Overprescription or Recreation: What Is Driving the Opioid Epidemic?

President Trump has convened a panel to address America's opioid epidemic. Its first mission should be to find convincing data to identify the actual cause(s) of the problem. That will be much harder than it sounds, since ideologues are always in plentiful supply.

Indeed, many influential people already seem to have a strong opinion about who is to blame. Claire McCaskill, a Senator from Missouri, points her finger at pharmaceutical companies. She is launching an investigation, but there is little need for one, given that she has already told us what its conclusions are ahead of time: 

"This epidemic is the direct result of a calculated sales and marketing strategy major opioid manufacturers have allegedly pursued over the past 20 years to expand their market share and increase dependency on powerful — and often deadly — painkillers... To achieve this goal, manufacturers... downplay[ed] the risk of addiction to their products and encourage[d] physicians to prescribe opioids for all cases of pain and in high doses."

In other words, Ms. McCaskill believes Big Pharma duped medical doctors into prescribing addictive drugs to their unsuspecting patients*. Of course, she throws in the word "allegedly" to make it sound like she's interested in an unbiased investigation.

Joe Manchin, a Senator from West Virginia, has more sensible views on the topic, as elaborated in an interview with STAT. Still, Mr. Manchin believes that marijuana is a possible gateway drug to opioids, though the evidence is hardly convincing that marijuana serves as a gateway to anything. Furthermore, recent research suggests that medical marijuana could reduce dependence on opioids.

This week, Special Report on Fox News is running a five-part series on the opioid epidemic. (See Part I.) One of the former addicts they interviewed gives insight into how difficult it will be for researchers to tease apart the true nature of the crisis. The interviewee, who got addicted to OxyContin following a surgery and switched to heroin, was asked about why it was so hard to quit. He said:

"I didn't think I could do it... I loved it. It was my everything. I loved it more than my family, more than my job, more than my friends, more than my girlfriend at the time."

How should we think of his case? Clearly, he was introduced to opioids by a doctor, but he continued using them because he seemed to enjoy it. So, who should we blame? Doctors? Big Pharma? The patient? Is this a case of overprescription or recreation?

Answering that question will be key to solving the crisis.

*Note: It is true that Purdue Pharma, which manufactures OxyContin, was fined $634.5 million for "claiming the drug was less addictive and less subject to abuse than other pain medications," according to CNBC.