Follow up: Origins of the Opioid Crisis

Some people have responded to the information in this weekend’s post with reactions approximating, “Okay, Purdue played a role in the crisis. Purdue is bad. But, what good does your attention to them do us? This hasn’t been a prescription crisis for years now. We’re in a fentanyl crisis now and focusing on pharma does nothing to address the deaths occuring today.”

To be sure, there is truth in this statement, but it also misses some important truths.

In response to a tweet calling attention to this “reckless” and “dangerous”, a former policy-maker responded with this tweet.

Keith Humphreys provided additional context—that other countries are seeing similar effects from increases in prescribing, and there’s still time for them to learn from our experience.


It’s worth wondering about the reasons for resistance to the narrative that Purdue and other drug manufacturers played an important role in the development of the current crisis. A few potential reasons come to mind.

  • Resistance to the idea that drug access and supply play an important roles.
    • This notion raises potential consequences of drug legalization.
      • Especially since the focus on prescription opioids involves an legal and regulated drug.
    • The idea the increased exposure increases risk might be viewed as fuel for drug hysteria, for which there is a long history with significant consequences.
    • The idea that exposure increases risk may also be understood as a threat to disease models that emphasize genes and hereditary factors.
  • A desire to frame drug users as rational actors responding to adverse social conditions may be behind some of the resistance.
    • For some, this is view is shaped (knowingly or unknowingly) by the economic monoculture. This monoculture is invested in the agency of all actors and free-will. Beliefs akin to rational addiction theory may be part of this view.
    • For others who may wish to challenge the economic monoculture, this makes social change the target for change. This makes addiction policy a vehicle for much larger and ambitious policy goals.
  • Concern that attention to access and supply may harm pain patients.
  • Concern that anti-pharma sentiment may interfere with the expansion of access to MAT.

I think all of these concerns could be addressed without negating or minimizing the role of prescription opioids in the opioid crisis.

I don’t assume this is a complete list, or that captured the concerns accurately. What did I miss?