Burning Question

“Would today’s fentanyl crisis exist without OxyContin?” a journalist asks in an interview.

My knee jerk response was ‘NO”.

This question and my answer has been churning in my head ever since.
Maybe because I didn’t answer correctly, or rather, fully.

Looking across the world fentanyl is everywhere, but the scale is different, so much smaller.

So many books, films, TV shows unravel the complexities of how we got here.

Harry Nelson noted in his book The United States of Opioids that for a wild fire to take hold, the ground must first be dry.
So how come America’s ground was so parched?

Patrick Radden Keefe lays out how the Sackler family desiccated that ground in Empire of Pain.
A pill for every ill. From Valium to OxyContin they took your mental and physical pain away. No effort required. Whilst destroying access to alternatives.

The film Heroin(e) explains that if you have a manual labor job and are injured, there’s no taking a day off, take a pill and back to work you go.

The brilliant Pharmacist documentary shows the FBI’s inability to respond in a timely manner as Dan Schneider, a man ‘with the kind of grief that can not bare it to happen to anyone else’ gets shit done.

A health insurance system that reimbursed for pain pills but not for physical therapy .

And if the pill is non-addictive … why wouldn’t you? Sam Quinones observes in Dreamland.

The documentary The Crime of the Century uncovers the FDA capture.

Beth Macy observes in Dopesick, as do all these other books, how the ‘non-addictive’ pseudo-science dished out by OxyContin sales teams made the doctors complicit and how the American Medical Association was co-opted by the Sacklers to threaten medics with losing their medical licenses for under prescribing pain meds, whilst access to Medical Assisted Treatment (MATS) were hindered.

The excellent TV miniseries of Dopesick depicts Richard Sackler fuming as he fails over and over to expand into the European Market, barred by their regulatory bodies that were not, like the FDA, rendered impudent by his wily ways.
If, you only have time for one thing … make it this.

Please note: these documents do so much more, I am just cherry picking in search of an answer to that question.

A convergence of terrible labor laws, captured regulatory bodies and healthcare systems, the power of the pharmaceutical lobby, a pay to play legal system, social inequity and a nation in pursuit of happiness was the perfect storm to set the blaze of pain and death, and enable the Sacklers et al to game the system and make insane amounts of money from the misfortune of others.

The Sacklers were the first through the gate and unbridled by any public shareholders, anesthetized by greed without regulatory guardrails or meaningful consequences, wrote the playbook of how to game the system for all to see and anyone to replicate whilst those they knowingly addicted paid the price in jail time and dead children. That playbook still stands.

Finally OxyContin was restricted just as clumsily as it was rolled out, leaving a highly addicted population no where to go but to heroin, and as that was curtailed, to fentanyl.

So I bring myself back to the question “Would today’s fentanyl crisis exist without OxyContin?” and I still don’t know.

But as the high octane OxyContin hit the arid US ground, the Sacklers sure did fan it.
And in the absence of OxyContin, it didn’t blaze quite as ferociously in other nations.

I guess my answer remains NO.