Author of Dreamland, on opioid epidemic, says it began with easy answers to complex problems, and trying that again won't work

By Al Cross
Kentucky Health News

The opioid epidemic began with a desire for "easy answers to complicated problems," and the solution to it needs to avoid similar mistakes, the author of the seminal book on the topic said Sunday on KET's "Connections with Renee Shaw."

"As a culture we need to learn patience. It took us a long time to get into this and it will take a long time, I fear, to get out of it," said Sam Quinones, author of Dreamland, which made many "best books of 2015" lists, including Gov. Matt Bevin's.

Quinones said the epidemic was created partly by the attitude "I want my problems to be fixed with a pill and I don't want to be part of the solution," and by "a one-size-fits-all-magic bullet for everybody, which is narcotic pain killers . . . . in quantities that were just excessive."

Pharmaceutical companies capitalized on a growing medical consensus that treatment of pain was more important than previously thought. They adopted "a new business model, quadrupling their total sales force in a 10-to-12-year period and taking advantage of physicians who were increasingly in a hurry and eager for quick solutions, Quinones said.

"Had they stopped a third of the way into that we wouldn't be here," he said, "the problem was they kept pushing," and making the argument that the drugs weren't addictive.

Quinones said he was part of the phenomenon several years ago, after an appendix operation. He said it took two days for the pain to subside, but he had been given a 60-day supply of Vicodin, a mixture of acetaminophen and hydrocodone, an opioid synthesized from codeine. "The message in that bottle is that these are not addictive," he said, "and I'm quite sure I could have gotten another refill and maybe two."

The epidemic has expanded to illegal drugs, users of which tend to form communities, Quinones said. He said people need to be aware of warning signs of heroin use, which include dropping old friends, shunning family, and having new friends from uncertain places.

As the epidemic has grown, Quiniones said, "You see more and more politicians understanding the depth of this problem." He noted an article he did for The New York Times in June, on how more than 20 Kentucky jails have started "therapeutic communities" for inmates with addictions.

"That is one of the most interesting ideas to come out of this epidemic," he told Shaw, because "Jail was the great missed opportunity," the moment inmates realize realize the error of their ways and this the best time to begin recovery."

At the same time, Quinones said he sees an over-reaction to the epidemic from some physicians, who simply stop prescribing painkillers for people who need them for chronic pain rather than tapering them off and working with them.

One way to taper them off is with different forms of opioids. "Medically assisted treatment of addiction now recognized as very important and essential," Quinones said. "The term is not medical treatment for addiction, it's medically assisted treatment." He said that is important to remember, because of the fear that the approach will "give suboxone to everyone without therapy, without this community feel" that is needed to improve the chance of maintaining recovery.

Slome have suggested the legalization of marijuana, at least for medical purposes, because some users have found it useful to treat pain. Quinones said he once favored it, but since growers now produce much more potent varieties, he is against legalizing "such a potent form" because not enough studies have not done on the drug's effect on developing brains. "There are probably very great medical benefits we can get from marijuana," he said, "but there are also very significant downsides."