Opioids are bad news, aren’t they? Of course they are.
First, they’re addictive. So much so that trying to go cold turkey creates awful withdrawal symptoms.
Opioids change the addict’s personality, making him unable to function. And, if the reports are to be believed, an overdose of such drugs kills people on a pandemic scale evoking the memory of the Black Death.
You’d think no man-made substance can possibly be worse. But you’d think wrong.
Prepare yourself, for I’m about to tell you something that should make every decent person shudder and then rise in revolt. For there exists an addictive drug that punishes withdrawal much more severely than any opioid.
That drug too can instantly kill in overdose but, unlike opioids, it can also kill with moderate use over time. Hence it’s no wonder that it claims many more victims than opioids, by a factor of magnitudes.
And you know what the most terrible thing is? Unlike opioids that are tightly regulated, available only on prescription and under medical supervision, this drug can be scored at every street corner – legally and in any amount.
It’s no wonder that, while opioids have relatively few users, this drug is consumed by most people on most days, occasionally to excess. And – rage is constricting my throat even as I write – the makers of this awful substance are never prosecuted.
But enough suspense. This diabolical concoction is alcohol, and everything I’ve written about it so far is true.
You might say that alcohol has acquired a patina of time. After all, we know that even Noah got legless after the Flood, establishing a tradition that has since been faithfully followed.
But then opioids and other psychotropic drugs aren’t necessarily newcomers either.
The Therapeutic Papyrus of Thebes of 1552 B.C. lists opium among other recommended medicines. Even further back, Sumerian ideograms of about 4000 B.C. describe poppy as the ‘plant of joy’.
Helen passed illegal substances on to Telemachus and Menelaus and, if she lived today, would be nicked faster than you can say ‘let’s see what’s in your amphora, sunshine’. And Avicenna, that great medieval medic, himself died from an overdose of opium.
Nor can even a conservative plausibly object to drugs on political grounds: not all users are left-wing. For example, though Byron and Shelley were a bit pink, Coleridge, who popped opium and drank laudanum like nobody’s business, was as conservative as one can get.
Freud, who snorted cocaine like a suction pump, was indeed politically unsavoury, but surely Queen Victoria was no subversive, and yet laudanum figured prominently on her diet.
Even though adverse consequences of narcotics were common knowledge, drug use in Britain was unrestricted until the 1868 Pharmacy Act and uncriminalised until the 1920 Dangerous Drugs Act, and we can’t seriously believe that what was moral in 1919 all of a sudden became a sin in 1920.
Now, ethical (meaning prescribed) opioids are widely used for pain relief, and we should all go down on our knees and thank the manufacturers for them. For it’s largely because of them that so many of us are spared horrific pain.
Pain comes in various degrees of severity, and doctors routinely judge it on some kind of scale. All sorts of remedies can work at the lower, mild or mild-to-moderate end. But, as any doctor will tell you, severe pain can only be alleviated by opioids.
At the extreme end, for example in some cases of advanced cancer, such drugs are used in huge, sedating doses. Yet patients prefer that to writhing in agony, and I can testify to that from personal experience.
Iatrogenic addiction is fairly widespread, and no doubt some doctors respond to patients’ entreaties for drugs with too much alacrity. Even ethical drugs can be prescribed unethically.
All this is a follow-up to the article I wrote the other day about the hysteria around the Sackler family, one of whose companies makes OxyContin. (http://www.alexanderboot.com/opium-for-hedonistic-people/)
Since then the pitch of that hysteria has gone through the roof. Recipients of huge charitable donations from the Sacklers, such as our own National Portrait Gallery and Tate have told the family to keep its blood money.
This though, say, the National Gallery thankfully accepted a whole wing from the Sainsbury family that flogs highly addictive booze on an industrial scale. Nor are Seagram’s donations ever thrown back into the donors’ faces.
The Sacklers have now been sued in a New York US District Court because their “ruthless marketing of painkillers has generated billions of dollars – and billions of addicts”.
“Eight people in a single family,” continued the lawsuit, “made the choices that caused much of the opioid epidemic. They got more patients on opioids, at higher doses, for longer than ever before. They paid themselves billions of dollars. They are responsible for addiction, overdose and death that damaged millions of lives. They should be held accountable now.”
On this evidence I’d suggest that the epidemic of madness is more widespread than drug addiction. Chaps, the Sacklers haven’t got a single patient on opioids – it’s doctors who prescribe drugs, not pharmaceutical companies.
And if such drugs are bought in a dark alley, it’s not the Sacklers but pushers who sell them. In either case, medical or recreational, the initiative for use often comes from the user himself.
No doctor would prescribe an opioid if the patient says his pain isn’t that bad. No pusher will flog a single pill of Oxy unless the user sneaks into the aforementioned dark alley.
And, even though I can just about imagine that perhaps some ignoramuses have never heard of the opioids’ addictive potential, I can’t for the life of me imagine a doctor who doesn’t know it. And yet Oxy is prescribed.
I don’t doubt that, when the Sacklers applied for a licence, they accentuated the positives of their product rather than its negatives. Such is the nature of marketing, and we could debate the morality of it till the doctors come home.
But I also know that, before the FDA or our own dear NICE and the BMA issue a licence for any drug, never mind an opioid, they demand to see enough trial evidence to fill a large van. Having invested years and millions into developing the drug, the manufacturers are happy to oblige, giving themselves a chance to recoup their investment.
The proverbial fine-toothed comb is then passed over every letter, every word, every graph or chart, every bit of experimental and clinical evidence. Platoons of outside consultants are drummed up to supplement the efforts of the thousands of experts working for the regulatory bodies.
If a bad or dangerous drug gets through, which happens extremely rarely, who’s at fault then? Surely the FDA should appear as a co-defendant on that lawsuit? Or, since I’m convinced – and know from personal experience – that Oxy is a wonderful medicine, shouldn’t the overprescribing doctors be sued too?
If a drug has effects, it has side effects. Blaming the manufacturer for the way a licensed drug is used, misused or abused isn’t only idiotic – it’s also counterproductive for the medicine’s effects may as a result be denied to those who need them badly.