to be properly funded by the state. These public institutions should not be a part of sanitising the reputation of people who have profited from mass deaths and spreading addictions in the working class.