Prevention of Drug-related Deaths

In 2016 and 2017, policies, initiatives, and regulations discouraging opioid prescriptions began to appear after two-thirds of the 63,600 deaths by overdose in the United States were found accounted for by opioids (Kertesz, Gordon). Due to the chronic overprescription of opioid painkillers, thousands of individuals are trapped in addiction, and when they cannot get hold of over the counter prescriptions, they turn to heroin and fentanyl (American City and Council). On the other hand, in the late 1990’s, after an opioid scare, there were multiple cases against inadequate pain treatment due to not prescribing opioids to patients (Hoffman, Tarzian).

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“The imbalance between strong prescription control and weak pain and addiction treatment expansion exemplifies the policy scholar’s notion of ‘bounded rationality’” say Kertsz and Gordon, in their policy case study on the crisis of opioids. This problem has plagued many countries, but specifically in America the rhetorical bias of dominant party’s agendas and ideologies has propelled the rise in opioid-related drug overdose death due to inappropriate marketing and prescribing.

Rhetoric and science, although seemingly in opposite fields, are actually very much so intertwined. In approximately 333 B.C., Aristotle, renown Greek philosopher, wrote Rhetoric and Poetics, in which he defines rhetoric as “the faculty of observing in any given case the available means of persuasion.” Rhetoric is utilizable in virtually every field, and consists of paradigms, or rhetorically constructed collections of facts (Kaplan, 69). New paradigms emerge when new facts arrive that surpass or challenge the current ideals, and are hence rhetorical because they are trying to persuade an audience to release an old way of thinking and adopt a new way of observing and reflecting on a situation (Kuhn 45). Due to the immense authority placed in the field of science, these paradigm shifts have the velocity to influence enormous groups of people, thus both directly and indirectly molding society’s views on certain topics and crises.

This paradigm shift was exemplified in the past through a different health crisis of cigarettes, which can be attributed to the endorsement of smoking by medical professionals for its “health benefits” (Kuhn 47). In 1946, there was an advertisement for Camel Cigarettes with the slogan “More Doctors Smoke Camels than Any Other Cigarette,” utilizing the ethos of the medical profession to suggest that doctors had suggested cigarettes for health benefits, even when studies in 1950 linked smoking to lung cancer (Brandt 105). In this health crisis, effective rhetorical communication proved vital in shifting the paradigm of smoking through antismoking efforts, switching the public’s view of smoking as beneficial to health, to cancerous and less socially acceptable. Over-all, Brandt claims, “health-communication campaigns disseminated the information linking cigarette smoking and cancer and have successfully changed consumer behaviors and physician recommendations concerning cigarettes,” proving the power of dominant parties ideologies in causing and addressing health crises (Kuhn, 245).

Much like cigarettes in the mid 1900s, “prior to 2011, a ‘policy monopoly” of regulators and pharmaceutical manufacturers allowed and encouraged high levels of opioid prescribing” (Kertesz, 171). In 1980, opioids were used so often in treating acute pain that propoxyphene was the second most dispensed prescription drug in the United States, and in 1990 chronic pain reports rose due to “greater patient expectations for pain relief, musculoskeletal disorders of an aging population, obesity, increased survivorship after injury and cancer, and increasing frequency and complexity of surgery” (Dasgupta). Pharmaceutical companies quickly took advantage of the increased desire for pain treatment, as rates of overdose and addiction increased exponentially. As these rates increased, an exigence became obvious in the conflicting stigma endorsed by different rhetorical platforms:

“The pharmaceutical companies have launched aggressive marketing campaigns expressing the benefits of opioids and encouraged physicians to prescribe, the CDC has encouraged physicians to stop the overprescribing of opioids, and local police departments and hospitals are overwhelmed with overdoses.”

Opioids increasingly became a nationwide epidemic, crying out from the dark while pharmaceutical companies desperately hushed the noise as they brought in billions. By 2015, the National City-County Task Force was formed to to asses the crisis and figure out a response to the opioid epidemic. They found that in 2016, around 64,000 individuals died of drug overdoses in America (about 6,000 more than died in the Vietnam War), and from 2000 to 2010, drug overdoses in Clermont County, Ohio, increased by 2,300 percent (American City and Council).

With the number of deaths, and the extent of the exigence, it is reasonable to question why rates have not changed. Ethics of doctors and pharmaceutical companies are called into question, as well as the authority to prescribe without strict guidelines or apparent concern for the outcomes of their patients besides the medical problem from which they seek relief. In a place of such power, the disregard of ethics gives criminal implications, which unfortunately has not been far from the truth: “Dr. Alan Arnold Godofsky, 61, of Ohio, was found guilty of five counts of distributing oxycodone outside the scope of professional medical practice and not for a legitimate medical purpose” (Brookbank 1). Hundreds of other doctors have also been found guilty of misleading or abusing responsibility in the prescription of opioids specifically, such as Doctor Patel from Nevada, who undeniably prescribed opioids to patients for profit after showing them fake x-rays (United States Attorney’s Office). The public trusts in the ethos of doctors and their oaths to perform ethically, and thus those in medical authority have the ability to utilize their rhetorical bias to further their personal agendas if they choose corruption, increasing the number of addicts as well as the money in their pockets.

On the other hand, the doctors are able to work through trust in pharmaceutical companies who provide chemical solutions to health problems. “We have a belief that [opioid] manufacturers and distributors engaged in deceptive and fraudulent marketing practices. We feel they tried to pressure and cajole physicians into prescribing opioids for chronic pain opposed to acute pain, which was the original restriction for the use of the drug” (American City Council). This belief has been proven since in the case of Purdue Pharma, run by the Sackler family.

As of April 2, 2019, Purdue Pharma agreed to pay $270 million to settle a lawsuit with the state of Oklahoma and donate $70 million to opioid research after their aggressive marketing of OxyContin continued with knowledge of the pain they were causing, and is facing over 2,000 other lawsuits by cities, counties, and states related to the opioid crisis (ABC News). On May 2, 2019, a federal jury found Insys Therapeutics, a company that sold fentanyl-based painkillers, guilty of racketeering charges, “finding they had conspired to fuel sales of its highly potent drug, Subsys, by not only bribing doctors to prescribe their product but also by misleading insurers about patients’ need for the drug” (New York Times). Through these examples, the conflicting paradigms are evident: pharmaceutical companies are claiming opioids are beneficial to health, exhibiting their ideology and agenda that money matters more than the epidemic, encouraging doctors to push the drugs either for “health” reasons or also for profit, all as the patient sits at the mercy of their trust in medical field’s authority.

In the scholarly field, hundreds of studies have been done concerning the opioid epidemic and the velocity that differing rhetorical bias has given the exigence. Every scholar appears to agree that it is in fact an exigence that needs to be addressed, and rhetoric is a means to address the hegemonic ideologies that pharmaceutical companies push. One scholar argued that it is “action, not rhetoric” needed to address the crisis, stating that publishing literature and speaking against the crisis is not causing the necessary immediate change. The article offers a response to the exigence in this action, offering solutions such as “improving clinical decision-making, improving access to non-judgmental evidence-based treatment, investing in comprehensive public health approaches to problematic drug use, and changing the way law enforcement actors interact with people who use drugs” (Davis).

It is clear through scholarship that rhetoric is also obviously vital in the fight against large pharmaceutical companies to break the inappropriate prescription cycle, but as Davis says, and most of the scholars imply, immediate action is required as well in order to save the hundreds of thousands of lives at present who are facing addiction before they are lost to opioid-related overdoses. As seen in the recent and ongoing cases against major pharmaceutical companies, rhetorical studies on the opioid crisis and the utilization of rhetorical action against the doctors and companies directly in the court of law has begun to change the stigma around opioids. It is through this understanding of how the push of rhetorical bias of dominant party’s agendas and ideologies has propelled the rise in opioid-related drug overdose death due to inappropriate marketing and prescribing that will open America’s eyes to end the widespread acceptance of this corrupted crisis.

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