The Pharmaceutical Industry and the Opioid Epidemic

The opioid epidemic has taken an estimated $1 trillion from the United States' economy for the past eighteen years. It has been a continued problem throughout the United States for the past fifty years. It all began in the 1990s. The pharmaceutical industry began to market the drug Oxycontin. The industry portrayed Oxycontin as a non-addictive painkiller that was created to treat all types of pain. The advertisements stated that less than 1% of patients who took Oxycontin became addicted. Because of this, physicians and pharmacists began prescribing Oxycontin to almost all anyone who had a problem with pain. In a matter of ten years, the number of opioid prescriptions quadrupled in the United States. The pharmaceutical industry then began to distribute a new drug called fentanyl. This drug was only intended to alleviate pain for patients who had cancer, but it of course was used for many other things. Pharmacies made the success of fentanyl known while companies made the drug into a more engaging, faster-acting product. Today, the nation produces and consumes thirty times more fentanyl than the year before Oxycontin was first marketed. According to the American Society of Addiction Medicine, of citizens aged twelve and over, 2% had a drug abuse problem involving opioids in the year 2016. And over 80% of opioid addiction began in doctors' offices (Wright, 2019).

The element that furthered the epidemic was the supply of fentanyl by the black market. Once people were taught how to make the fentanyl, that was it. The drug boomed. The black market resulted in many street drug dealers replacing or mixing heroin with fentanyl. The problem with this was that fentanyl and heroin looked exactly the same. Therefore, neither consumers nor dealers would know how much fentanyl was mixed in with the heroin. This made the supply very deadly. While the two drugs may look the same, fentanyl is 50 to 100 times more powerful than heroin. The black markets’ supply of opioids hit the streets, and immediately proved to be deadly. The death rate from opioid overdoses more than tripled from 2009 to 2016 (Wright, 2019).

To begin, the ABC-X Model was created by Reuben Hill. Hill started off by investigating how families adjust to husbands leaving and then returning. But eventually, he noticed that the ways families adjust and adapt to any stressor event are very different. So to show exactly how these families adjust and adapt, he created the ABC-X model. The model first begins with an event or stressor that happens within a family. This can be a negative or positive event. This event will then lead the family to the next part of the model, their resources. Resources can include financial support, family support, and etc. The amount of resources a family has plays a big part in how a family adjusts to an event or stressor. If a family has sufficient and appropriate resources they are more likely to have lower degrees of stress, compared to a family that has less or no resources. The next part of the model is perceptions or appraisal. Hill called it the “definition of the event”. This consists of how the family thinks about or views what they are experiencing. Many factors can influence how a family perceives a stressor. Factors such as previous experiences, family values, religious/spiritual beliefs, and etc. How the family perceives the stressor event leads to the last part of the model, the actual stress or crisis. Family stress is defined as a disturbance in the steady state of the family system. A family crisis is a disturbance so overwhelming, where the pressure is so severe that the family stops functioning.

To continue, after a family goes through stress or a family crisis, they must cope (or not cope) with that stress. In order to describe or show how a family goes through this coping process, Hill then created the double ABC-X model. This model is very similar to the regular one. It begins again with a stressor, but this time it’s a stressor pile up. The stressor pile up includes unresolved aspects and/or consequences of the initial stressor in the previous ABC-X model. Or it can be all new stressor events all together. Next in the model come the resources. The family will use existing resources, which again come from the previous model, or the family can acquire and use new resources. The family will then go through the perception stage again. This stage consists of how the family perceives both the previous stressor event and the current stressor event. How the family perceives all the stressor events will then lead to the family’s adaptation, the last stage of the double ABC-X model. This consists of how the family is managing the stress. If the family is functioning beneficially after all the stress, they are going through bonadaptation. If the family is not functioning beneficially after the stress, they are going through maladaptation.

As I stated before, resources play a big part in how a family adjust to a stressor event. Take Jonathan as an example. On the outside Jonathan was a handsome and gentle kid with a warm spirit. But on the inside he struggled with anxiety and depression, which eventually spiraled into opioid addiction. Jonathan had many great resources to help him get through his addiction. The first being financial resources. His parents had all the money to get him help from doctors, and even send him to treatment programs (Winnefeld, 2017). The treatment programs he went to were also an excellent resource Jonathan was able to have. Because his family had the financial resources and because Jonathan was able to attend these treatment programs, he was able to get better and turn back into his old self. According to his parents, he was more communicative and more happy to see them when they visited. He was doing so well that he even led a 12-step Alcoholics Anonymous meeting once a week. He even went as far to get his emergency medical-technician qualification. He wanted to use it to help others, especially young people, avoid his experience (Winnefeld, 2017).

Since Jonathan was doing so well, his parents believed he was completely better. They perceived him as they stated, “his old self” and they believed that he wouldn’t go back to doing drugs at all. They were blinded by their own optimism. His parents stated, “We read his restlessness as an understandable case of nerves about what was coming next, or perhaps too high a dosage of anxiety medicine.” In all actuality, Jonathan was experiencing symptoms of withdrawal which ultimately led him to overdose. Unfortunately, his parents could not see the signs of his relapse in advance due to their strong belief that his addiction was gone (Winnefeld, 2017).

Next, the life of a coal miner, Arnold Fayne McCauley, can also show how resources play a big part in families adjusting to a stressor event. He had been prescribed immediate-release opioids due to numerous injuries in the coal mine. He took them as prescribed at first, but then Oxycontin came out and he became addicted. He was sent to rehab numerous times, but it just did not work. McCauley ended up dead in a field after he had lost his family, after he had lost everything (Davies, 2018). In this case, it was the absence of a resource that affected the outcome of McCauley’s life. He did not have his family or anything anymore to support him, therefore he gave up.

To continue, a common societal perception or belief is it’s always the user’s fault for misusing the drug. Which is not always true . In McCauley’s case, he was always able to get off the immediate-release opioids that had been prescribed to him for his injuries. It was not until he was prescribed Oxycontin (a pill so much stronger than other opioids he had taken before) that he became addicted (Davies, 2018). People were blaming McCauley for misusing the drug, but it was clearly not his fault. He had lost his family and everything else due to the fact that they blamed him for his addiction. Which is what ultimately led him to his death.

Finally, interventions that could be implemented at the community level which could help families cope with crisis situations are different city helpline numbers. Each town or city in Maryland would have its own helpline number. The person answering the phone will be someone in that specific community that can get to the caller right away. This way, the caller will have immediate support. The person answering the phone will travel to the caller, and they can do whatever the caller wants to do. Whether it’s going for a walk or simply talking about the crisis, the caller will have that immediate support. It would be helpful to the caller because they wouldn’t have to talk over the phone about their crisis to a random person that they don’t know. Since the person answering the phone is from their same community and will come right to them, the helpline becomes way more intimate and makes it easier for the caller to talk about their situation. It’s much easier to talk about something, especially a crisis, when the person you’re talking to is sitting right in front of you.

Lastly, a federal level policy could be implemented in order to help families cope with crisis situations. The government could make a law which requires each state to have a family crisis help center in every city or town. This way it’ll be much easier for anyone to get to the center quickly if need be. Also, it would eliminate any embarrassment of going to a help center. People would see it as “normal” and a good thing. The help center could be a place for families to talk about what they are going through (to themselves or to other people), or it could simply be a space for a family or anyone to just relax.

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