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The Weeds: how America became addicted to opioids

Discarded needles at a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania.

On the July 7 episode of The Weeds, Vox’s German Lopez and Matt Yglesias zeroed in on the opioid crisis — which has fueled the drug overdoses that killed more Americans in 2016 than the Vietnam and Iraq wars combined and are expected to kill 94,000 Americans in 2027.

German and Matt discuss the origins of the opioid crisis in the United States, which, as German wrote in his explainer on the topic, can largely be attributed to aggressive marketing of drugs like OxyContin by pharmaceutical companies.

German has also written that while the number of people diagnosed with an opioid-related disorder rose by 493 percent over the past 10 years, the number of those receiving treatment, which included a drug like methadone or buprenorphine, used to wean the user off their addiction, rose by only 65 percent.

In the episode, Matt and German discuss this issue of access to proper treatment for drug dependence — particularly in rural areas — and the ways in which the government’s focus on prevention of future addiction has left many people already dependent on drugs to turn to the black market to satiate their cravings.

Matt also brings up the role of demographics in the opioid crisis — those in affected areas like West Virginia, Ohio, and Pennsylvania are predominantly white — and how that has played into the way the epidemic has been covered by media and addressed by politicians, especially compared with the war on drugs.

You can listen to the episode here, or subscribe to the show on iTunes here.

Here’s German and Matt on the difference between acute pain and chronic pain, and the ineffectiveness of opioids in treating the latter — though they are frequently prescribed to do so:

MATT: When you philosophically turn the page and say, “Well, we’re gonna use opioids to treat chronic pain,” and you have a country where a lot of people have chronic pain, even if it’s a relatively small share of them who get addicted, you’re talking about a lot of people. Chronic pain in the United States is not a rare medical condition, and developing opioid dependence, if you’re a long-term user, is also not — it’s maybe a minority of people — but it’s not all that rare either.

GERMAN: Right. And I should say one thing that’s important to pull out about this is that the research on how effective opioids are for chronic pain is actually terrible. I mean, we know that opioids are good for acute pain. I think anybody who has taken them for acute pain can testify to that. They make you feel good for a bit. But for chronic pain, the studies that have come out suggest that they’re not that good. The evidence is very weak on this.

And in general, that’s because all medical treatments for chronic pain are pretty bad. You have to do this on an individual case-by-case basis. Opioids might work for some people. They might be absolutely terrible for other people. But that’s important to point out — just because when pharmaceutical companies ran ahead and doctors bought into this idea that opioids are good for treating chronic pain, there really wasn’t any good evidence to support that. So in a big way, the basis for [how] this epidemic started could’ve been avoided if people just picked up a study and looked it and believed it and demanded better evidence for what they were doing.

MATT: Right, so part of it is we have not ever found good solutions for chronic pain, and part of it is that opioids are well-known — as a lot of drugs are — for creating a tolerance and a kind of spiral of dosage that you need. So, you know, maybe for some period of time this seems to be working well, but if you’re not talking about a cure, you’re talking about a treatment, and it’s gonna lose efficacy.

GERMAN: And not only that, but there’s actually some evidence that they might make your pain worse in the long run because they make you more sensitive to pain. There’s some research on this that’s kind of — I mean, it’s weird, but one way to understand this is: I’ve talked to one addiction expert before, and the way that she treats some patients, their pain actually gets better after they get off opioids because after they get through the withdrawal, which is really painful, they realize that a lot of the pain they were feeling when they’d felt like, “I need to take another pill,” was actually the beginnings of withdrawal pain.

And in that way, by not having that withdrawal pain anymore because they detoxed, their overall pain score improved. And that’s one way that opioids can actually make your pain worse, by making you dependent, but otherwise, they also just seem to make you more sensitive to pain in general.

MATT: Right, and I think anyone like me who gets into, like, a coffee addiction spiral, right, you can relate. At a certain point in your life, this is helping you wake up in the morning and you’re more alert and on point, but then, you know, X years into it, it’s like you wake up in the morning and you’re way worse.

GERMAN: It’s actually a few weeks into it.

MATT: Well, even better.

GERMAN: You can become tolerant to coffee. It’s really weird.

MATT: Right, you know, and so, then it’s still “true” that drinking your morning cup of coffee helps you get going in the morning, but that’s because you’ve set your baseline to such a shitty place.

Show notes:

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