Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, And Why It’s So Hard to Stop, by Anna Lembke MD

A study probes a silent global epidemic: addiction to prescription medication, says David Healy

January 5, 2017
OxyContin pills
Source: iStock

If you travel to North America these days and ask about opioids, pretty well everyone you meet is likely to know someone affected: a relative, someone in their neighbourhood, a friend’s family member. It doesn’t matter whether the person you ask is from a “vibrant” part of town or a middle-class ghetto. As many people are on opioids as have attention deficit hyperactivity disorder or take antidepressants, and the death rates from these drug accidents combined dwarf those from road traffic accidents.

There are about 30,000 opioid-related deaths per year, more than 500,000 in the past two decades and heading towards 1 million since the epidemic took root in the 1980s. This makes opioid deaths the biggest single killer in North America at present. The wonder is that Europe remains comparatively spared.

But the twist in the story is that these opioids aren’t bought on the street. We’re talking Marcus Welby, M. D. or Dr. Kildare rather than The Wire or Hill Street Blues. We’re talking about pharmaceutical companies that support pension funds, rather than the Mafia.

As with SSRI antidepressants, at the heart of the marketing of prescription opioids were two elements. One, as with serotonin, was a myth: in this case, the claim was that people in genuine pain don’t get addicted to opioids. The other was the incorporation of clinical trials into treatment guidelines. There is no place for clinical wisdom in guidelines – wisdom is not evidence-based. Doctors were suddenly faced with patients who were angry if they were not being treated according to the standard of care.

This epidemic needs a good history, and Drug Dealer, MD isn’t that history. But using a handful of cases, Anna Lembke skilfully brings out the key issues. At times she gets very basic, but she held my attention nonetheless because on the next page she invariably brought in the complications. You expect an upbeat ending, but none of her cases turns out well, which is quite a position for a clinician treating a problem to take. It might have been difficult for a man to admit impotence in the same way.

This is a story with mythic resonance. Opioid use was the problem in 1914 that made all drugs prescription-only, an arrangement that has resulted in us all being treated like addicts by our doctors, who control access to treatments. The book outlines how Purdue Pharmaceuticals and AbbVie (or Abbott, as it was then known) exploited this arrangement to turbocharge the sales of OxyContin, which Purdue introduced in 1996, and followed by other companies with opioids such as Fentanyl. Stronger variations on OxyContin and Fentanyl have since been put on the market by the US Food and Drug Administration’s right hand, while its left hand is increasingly frantically trying to help control the epidemic. The latest move is to make powerful drugs, such as the opioid antagonist Naloxone, available without prescription.

Meanwhile, if you do visit North America and know any doctors who have any contact with this problem, you are likely to find them spooked by tales of stronger opioid derivatives being synthesised in Chinese labs, small amounts of which could wipe out the populations of entire states. It is difficult to resist thoughts of a replay of the Opium Wars.

David Healy MD is professor of psychiatry, Bangor University.


Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, And Why It’s So Hard to Stop
By Anna Lembke MD
Johns Hopkins University Press
192pp, £15.00 ISBN 9781421421407
Published 14 January 2017

You've reached your article limit.

Register to continue

Registration is free and only takes a moment. Once registered you can read a total of 3 articles each month, plus:

  • Sign up for the editor's highlights
  • Receive World University Rankings news first
  • Get job alerts, shortlist jobs and save job searches
  • Participate in reader discussions and post comments
Register

Related universities

POSTSCRIPT:

Print headline: A pill a day takes the craving away

Have your say

Log in or register to post comments

Featured Jobs

Most Commented

Monster behind man at desk

Despite all that’s been done to improve doctoral study, horror stories keep coming. Here three students relate PhD nightmares while two academics advise on how to ensure a successful supervision

Sir Christopher Snowden, former Universities UK president, attacks ratings in wake of Southampton’s bronze award

opinion illustration

Eliminating cheating services, even if it were possible, would do nothing to address students’ and universities’ lack of interest in learning, says Stuart Macdonald

Female professor

New data show proportion of professors who are women has declined at some institutions

celebrate, cheer, tef results

Emilie Murphy calls on those who challenged the teaching excellence framework methodology in the past to stop sharing their university ratings with pride