Prescription opioid addiction is slashing and burning its way across the American landscape. Since the late 1990s, the rate of narcotic painkiller addiction (and overdose) has soared, and addiction treatment centers are now overflowing with men and women dependent on drugs like OxyContin, fentanyl, Vicodin and Percocet. The arrival of the 21st century has also been accompanied by a sudden rise in heroin use, and this is directly related to the narcotic painkiller addiction problem. Even though heroin is an illicit drug, it binds with the same receptors in the brain as its prescription opioid cousins, meaning it can be used interchangeably with these drugs. Surveys show three-quarters of currently using heroin addicts started out on OxyContin, Percocet or similar legally prescribed medications, shifting to heroin only when they were no longer able to afford the original substance. Even on the black market, opioid pills, patches and crushed powders are far more expensive than heroin, and this has fueled the shocking return of a scary street drug that had seemingly fallen out of favor long ago. All of this is said to be a direct outgrowth of the United States medical profession’s prodigious embrace of prescription painkillers, which are now being routinely distributed to patients complaining of all levels of pain. Many of the recipients of these drugs come from relatively comfortable economic backgrounds, and this has led some to identify this new epidemic as largely a middle class problem. A 2015 study by the Centers for Disease Control and Prevention (CDC) confirmed that heroin use has grown significantly among women, those with higher incomes and people with private insurance. This adds evidence to the assertion that the new opioid epidemic has its roots in middle class culture. But a deeper look reveals a more complex picture. While opioids and heroin are cutting a wider demographic swath than heroin alone did in the 1960s and ’70s, the real story of America’s runaway opioid addiction problem is more nuanced than many believe.
Opioid Addiction and the Decline of the Middle Class
In any given year, doctors in the U.S. will write about 250 million prescriptions for opioid painkillers, which is more than enough to fill at least one pill bottle for every American adult. A good portion of these prescriptions are being distributed to those with moderate-to-high incomes. That fact, along with anecdotal evidence from opioid abuse survivors, has led many to conclude that opioid addiction is overrepresented among the middle class. But there are reasons to question this claim and some of the assumptions behind it. According to the U.S. National Survey on Drug Use and Health, 75% of those suffering from opioid addiction did not start out abusing painkillers obtained legally from a physician. Instead, they purchased opioids on the black market or got them from family, friends or other acquaintances, with the intent of using them for recreational purposes. A 2015 University of New Mexico study revealed that chemical dependency rates are only about 10% among those with legitimate prescriptions for opioid painkillers. This shows most people using these drugs for chronic pain are doing so responsibly and are not the ones filling up beds in drug treatment facilities. Looking more deeply into the issue of cause and effect, researchers have identified five primary risk factors that increase the risk of opioid addiction:
- Age. Ninety percent of those who develop substance use problems (including opioid addiction) first run into trouble in adolescence or in early adulthood.
- Use of multiple substances simultaneously. Most people who abuse opioids have a history of using and/or abusing alcohol and various other intoxicants.
- Childhood trauma. Two-thirds of opioid addicts suffered at least one significant episode of violence or terrible personal loss during childhood, suggesting their use of drugs is really a form of self-medication.
- Mental illness. Approximately 50% of opioid abusers have been diagnosed with some type of mental health problem or personality disorder. Again, it would seem that prescription medications are being used for the purpose of self-medication.
- Unemployment or underemployment. People who live below the poverty level are far more likely to have substance use problems than those with more income and/or assets — and opioid painkillers and/or heroin users are not an exception to the rule (there are three-and-a-half heroin addicts with household incomes below $20,000 for every heroin user with a household income of more than $50,000).
We should not overlook the implications of the final risk factor. The massive increase in opioid abuse has coincided with the collapse of the American middle class, which has suffered significant job loss and a dramatic decline in its collective purchasing power. Young people from such backgrounds who’ve turned to opioids and other drugs may be drowning in pessimism about their futures based on what they’ve seen happen to their parents and in their families. If drug use is primarily a method for coping or escaping from psychological turmoil, it may explain the apparent connection between opioid abuse and middle class life. In reality it is not those firmly entrenched in the middle class who’ve been abusing OxyContin, fentanyl, Vicodin and Percocet or turning to heroin instead, but those who’ve technically fallen out of the middle class or are hanging on by their fingernails.
Opioid Addiction Is an All-American Disease
Opioid painkillers enter the market as legally prescribed drugs. But it is their diversion for recreational use that is responsible for the 29,000 overdose deaths and huge growth in addiction that are receiving so much publicity. Increased heroin use is a side effect of this pattern of behavior, and economic dislocations are one factor driving the current opioid/heroin epidemic. The outbreak of drug abuse and premature death related to opioid consumption is not a middle class phenomenon at its core, but it is clearly related to the financial struggles experienced by families that have seen their financial security slip away. Our present epidemic of opioid addiction is, at least in part, a result of the economic stagnation that has plagued the U.S. economy since the turn of the 21st century.