“Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it,” “Many in U.S. know someone affected by…opioids,” “Purdue Pharma Knew Its Opioids Were Widely Abused.”

These recent headlines show that big pharmaceutical companies and prescription drugs have affected most American families; whether it be worries about pricing and health care, or the limits of who we can trust, and what drug to take. What started as a way to manage surgery, injury, and chronic form has impacted thousands of families.

In writing an article like this, I hope to have productive conversations about drug use, understanding that the pharmaceutical industry casually slips into the lives of Americans every day. Additionally, this means acknowledging that the statistics used in this article often correlate to the life of a student, parent, or working citizen. Approaching the topic by learning about the complexities of who has control over what—the consumer or the producer—connects the advocates who utilize statistics like this and the thousands of Americans who enter a system of corporate executives, physicians, and profits after each hip surgery, sports injury, or battle against chronic illness.

Reports from the Justice Department show that in the late 1990s, when the Sackler family, owners of Purdue Pharma humbly descended from Galician and Polish grocers, released a new drug dubbed “OxyContin” into the market, they were beginning to understand the implication of opioid abuse. For example, in early clinical trials performed by Purdue, 82% of elderly patients with a common type of arthritis experienced unfavorable or adverse results using Oxy. While the drug is now known to be addictive, the rise of the internet and Purdue Pharma’s recruitment of doctors and physicians to market the drug made it easier for consumers to access the drug. Since then, the Sackler name has appeared on university campuses and in museums in an effort to give a portion of the family’s profits to institutions that could increase public image and make ‘Sackler’ a household name. 

Today, almost 1 in 7 students have reported misusing prescription opioids. For some teenagers, addiction to OxyContin started with a physician. As Arthur Gale, MD, writes, “It is estimated that in nearly one half of the cases drug addiction began with a doctor’s prescription… …Purdue told its representatives to tell doctors that only persons with an “addictive personality” became addicts.” The Sackler family’s enormous influence has also impacted medical institutions like the National Academies of Sciences, Engineering and Medicine, a non-governmental organization that advises on opioid policy, when the Academies accepted millions of dollars from Purdue’s owners. With two private industries that have deep ties to government and regulatory bodies, who’s to blame, physicians or big pharma? As Patrick Radden Keefe writes in his book, Empire of Pain, “The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert public institutions.” The answer is, of course, both, but it’s still unclear what change we’ve seen in keeping these actors in check.

While in rural areas of the country, Americans have a higher likelihood of experiencing opioid abuse, Montana has seen relatively low levels of opioid addiction and abuse. According to the Montana Department of Public Health and Human Services, there were only 2.7 deaths because of opioid overdoses per 100,000 residents from 2017 - 2018. The department credited the rollout of a state prescription drug registry for medical providers and the use of drugs like buprenorphine to treat opioid users. 

While Gallatin High School has had very few cases of opioid misuse or distribution, school nurse Kate Groundwater voiced in an interview, “there’s a few students that have had family members addicted to opioids.” Groundwater explained that this sometimes leads to a cycle of foster care and familial struggles. This same story is reflected in reporting from the New York Times that brought readers inside a high school affected by OxyContin. At Minford High School in Minford, Ohio, dozens of students that graduated in 2000, four years after the introduction of OxyContin, were impacted by the drug. One such graduate, Ashley Moore, explained, “OxyContin just started showing up at parties around junior year. People wanted to try it. It was fun. It got to where kids were doing it in the parking lot before school. By senior year it was so common.” This demonstrates one of the things that this article seeks to reveal: using scare tactics to expose students’ drug abuse isn’t effective because drugs like OxyContin have become an unacknowledged culture in some areas. Researchers mapping the use of opioids continuously report that states such as West Virginia, Ohio, and Kentucky that have experienced high rates of unemployment and unsafe working conditions in mines and factories are ground zero for the opioid epidemic. In these areas, opioids have become more embedded into work, recreation, school, and family than opioid education.

The normalcy of prescribing Oxy was shown to me talking to Kate Groundwater. As we talked, she told the story of her time working with an orthopedic surgeon around 2014 after going through nursing school, in which she was told that “pain is whatever the patient says it is. Stop asking questions, just treat the pain.” Kate continued, “His very typical prescription model was…you prescribe Oxy to almost everyone.” The surgeon tapered off his patient’s dosage, first prescribing 3 doses of the drug and gradually reducing intake to one dose per day. “God only knows how many became addicted to OxyContin. He was prescribing a lot of OxyContin.”

In another job, OxyContin was used to treat cancer and sickle cell anemia patients. Groundwater stressed the difference between acute and chronic conditions. “Opioids can be extremely effective [for an acute condition.] When you get into real trouble is when people have chronic issues.” Because cancer and sickle cell anemia patients sometimes live with their conditions for years on end, many become “just totally addicted to it.”

As the only nurse for around 1500 students at Gallatin High School, Kate Groundwater mostly deals with headaches, stress, aches, and issues with mental health. While she recommended some students to drink more water and get more sleep, she reached over to a corner of the office. “The one reassuring thing is that we do now have narcan. The nurses have narcan and all officers at the school have narcan.” Narcan, also called Naloxone, is a nasal spray used to block the impacts of an opioid overdose and can restore normal respiratory function within minutes.

While drug education centers around what people our age have to do to change their lifestyles, something as basic as coping with pain has become its own gateway drug. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 25% of the time, prescription pain relievers for nonmedical use among users aged 12 or older comes from prescriptions from one or more doctors. Additionally, more than half of nonmedical use stems from the painkillers family members and friends have on hand, often obtained legally from a medical provider. The War on Drugs seems to have morphed into a battle against pain itself. It’s clear why American families want to separate themselves from companies like Purdue and the physicians that they use on their behalf, but as Kate Groundwater put it, Oxy, “percolated to even… nursing schools. It was part of our education.”