# Issues in Interdisciplinarity 2019-20/Power in the opioids in the US
## Introduction

Opioids are used as painkillers, commonly prescribed in the US for patients suffering of extreme pain. When people talk about the opioid epidemic, they are referring to a variety of behaviours and events related to the abuse of prescription painkillers and/or Opium-derived illicit substances. The abuse of prescription Opioids (e.g. Hydrocodone, Oxycodone, Heroin, and et cetera), hospitalisations, overdoses, and deaths are all aspects of the Opioid epidemic currently affecting the 2.1 million Americans with an Opioid addiction. An average of 115 Americans die each day from Opioid-related overdose.

## Different disciplinary perspectives in the study of the opioids crisis
### Power of opioids over the human body

It is first important to consider the power opioids have over the human brain. A scientific definition of addiction is "a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.”
This definition explains how physical addiction is representative of a power structure between drugs and the human brain, as physically addictive drugs cause human beings to develop dependancies and may negatively effect their entire lifestyle.
Opioids trigger the release of endorphins, ones brain's "feel-good" neurotransmitters. Endorphins muffle ones perception of pain and boost feelings of pleasure, creating a temporary but powerful sense of euphoria. When an opioid dose wears off, one may find themselves craving this euphoria. This is the first milestone on the path toward serious addiction.
When opioids bind to opioid receptors, they create a potassium conductance, which makes a neuron less likely to fire an action potential, and they inhibit calcium conductance, which makes a neuron less likely to release neurotransmitters. What effect these actions have depends on where the receptors are found. When opioid receptors on neurons in the spinal cord that carry information about pain are activated, it can inhibit the transmission of pain information to the brain.
Opioids can also act on descending pain modulatory systems to eliminate the pain. For example, by binding to receptors in an area of the brainstem called the periaqeuductal gray, opioids can prompt the inhibition of pain signalling in the spinal cord via a pathway that first synapses in the medulla.
The result of the biological effect of regular opioid abuse is physical dependency. In the article published by psychiatrists Thomas R. Kosten and Tony P. George, the power opioids have to catalyse a physical dependence is explained:
"Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalising effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments."
Many individuals who find themselves physically addicted to opioids then seek rehabilitation. However, treatments are often expensive ("Well-known centers often cost up to $20,000 for a 30-day program"), physically demanding, and long term. The treatment includes managing the physical pain associated with withdrawals as well as the psychological consequences of addiction. In addition, the relapses are frequent ; 40 to 60% of the patients in a drug addiction relapse.
Lastly, as the addiction starts with prescriptions, the patient will seek more and more as the opioids' necessity gets more powerful. In consequence, after the "doctor-shopping" (visiting multiple doctors in order to obtain more prescriptions) phase, the addicts often turn to injecting as the tolerance grows. This leads to death by overdose or even sicknesses like HIV from the injections.

### Power pharmaceutical companies have over governments

Another power structure present in the United State’s opioid epidemic is the power pharmaceutical companies have over members of senate and federal agencies.
While addiction statistics and scientific explanations have established the opioid epidemic as an issue that warrants government intervention, American pharmaceutical companies have been known to lobby state senators as well as congressmen in order to maintain high profits from opioid sales.
The pharmaceutical company as a collective, “which has about two lobbyists for every member of Congress, spent $130 million on influencing legislation in 2019. To put this in perspective, considering that gun control is another one of America’s pressing issues, lobbyists for pro-firearm rights donated a mere $8.1 million to influence legislation the same year. Furthermore, “nine out of 10 members of the House of Representatives and all but three of the US’s 100 senators have taken campaign contributions from pharmaceutical companies seeking to affect legislation on everything from the cost of drugs to how new medicines are approved”, with certain individuals in the House such as Paul Ryan receiving donations totalling approximately 230,000. With these statistics, it can be reasonably inferred that lobbying on behalf of pharmaceutical companies has swayed legislators to be more lax on the industry, perfectly demonstrating the power the industry has in politics, law making, and consequentially American society.
Lobbying on behalf of the pharmaceutical industry also develops a power structure involving Federal agencies. A recent scandal involving Donald Trump’s nominee for Drug Czar Tom Marino in April 2016 revealed his role in forging legislation which would have made it “virtually impossible for the DEA (Drug Enforcement Agency) to freeze suspicious narcotic shipments from the companies”

#### Marino received a donation of nearly $100,000 from the pharmaceutical industry that same year (ref). Furthermore, pharmaceutical companies engaged in unlawful activities have not faced sufficient punishment in the recent years. For example, pharmaceutical company “The McKesson Cooperation” were under investigation for providing millions of opioid pills to American pharmacies without sufficient due diligence in 2017, and while DEA proposed a $1 billion fine for the company, Mckesson were only fined $150 million, an almost insignificant sum in comparison to the company’s $200 billion in revenue the same year. This is only one of multiple examples of how pharmaceutical companies have used their power to evade harsh legal penalties and preserve their wealth.
### Power of individuals over the opioids crisis

The second point worth concerning is the efforts artists were contributing to combat opioid epidemic. For instance, the “prescribed to Death” memorial is to represent, remember and memorize the victims of the opioid crisis.; Moreover, arts and storytelling have been successfully changing the public perception of opioid addiction. The opioid addiction recovery helper, Nancy, helped her client Ava to express her feelings about using opioids in her drawing, claiming that the patient cannot control their lives and is gradually disconnecting from reality as a result of her addiction. She hopes people can see their lives as what they are truly is.; Aside from art forms, social media is another powerful tool for combating opioid epidemic. For instance, the non-profit, state and donor supported organization pages primarily on facebook and instagram, got 250,000 visits in March, publishing contents related to research data and looking for reinforcing the social norm about opioid uses. The contents are created by students.; In the American music industry, Macklemore realised “Drug Dealer”, a new song and music video, referencing some celebrity death by having opioid. With that, he met President Obama to talk about this important issue. The official music video on Youtube has more than forty million views and seventeen thousand comments. The power of celebrity on combating opioid epidemic is definitely unstoppable.

#### Overall, people in the U.S. society are using their power (i.e. getting access to the public media or has their power as an artist) to combat opioid epidemic and it turns out the achieve really good results.
### References

* ↑ https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
* ↑ https://www.youtube.com/watch?v=NPlNCqBHPnE
* ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/
* ↑ https://www.addictioncenter.com/rehab-questions/cost-of-drug-and-alcohol-treatment/
* ↑ https://www.rehabspot.com/opioids/opioid-epidemic/
* ↑ https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment
* ↑ https://www.addictioncenter.com/drugs/
* ↑ https://keck.usc.edu/from-pill-to-needle-prescription-opioid-epidemic-may-be-increasing-drug-injection/
* ↑ https://www.opensecrets.org/federal-lobbying/industries/summary?cycle=2016&id=H4300
* ↑ https://www.opensecrets.org/federal-lobbying/industries/summary?cycle=2019&id=Q13
* ↑ https://www.theguardian.com/us-news/2017/oct/19/big-pharma-money-lobbying-us-opioid-crisis
* ↑ https://www.theguardian.com/us-news/2017/oct/19/big-pharma-money-lobbying-us-opioid-crisis
* ↑ https://www.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/
* ↑ https://www.cbsnews.com/news/the-opioid-epidemic-who-is-to-blame-60-minutes-2019-08-25/
* ↑ https://www.mckesson.com/about-mckesson/newsroom/press-releases/2017/mckesson-reports-fiscal-2017-fourth-quarter-results/
* ↑ https://projects.iq.harvard.edu/files/historyopioidepidemic/files/yeun_final.pdf/
* ↑ https://www.mcleanhospital.org/opioid-project/
* ↑ https://youthtoday.org/2018/04/social-media-a-powerful-weapon-in-combating-opioid-crisis-reaching-teens//
* ↑ http://www.halfofus.com/video/prescription-for-change-ending-americas-opioid-crisis//