Thirteen years ago, I started a pharmaceutical sales career for Wyeth Pharmaceuticals, peddling samples out of my bag near the lush beautiful beaches of Newport and Laguna beaches in California. I threw ornate dinners for local psychiatrists to boost the sales of Effexor XR for depression and anxiety, even though it was clear that the physicians I sold to —the “pain docs”—prescribed Effexor off-label for pain. Almost a decade later, I parked my sporty Infiniti company car in Beverly Hills and traded my $200,000-plus salary, which I was then receiving from a boutique firm called Medicis, for a used epidemiology textbook at the Johns Hopkins Bloomberg School of Public Health in Baltimore, where I started a Master of Public Health program in 2011. What I did not realize at the time was that my own actions in closing a drug sale, without any bioethical considerations of what I was doing, helped contribute to the over prescription of powerful psychotropic drugs much like that of OxyContin, a powerful pain killer.
While the pharmaceutical industry is typically looked to as the public’s life raft when health epidemics arise, it is one of the major culprits of the addiction epidemic. Prescription drug induced mortalities have surpassed car crash fatalities for the first time, as primary care physicians overprescribe opiates and patients abuse them. I was made aware of this new American epidemic almost two years ago when I attended a town hall at my alma mater on “prescription drug abuse.” It was openedby former President Bill Clinton, who told a story of two young men he had known who died as a result of opioid painkillers.
It’s not just the prescription drugs that are the problems, though. Opiates are also the gateway for street heroin; in fact, three quarters of heroin addicts started their addictions with pain pills. According to NPR, between 2007 and 2013, there has been a 150 percent increase in heroin use in the U.S. At the same town hall conference at Hopkins, former Congressman Patrick Kennedy fiercely tried to explain the plight of the stigmatized and institutionalized addicts, thrown into a “revolving door” of antiquated rehabs and relapse, and urged attendees to heed a call by the FDA to treat addiction as a chronic disease much like type II diabetes, not anacute flare-up condition to be addressed in a 30-day rehab.
The Hopkins town hall made me realize that I had come full circle. I left the pharmaceutical rep business to search for meaningful ways to ameliorate the nation’s health. I now understand that science can change cultural perceptions of illness in line with some of the 20th century French philosopher Maurice Merleau-Ponty’s writings on the phenomenology of perception. That is, pharmaceutical innovation, medical breakthroughs and publicity change our perception of stigmatized patients: Highly active antiretroviral therapy (HAART) changed the life span and view of HIV patients in the 1990s (as did celebrity infection admissions —think Magic Johnson and, more recently Charlie Sheen), Prozac changed the perennial stigma of depressed and anxious patients with new hope in the 1980s, and even Viagra somewhat removed a stigma of growing older in society with diminishing sexual desires.
Many if not most of us know someone close to us struggling from addiction, wrapped up in the criminal justice system, kicked out of school, and stigmatized from our communities —from Donald Trump’s older brother, to the homeless veterans who struggle with substance abuse in our city streets, to the Lumbee Native American tribe of North Carolina, to the lower-income African-Americans who relapse back and forth in between prisons and unemployment, and finally to the “vanishing population” of the white male middle-class.
But it doesn’t have to be that way. The time has come for anew approach, a new modality, and a new cultural acceptance so that addicts can reintegrate into our society as one of us, not one of “them.”