Opioid Addiction Is a Brain Disease, Not a Moral Failing—and We Have to Stop Looking At It That Way

An eye-opening chat with Warning: This Drug May Kill You director Perri Peltz.

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The opioid epidemic is now the worst drug epidemic in history, with nearly 100 Americans dying every day from an opioid overdose. In fact more people are now dying from opioids—both heroin and prescription painkillers like OxyContin, Vicodin, Fentanyl, and Percocet—than from car accidents or gun homicides.

Despite the alarming numbers, it can sometimes be hard to envision the real, human face of this heartbreaking problem. Which is why HBO Documentary Films decided to follow along as four families, whose lives have been decimated by opioids, try to climb out of the depths of addiction and despair. The resulting film, Warning: This Drug May Kill You, premiering today on HBO, is an unflinching look at the reality of the epidemic and the disease of addiction. It's terrifying and often hard to watch, but you should anyway.

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Here, director Perri Peltz details how we got here, what women especially need to know, and what can be done to curb this devastating epidemic.

Marie Claire: Why did you want to make this documentary?

Perri Peltz: About a year ago, it seemed that the problem of Americans overdosing and dying from drug addiction was being described as bad people, particularly kids, who were abusing good drugs. But as it turns out, that's just not the case. Sheila Nevins, the president of HBO Documentary Films, and I were particularly interested in finding out the stories of people and families who had been ravaged by this disease of addiction and understanding what really was happening.

"If we take these drugs long-term, dependency develops quickly, within as little as a week."

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What we found was that, and let's not make any mistake about it, this is an epidemic of addiction. This is a brain disease—this isn't a moral failing—and we have got to stop looking at it that way. I hope this documentary helps to show the humanity of the people who are struggling with the brain disease of addiction because that is what this is—this isn't about bad people, this is about good people who became addiction oftentimes in the process of being prescribed medication for pain.

MC: How did you choose the people the film follows? I noticed all of the subjects started with prescriptions, and that they are all white.

PP: We teamed up with several outreach and recovery organizations across the country and worked with them very closely to find different stories that we hoped, collectively, would reflect the epidemic. Evidence tells us that when patients are black, doctors prescribe opioids more cautiously. There seems to be some kind of racial stereotyping at play that has had a protective effect on communities of color. This is predominantly a white person's drug addiction epidemic, so that's why you see white people in our film.

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We did decide that every addict in this film would be someone who started out with a prescription for an opioid from a doctor. We felt the story had been told about straight use of heroin, but the story that hadn't been told is that the vast majority—somewhere around 80 percent—of current heroin users began with an addiction to prescription opioids. So as much as people might want to look at this and say, 'Oh this is really a heroin problem,' yes, it is a heroin problem, and no one is saying differently, but it starts more often than not with a prescription.

MC: How did that happen?

"It is unacceptable that the way we have treated people who have become addicted in the past is by throwing them in prison."

PP: In 1999, Purdue Pharma [the maker of OxyContin] went on a massive marketing campaign. Back then, prescription opioids were only used in extreme cases—post surgery, end of life care, cancer pain—cases of really serious and severe pain. Doctors knew the molecule was highly addictive so they stayed away from it. But in the mid-'90s, people were complaining that we were under-treating pain in this country, and here was this new drug coming out of Purdue Pharma that was an extended release opioid medication. There was a very aggressive marketing campaign—we use a clip from an ad in the film where they had a doctor saying, "Less than 1 percent of people who use prescription opioid long-term will become addicted"—that changed the mindset of physicians across the country.

MC: That's the scariest thing about the film—these people all started off taking drugs their doctor had prescribed. I mean, who wouldn't follow their doctor's instructions and take the painkillers they were told to take after surgery?

PP: Exactly. When your doctor gives you something, we know our doctors have our best interest at heart, so we take it. I really do think for the vast majority of cases, doctors didn't think they were doing anything wrong—they were doing what was being recommended at the time, and many times people were able to take these drugs and not have a problem with it. But what we do know is that if we take these drugs long-term, dependency develops quickly, within as little as a week. What we all have to realize is that these pills are chemical cousins of heroin—one is an illegal opioid and one is legal, but they are relatives.

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I want to make it clear, though, that I am not trying to say these are bad drugs. Opioid medications in the short term for severe pain are very effective. The problem is when they are used for long-term chronic pain. What we want people to know is, if you are prescribed these medications for severe short term acute pain, by all means take the medication—no one wants anyone to suffer and be in pain. But realize how addictive these drugs are and get off of them as quickly as you can. So it's really more about educating people about these drugs so that everyone can make their own decision about their pain versus the addictive nature of these drugs.

MC: How is this drug epidemic being handled differently from those in the past, like the crack epidemic in the 1980s?

PP: We are having a public health response to this epidemic. We are looking at treatment options, there are drugs being made available for treatments, and we aren't just throwing people in prison. So this is a very different response than the traditional criminal justice response that we have had to past drug epidemics. It is unacceptable that the way we have treated people who have become addicted in the past is by throwing them in prison. It's appropriate that we're responding now by trying to get people the treatment they so desperately need. The racial divide here is absolutely unacceptable, and we have to do much better for all people who are addicted whether they are white, black, brown, any race—the humane way to respond to addiction is in a public health fashion and by getting people the help they need.

"Life expectancy for middle-aged white women has dropped dramatically over the past decade."

MC: Is there anything that women, specifically, need to know?

PP: Life expectancy for middle-aged white women has dropped dramatically over the past decade. Researchers didn't understand what was going on and so they were studying it and then very recently they realized it is driven by opioids. Why is that? They say now that it is because women are more likely to see a doctor for pain. 70 percent of people with chronic pain are women. So that may explain why, between 1999 and 2010, overdose deaths from prescription painkillers increased more than 400 percent among women, compared to an increase of 237 percent among men. More men continue to die of overdoses, but the dramatic increase is happening among women.

MC: What can and should be done to curb the epidemic?

PP: There are many things that we can do to bring this horrible epidemic to an end. We can prevent more people from becoming more addicted—that's number one—with prescribing laws and making sure that people can't get too many of these opioids when they are initially prescribed them. So that's number one. Number two is, we have to make sure the millions of people who are already addicted have access to good and effective treatment. Finally, it's critical that we remove stigma and that's why we've made this film, to show that this can happen to anyone. We must do something to let people in this country know that addiction is something that can be treated and this epidemic is something that we can fix.

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