Several weeks ago, the heartbreaking and informative book Generation Rx was released. Last week, we ran the first part of an interview with its author, Erin Marie Daly, on her brother’s heroin overdose, what can be done to help addicts and how her family has recovered from their grief after five years; here is part two.
You cite some incredible statistics in your book. The astounding 300% increase in the raw numbers of opioid prescriptions for instance. Do you think the government needs to take a more active role in regulating these drugs?
Yes. The government’s failure to police these drugs isn’t the sole reason behind the current addiction epidemic, but it’s one factor. There are so many elements that have contributed: the overly aggressive lobbying of pharmaceutical companies and their misrepresentations regarding opioids’ risks and potential for addiction; our society’s collective desire for a “quick fix” via a pill; the fact that there’s always going to be a “drug du jour,” and right now opiates are it. But I’ve really been shocked by some of the FDA’s actions in light of the seriousness of this epidemic. For example, the FDA approved extended-release OxyContin despite the fact that it hadn’t been proven to have a significant advantage over conventional, immediate-release oxycodone; the OxyContin abuse epidemic followed. Then just recently, the agency approved Zohydro, a new version of pure, extended-release hydrocodone that many critics fear could be the next OxyContin. This approval came despite the fact that that the FDA’s own advisory committee voted 11-2 against allowing the drug on the market. Since then, 29 state attorneys general have urged the agency to reconsider its decision, Massachusetts Gov. Deval Patrick attempted to ban the drug (a federal judge later blocked that order), and Delaware put emergency prescribing regulations into place regarding Zohydro. So the FDA’s stance just doesn’t make sense in the context of the ongoing public health crisis that is occurring, and the fact that so many entities are clearly very concerned about Zohydro’s potential impact on the painkiller abuse epidemic. To me, it just feels like the cycle is repeating itself, and it’s disheartening.
Where does one draw the line? Is it possible to accommodate the needs of those who suffer chronic pain and not put young people in harm’s way when it comes to susceptibility to these addictive drugs?
I absolutely believe there is a time and a place for the use of opioids. I’ve had several people close to me, including my father, die of cancer, and there is no way I would ever want to deprive someone in that situation of pain relief. It baffles me when people think I’m trying to advocate for the abolishment of opioids. But I do think that on the whole, they are over-prescribed, and that in many cases people don’t understand their risks—especially in situations where they are prescribed large quantities of pills for long periods of time, for situations other than short-term post-surgical and trauma-related pain, and for palliative care. There is evidence that opioids aren’t the right answer to treat chronic pain over the long term; as patients build tolerance, they require higher and higher doses, and at some point may develop a condition called hyperalgesia in which sensitivity to pain actually increases. My hope is that doctors will become educated the true risks and benefits of prescribing such medications, and when it’s medically appropriate to do so; and that individual patients will also take it upon themselves to learn about their options.
Will this prevent young people from abusing painkillers? Of course not. But if there is more awareness among parents, maybe they’ll be more hesitant to take these medications or have them lying around, and more likely to talk to their kids about the dangers of prescription drugs, which can only be a good thing.
Do you think Big Pharma was intentionally dishonest with the redirection in the 1990’s of both their prescription guidelines to doctors and their representation of the relatively small risks of addiction their products involved? What about their doubling down in the 2000’s, lobbying against regulation of their industry? Is it possible they were unaware of the human toll their product was causing while they (citing your timeline) “became the nation’s most profitable industry” in the 2000’s?
There is no way that opioid manufacturers were in the dark about the spike in addiction, overdose and death as a result of their products. Countless people who were legitimate patients became drug addicts because these companies deceived doctors and consumers about the risks of painkillers, which they claimed were safer than over-the-counter medicines like Advil. And countless more who were not legitimate patients became addicted to painkillers because the black market was flooded with pills, which has led to the surge in heroin. The worst part is that so far, every response of Big Pharma to this crisis has been for show. Take OxyContin maker Purdue Pharma, which has implemented some educational programs on the dangers of pharmaceutical drug abuse, such as a campaign to increase awareness about the importance of safe storage and disposal of prescription medicine. Given that OxyContin pulls in nearly $3 billion per year in sales for Purdue, why not pay for a program that would have a tangible impact on curbing overdose deaths by providing Naloxone—which costs on average $25 per dose—with every long-term prescription of OxyContin?
Can you describe the state of grief you and your family feels five years since Pat passed away? You write extensively of your mother’s grief; is she in a better place now?
It’s been an incredibly long and difficult journey for all of us, and we’ve all had our own paths. My other siblings, Caitlin and Brian, are doing really well. We talk about Pat easily, and they’re very supportive of the book. My mom supports the book, but it’s too painful for her to read it at this point, and I understand that. I’ve had a lot of encouragement from extended family members and friends, which has kept me committed to the mission of writing the book, which is to chip away at the stigma and shame surrounding painkiller and heroin addiction.
The recent birth of my daughter almost five years after Pat’s death brought my grief to the surface again. It was abstract, but of course I’d always envisioned my children having their uncles and aunts—my siblings—as supporting figures in their lives. And Cait and Bri (and their spouses) are the most loving, wonderful, present uncles and aunts. But I constantly feel that pang when I think of Pat, and what an amazing uncle he would have been to my daughter. It comes at the silliest times, like today when she climbed up the stairs in our childhood home for the first time—the same stairs Pat and I descended when we were practicing walking down the aisle for my wedding. I can’t help it: I will always miss Pat. He mattered deeply to me and many others, and there is such a light in this world that is lost without him here.
Photo courtesy of Erin Marie Daly; used with permission.
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