The first time I walked into the cafeteria of the inpatient treatment center where I was to spend the next month, a group of men in their 50s took one look at me, turned to each other, and said in unison, “Oxy.”

I was 23 at the time. It was a safe bet that anyone under the age of 40 in treatment was there, at least in part, for misusing OxyContin. While I was there for good old-fashioned alcoholism, I soon understood why they’d made that assumption.

It was January 2008. That year, doctors in the United States would write a total of 237,860,213 opioid prescriptions at a rate of 78.2 per 100 people.

The driving force behind those numbers was Purdue Pharma, the makers of the highly addictive opioid OxyContin, the brand name of oxycodone. The company spent billions of dollars to market the drug without telling the full story, capitalizing on doctors’ fear that they were undertreating pain.

Purdue told these doctors that there’s a highly effective, totally nonaddictive drug called Oxycontin ready to solve the problem. If only.

We know now what Purdue knew then: OxyContin is highly addictive, especially at the high doses the Purdue reps were encouraging doctors to prescribe. Which is why my treatment center was packed with folks in their teens, 20s, and 30s, who had become addicted to OxyContin.

The overzealous prescribing of opioids peaked in 2012, which saw 255,207,954 opioid prescriptions written in the United States, equating to 81.3 prescriptions written per 100 people.

The egregiousness of Purdue’s actions, and the dangerous overprescribing that resulted, is often why — when politicians talk about addressing the opioid crisis — they start by talking about implementing restrictions on opioid prescriptions.

But to implement those restrictions not only misunderstands the opioid crisis itself — it would be actively harmful for chronic and acute pain patients.

In 2012, one of the driving forces behind the epidemic was prescription opioids, but that hasn’t been the case for nearly seven years. Once doctors understood the addictive potential of these drugs, especially OxyContin, they’ve steadily reigned in their prescribing.

Opioid prescriptions have decreased every year since 2012, but the number of opioid-related deaths has continued to rise. In 2017, there were 47,600 opioid-related deaths in the United States. Less than half (17,029) of those involved prescription opioids.

Further, research suggests the majority of people who misuse prescription opioids don’t obtain them from a doctor, but rather misuse medication that’s been prescribed to family or friends.

So, why does any of this matter? Well-intentioned people might ask, “If prescription opioids have even a little to do with the opioid epidemic, isn’t restricting them a good thing?”

The thing is, we already have tons of restrictions on opioid prescriptions, but there’s no indication they’re preventing addiction and every indication they’re hurting chronic pain patients.

Trish Randall, who has chronic pain from a rare condition called pancreas divisum, describes being on long-term, high-dose opioids as facing a “suspected-murderer level of scrutiny.”

She outlines some of these restrictions in Filter:

“The patient must adhere to conditions like paper prescriptions only, no phone-ins; an in-person appointment every 28 days; and urine tests and pill counts at any or all appointments, or on 24 hours notice any time I receive a call. Only one doctor and one pharmacy can handle the prescriptions. Other conditions can include no cigarettes, alcohol or illegal drugs (on the theory that pain patients must be discouraged from sliding into addiction), and being required to attend psychiatric or psychological appointments.”

When prescription opioids aren’t involved in most opioid-related deaths, it’s cruel to create restrictions that prevent people with chronic pain from getting the relief they need.

When restrictions are imposed on those with chronic pain and they’re unable to get the medication they need, there’s a huge risk they’ll turn to black market opioids like heroin or synthetic fentanyl. And those drugs carry a much higher risk of fatal overdose.

Similarly, misusing prescription drugs is safer than misusing “street” drugs, even if the person isn’t a chronic pain patient but has an opioid use disorder.

It’s an uncomfortable truth. We’re conditioned to think of someone misusing prescription opioids as doing something harmful that should be stopped. But misusing prescription drugs is significantly safer than using black-market opioids.

Heroin and synthetic opioids like fentanyl are often cut with other drugs and have wildly varying strengths, making it easier to overdose. Obtaining the equivalent of these drugs from a pharmacy ensures that people know what and how much they’re consuming.

I’m not suggesting we should go back to the days of 81.3 opioid prescriptions per 100 people. And the Sackler family behind Purdue Pharma should be held accountable for aggressively overstating OxyContin’s safety and downplaying its dangerous risks.

But chronic pain patients and folks with opioid use disorder shouldn’t have to pay for the Sacklers’ misdeeds, especially when doing so wouldn’t curb the opioid epidemic. Funding treatment (including medication-assisted treatment) for those who need it is much more effective than limiting the prescriptions of pain patients just in case they misuse them.

The pendulum of prescription opioids did indeed swing too far to one side, but letting it swing too far in the other direction will only inflict more harm, not less.


Katie MacBride is a freelance writer and the associate editor for Anxy Magazine. You can find her work in Rolling Stone and the Daily Beast, among other outlets. She spent most of last year working on a documentary about the pediatric use medical cannabis. She currently spends far too much time on Twitter.