Letter to the Editor: In response to Future’s song ‘Mask Off’ and the opioid epidemic

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Percocets, Molly Percocets/ Percocets, Molly Percocets 

If you haven’t been living under a rock in the past two years, you’ve undoubtedly heard of rapper Future’s catchy song Mask Off. The song glorifies the rapper’s use of the opioid brand Percocet (Acetaminophen/ Oxycodone) and party drug Molly (also known as MDMA or ecstasy)- but all we focus on is that catchy chorus- “Percocets, Molly Percocets / Percocets, Molly Percocets…”

For a lot of young listeners, this could be their first time hearing about these foreign drugs thus sparking their curiosity in trying them (in a worst case scenario). But it’s not just Future increasing the popularity of these drugs, particularly opioids, but other artists as well. Researchers at the American Board of Family Medicine conducted a study examining lyrics from the past 40 years and found that there was an increase in lyrics in talking about opioid narcotics along with increased opioid use. But can we really blame Future and other lyricists, or is this part of a bigger problem linked to our growing opioid epidemic? 

The not so humble beginnings 

Opioids are a class of drugs (most are painkillers) that are highly addictive and can be derived naturally (from a common poppy plant) or made synthetically in a laboratory. You probably have heard of the prescription opioid brand names such as Oxycontin (oxycodone), Vicodin (hydrocodone), Codeine, Percocet (oxycodone), and Dilaudid (hydromorphone) or even the illegal opioid, heroin. The addictive nature of opioids comes from how the body reacts after its been ingested, snorted, injected, or administered. Molecules of the opioid bind to a receptor in the brain that initiate a chain of reactions allowing you to feel happy, calm, and pain free, creating a “high” or a feeling of euphoria. This comes at a price, as when taken frequently, your body becomes reliant on these drugs in order to feel happy and calm, instead of producing it naturally. Withdrawal from opioids turns out to be even more difficult as your body has to “relearn” how to produce these positive feelings naturally. Additionally, the body becomes so physically dependent on the opioid, that it creates a severe feeling of illness during immediate withdrawal. 

We can trace the history of the opium as its simple derivative of the poppy flower as a recreational tincture in Mesopotamia in 3400 BC, and from there, its colorful history bloomed. Wars, dynasties, and trade routes have all been built and centered around “King Opium”, but it was only until relatively recently that this drug reached the United States in 1775, as shown in the timeline above. So how exactly did we arrive at an opioid crisis 250 years later, where over 130 people in the US are overdosing on opioids everyday? 

We’re all just pawns in Big Pharma’s chess board 

I know, I know- even just using the phrase “Big Pharma” makes me sound like a conspiracist, but hear me out. In order to convince doctors to prescribe opioids, pharmaceutical companies (“Big Pharma”) not only aggressively marketed the drugs directly to doctors, but also downplayed the addictive properties in the 1990s. Particularly, drug representatives of Purdue Pharma, makers of Oxycontin, had completely pandered to the doctors- buying steak dinners, treating them out to golf, etc. all while knowingly keeping the knowledge from the doctors that their drug was extremely addictive. Why, may you ask? To increase their bottom line and make money. This reassurement from the pharmaceutical companies to doctors allowed the doctors to believe, in good faith, that opioids were basically a wünderpill that treated pain-killing needs for everyone- your dad’s achy knee, your grandmother’s arthritis, your best friend’s bad back. Not only that, Purdue Pharma never learned their lesson. Today, Purdue Pharma profits off of anti opiate addiction drugs.They aren’t just fueling the opiate crisis- they’re making money by attempting to fix it as well. Twisted, right? 

To put this all in perspective, out of all 195 countries in the world- only two, the United States of America and New Zealand, allow direct to consumer (DTC) advertising for drugs. The other 193 have outlawed DTC advertisement on the basis of medical ethics. This means that not only are the pharmaceutical companies are attacking not only the doctors, but also the patients- the people who haven’t had over six years of education in order to become an expert in the medical field. Not only that, the reason why we haven’t outlawed DTC is because pharmaceutical companies have a strong foothold in Washington D.C. and are refusing to let go. In comparison, for every one million Americans, almost 50,000 doses of opioids are taken every day, which is four times the rate in the United Kingdom– a country that has banned DTC advertising. 

Enough is enough! (Spoiler alert: it wasn’t) 

By the mid 2000s, the US finally took control of their senses and started cracking down onto the selling and distribution of prescription opioid drugs. In 2006, President George W. Bush passed Bill H.R.6344, allowing stricter control over opioid jurisdiction in the United States. However, when doctors began to prescribe less opioids, addicts turned to heroin to get their fix, further perpetuating the opioid crisis… and the rest is history. Today, 80% of heroin users have first misused heroin and 4-6% of people who misuse prescription opioids will later turn to heroin. Heroin and opiate misuse is increasing at alarming rates each year. In 2017, our surgeon general wrote a letter to the public regarding opiate addiction, declaring it a public health crisis. 

What can we do today? 

Personally, I believe that Big Pharma’s stronghold and pharmaceutical lobbying in Washington D.C is unethical. However, this situation is unavoidable as all pharmaceutical companies are privatized- thus they are constantly looking for ways to make more money- whether it be directly shilling the right buzzwords to the healthcare industry or advertising directly to the consumers. Although it is our inherent need to find a scapegoat, we can’t just point a finger at the obvious target that pharmaceutical companies are here. Physicians, the American Pain Society, and even the Joint Commission are all culpable. But regardless of who’s to blame, we still have millions of Americans addicted to opiates. I propose that we start joining the bandwagon and start outlawing DTC advertising. Not only that, I believe that we need to ensure that those running for public offices are refusing campaign money from the pharmaceuticals. However, this is only a drop in the bucket compared to the beast of the opioid epidemic. 

The major factor in the opioid crisis is the issue of the distribution and use of heroin and fentanyl- man made, synthetic opioids (and much more addictive and potent than naturally derived opiates) that cause the majority of opioid related deaths. Other than tighter border control, there’s not much we can do to stop the influx of heroin into the US. However, what we can do is increase awareness and end stigma for getting help regarding opiate substance abuse- regardless if it was through legal or illegal methods. We can also advocate for people who are taking high doses of opiates to carry a can of Naloxone, which can treat emergency opioid overdoses (think of an Epipen, but for opioids!). I believe we all have a role in fixing this opiate crisis, and even the smallest of actions can fix this problem in the long run. 

Sources: 

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278148/ 

2. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates 

3. https://www.poison.org/articles/opioid-epidemic-history-and-prescribing-patterns-182 

4. https://www.citizensforethics.org/a-bitter-pill-how-big-pharma-lobbies-to-keep-prescription-drug-prices-high/

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