Amelia and Hardy Leighton weren't your typical drug addicts. They were extroverted outdoorsy types – an attractive young married couple with close families and new jobs. Life was good. And then they were dead, the victims of an opioid epidemic that is sweeping North America. One evening last July they tried some recreational drugs laced with fentanyl, a painkiller with 100 times the strength of morphine. They never woke up. They left a two-year-old son, Magnus.
I had always thought that most of the people who died from overdoses were inner-city junkies with needles in their arms. That's not true any more. Many are middle-class suburban kids and adults who swallow or snort their poison.
Many opioid addicts picked up their habit from their own medicine cabinets. They got hooked on powerful painkillers prescribed by their own doctors. Or they swiped their parents' leftovers. Then, when their legal supply ran out, they started buying opioids on the streets.
"We've been writing so many scrips for so long that everyone has them around the house," says Keith Humphreys, an expert on drugs and drug addiction at Stanford University. "This hits every layer of society."
Today, drug overdose is the leading cause of accidental death in the United States. Overdose deaths, driven by opioids and heroin, claim 45,000 American lives every year – more than the number who die in car accidents, more than died of AIDS at the peak of the AIDS epidemic. This is almost certainly the case in Canada, too, though we don't know for sure because we don't keep national statistics.
Fentanyl, the deadly opiate that was the centre of a Globe special investigation report on the weekend, is just one part of the problem.
The larger problem is our massive addiction to painkillers. That addiction was no accident. It didn't start with criminals on the street. It started with legally manufactured drugs that were legally prescribed.
In the late 1990s, the medical establishment became increasingly concerned (and rightly so) that pain was not being adequately treated. Big Pharma saw a chance to make big money, and it started aggressively marketing narcotics. Its message was that everybody should prescribe them. Soon, everybody was. Prescribing rates escalated dramatically. In 2012, U.S. doctors wrote 259 million prescriptions for painkillers – almost enough to give each man, woman and child his pr her own bottle of pills. In Canada, doctors wrote pain prescriptions for one out of every two Canadians in 2015.
Deceptive marketing made the problem worse. OxyContin was peddled as a safer, less addictive painkiller than Percocet or Vicodin. Sales soon soared to $1-billion (U.S.) a year. But when crushed and snorted or injected, OxyContin produced a high as powerful as heroin. Purdue Pharma, the company that made it, was eventually fined $600-million for misleading claims in 2007. But it was too late. By then, oxy addiction was ravaging small towns across North America.
"The medical profession has to take some ownership of this menace," David Juurlink, head of clinical pharmacology and toxicology at Toronto's Sunnybrook Health Sciences Centre, told PostMedia News. As governments tighten access to oxycodone, doctors are massively overprescribing fentanyl. Half of new prescriptions for fentanyl are being written for first-time users who haven't first been given something less powerful. To Dr. Juurlink, this is "mind-bogglingly cavalier."
On top of that, Stanford's Dr. Humphreys points out that most of what we call "opiate overdoses" are really poly-drug overdoses. "With adolescents and young adults there's really a poly-pharmacy of everything: legal pharmaceuticals, illegal street drugs, alcohol," he says. "You meet a drug user, and virtually always you're meeting a poly-drug user."
We need to have way better prescribing practices, everyone agrees. We also need to clean out our medicine cabinets and get rid of the stuff. (Don't flush it down the drain. Take it back to the pharmacy.)
Changing people's attitudes about opioids will be a much, much bigger problem. Meanwhile, abusers need a lot more sympathy and help. Don't think of them as junkies. Think of them as the clean-cut couple down the street, and of the little boy they left behind.