Opioids – a crutch, a weapon or just the latest health crisis?

Andrew Sullivan’s beautifully crafted article in New York Magazine on America’s opioid epidemic is essential reading, even if you have no personal experience of the phenomenon, or if as an unsympathetic non-American you view it as just another symptom of that country’s decline.

Sullivan starts with a brief history of the poppy, the source of opium and all the synthetic compounds that offer us blissful relief from pain – both physical and spiritual – and thereby seduce us into the hell of addiction. He talks about how opioids work and offers reasons why so many Americans have found themselves in their thrall.

Perhaps his most important contribution to the discussion is to suggest that a solution lies not in “wars on drugs”, but in a deeper understanding of the causes:

To see this epidemic as simply a pharmaceutical or chemically addictive problem is to miss something: the despair that currently makes so many want to fly away. Opioids are just one of the ways Americans are trying to cope with an inhuman new world where everything is flat, where communication is virtual, and where those core elements of human happiness — faith, family, community — seem to elude so many. Until we resolve these deeper social, cultural, and psychological problems, until we discover a new meaning or reimagine our old religion or reinvent our way of life, the poppy will flourish.

His article leads me to three thoughts.

First, this is not just an American problem. To a greater or lesser extent, it’s everywhere. Sullivan’s description of American doctors who have little financial incentive to look deeply into the causes of the pain their patients present, and who dole out opioid prescriptions as a cure-all, should resonate with users of Britain’s National Health Service, whose guidance limits general practitioners to eight minutes per consultation. The temptation to prescribe rather than to deep-dive must be overwhelming.

Second, it would hardly be surprising if America’s rivals saw the US as a huge but diseased tree that only needs a few nudges to keel over. One super-power, Russia, seemingly believes that it can weaken and debilitate its greatest rival by subverting its democratic processes.

Does another, China, believe that by failing to clamp down on the mass-production and illegal export to the United States of fentanyl, by far the most potent and dangerous of all the opioids, it will make its own contribution to decline of the world’s most powerful economy? I find it hard to believe that one of the world’s most intensive surveillance states is incapable of stemming the flow of illicit fentanyl from within its borders if it wishes to do so.

If one was a patriotic American of a paranoid bent, one might be forgiven for thinking that stealing technology was only part of the plan.

And third, opioids are here and now. The next crisis will probably be antibiotic resistance caused by over-prescription. It’s already started, and it might soon dwarf the effects of opioid addiction.

One would hope that the drug companies are ploughing their opioid profits into antibiotic research. But to what extent are they? And are governments doing enough to prepare for and mitigate a clearly foreseeable crisis?

I don’t know the answer to either question. But it worries me that we seem to be living in an age in which the next quarter’s profit forecasts and the latest political opinion polls seem to be more important than the disasters lurking around the corner, and in which governments struggle to fix their cash-strapped health systems, while paying insufficient and ineffective attention to issues that threaten to blast the health both of people and corporations out of the water for years to come.

For all that, I comfort myself in the knowledge that should I be laid low in the hopefully distant future by some disease that used to be treated by a course of humble antibiotics, the equally humble poppy will still be there to ease me out of life with the minimum of pain and suffering.