There’s plenty of blame to go around for the heroin epidemic that is currently infiltrating into our communities across America. We started off by blaming the doctors, who do need to share some responsibility but what role do the pharmaceutical companies play? And is there really a Big Pharma conspiracy which implies that pharmaceutical companies and the medical establishment are in cahoots, working together in sinister ways that is not in the public’s best interest? Based on the theory that money and power corrupt, maybe so, but let’s put the Big Pharma conspiracy theory on hold and look at information we do know.

I know that after I had rotator cuff surgery I was prescribed OxyContin (Oxys). I was grateful for the relief it provided for the first 48 hours of excruciating pain. By the third morning after surgery I was able to manage my pain with Ibuprofen, a medication that has no addictive qualities and can be bought over the counter. But I still had about ten more days left of OxyContin. Ahhh… there’s part of the problem – I was prescribed too many pills and in fact my wonderful orthopedic doctor never inquired if I had ever had a problem with addiction or pain pills. Fortunately I do not, and so without the genetic predisposition to addiction and without any current emotional challenges and having a stable home life taking two days of “Oxys” did not stimulate any biological, psychological or sociological aspects common to folks with the disease of addiction. For a further explanation, please listen to my presentation at College of the Atlantic.

So what should I do with the extra pills – just put them in the medicine cabinet for my teenage kids to find? What if I did have a propensity to addiction? Would the extra pills have set me on the road to recidivism and to heroin when I ran out of the prescribed opiate pills? How does this all relate to Big Pharma? My point is that even if pharmaceutical companies are “pushing” doctors to prescribe stronger pain medication, patients at times do need pain relief and having appropriate opiates available is beneficial. I am not defending pharmaceutical companies, but let’s not inappropriately chastise them. We need and want good medicines and when we have intractable pain from cancer or other serious conditions, we want pain relief. Pharmaceutical companies do not make a person a “drug addict”; but that is not to say they can’t do more in terms of educating doctors and the public or being proactive in how they formulate pills.

When OxyContin was first manufactured, it was a pill that easily could be crushed for snorting or injecting. The pills were everywhere on the street and pharmacies were being robbed. The manufacturer then reconstituted OxyContin into a pill that could not be crushed. Once that happened the demand for “street” Oxys went down. It’s hard to get the “high” desired if all one can do is swallow the pill. Where did all the Oxy addicts go? They went to heroin because it was readily available and cheaper. What created the increase supply and decrease cost of heroin? That will be the next topic because the War in Afghanistan is Reason # 5!

Hope you enjoy this week’s look into some of the drama of Addiction on Trial. Please meet the pathologist who performs the critical autopsy.

“Dr. Freisen’s autopsy attire consisted of a scrub suit, surgical gown and hat, shoe covers, a clear plastic face shield, and a double set of latex free gloves. When preparing to perform Annette’s autopsy, he also placed a surgical mask over his face and nose and under the face shield to minimize the odor of her decomposing body. He moved through Annette’s autopsy with a forensic focus not exhibited when performing autopsies on the Aunt Millies of the world. He completed every standard examination of Ms. Fiorno’s remains with the full understanding that the results of this autopsy would be subjected to further dissection in the courtroom. However, if he had known his cross-examination would be choreographed by Attorney Shawn Marks, not that he knew of this Boston attorney beforehand, he may have performed and documented a more comprehensive autopsy. The word around town was that they had this Jimmy character dead to rights, with enough evidence before the autopsy results were known to send him down the river for good.”