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

Opioids prescription painkiller commonly prescribed in the United States of America. The 'opioid epidemic' refers to large scale over prescription of and addiction to opium-derived prescription pills across america. The abuse of prescription Opioids such as Hydrocodone, Oxycodone, Heroin, and et cetera currently affects 2.1 million Americans, claiming the lives of over 115 people every day. The following article will explore different power structures within this issue and how the influence the opioid epidemic along with wider society. These power structures include:
* Biology: the power opioids have over the human body.
* Politics: the power pharmaceutical companies have over governments through lobbying.
* Law: the power governments have over laws influencing the opioid epidemic.
* The Arts: the influence popular art forms have had on the opioid epidemic.

## Different perspectives in the study of the opioid crisis
### Biology

A definition of addiction is "a psychological and physical inability to stop consuming a substance, even though it is causing psychological and physical harm.” This 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 dependencies and may negatively affect their entire lifestyle. Opioids trigger the release of endorphins, the brain's "feel-good" neurotransmitters. Endorphins muffle ones sensation of pain and boost feelings of pleasure, creating a temporary but powerful sense of euphoria. When an opioid high wears off, one may find themselves craving this euphoria.
Opioids can also act on descending pain modulatory systems to eliminate the pain. By binding to receptors in an area of the brainstem called the periaqueductal gray, opioids can prompt the inhibition of pain. The result of the biological effect of regular opioid abuse is physical dependency. In an article published by psychiatrists T. Kosten and T. George, the power opioids have to catalyse a physical dependence is explained: "Opioid tolerance 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." Many individuals who find themselves physically addicted to opioids then seek rehabilitation. However, treatments are expensive ("Well-known centers often cost up to $20,000 for a 30-day program"). The treatment includes managing the physical pain associated with withdrawals as well as the psychological consequences of addiction. In addition, relapses are common; most of the patients in a drug addiction relapse, further indicating the power of opioids. Lastly, as the tolerance increases with addictions, patients may seek more powerful and cheaper, illicit opioids such as heroin. 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.

### Politics

Another power structure present in the United State’s opioid epidemic is the power pharmaceutical companies have over members of senate and federal agencies.
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 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. 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 the 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 in order to preserve their wealth via continuing to supply opioids in excessive quantities to the American people.
### Laws

Both federal and state administrations have tried to jam the opioid crisis by developing a pain policy. Indeed, many states have already adopted regulations laws to fight against opioid addictions. All states have adopted the Prescription Drug Monitoring Program, an exam that physicians must pass to prescribe opioids. However, the test is a handbook of 11 questions with the responses at the end.
The most powerful institution for taking decision concerning drugs is FDA. The Food and Drug Administration is a federal agency evaluating the safety and effects of every products related to health and food. In order to fight against prescription of opioids, the FDA created the TIRF-REMS program. A strict set of rules to make sure doctors prescribed opioids only to late stage cancer patients. Nevertheless, the FDA outsourced the program to the pharmaceutical companies and these companies hired McKesson, one of the world’s largest drug distributors to run it. Furthermore, Barack Obama enacted the Comprehensive Addiction and Recovery Act in 2016. It is intended to increase both the number of prevention and treatment programs. Nevertheless, he also signed into law the 21st Century Cures Act and the “Ensuring Patient Access and Effective Drug Enforcement Act” which reduce respectively the action of FDA and DEA.
Concerning the illegal side of the opioid crisis, the problem extends beyond the United States of America, as statistics indicate that China is the biggest Opioid supplier in the pharmaceutical industry out of the entire country. The Trump administration pushes for China to adapt proper laws but even if China has regulations, the government rarely enforced them since the output is not intended for Chinese people. However, as this issue affects the trade war with the US, China is working with the U.S law enforcement to find a solution.

### Arts

Arts and storytelling have been successfully changing the public perception of opioid addiction. 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. Nancy, an opioid addiction recovery specialist, 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. Furthermore, In the American music industry, rapper Macklemore realised “Drug Dealer”, a new song and music video, referencing some celebrity deaths induced by opioids. With that, he met President Obama to talk about this important issue. The official music video on Youtube has more than 40 million views and seventeen thousand comments; thus proving the power structure of the media over society in raising awareness about the opioid epidemic.

### References

* ↑ https://www.rehabspot.com/opioids/opioid-epidemic/
* ↑ https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
* ↑ 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.washingtonpost.com/graphics/2017/investigations/dea-drug-industry-congress/
* ↑ 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://www.mckesson.com/about-mckesson/newsroom/press-releases/2017/mckesson-reports-fiscal-2017-fourth-quarter-results/
* ↑ https://www.cbsnews.com/news/the-opioid-epidemic-who-is-to-blame-60-minutes-2019-08-25/
* ↑ https://www.theguardian.com/us-news/2019/nov/10/opioids-us-china-trade-deal-trump
* ↑ https://www.theguardian.com/us-news/2019/nov/10/opioids-us-china-trade-deal-trump
* ↑ https://www.mcleanhospital.org/opioid-project/