HBO Max’s new documentary, Crime of the Century—for which I was interviewed and about which I have written—promulgates the viewpoint that using opioids inevitably leads to addiction.
That is a breathtakingly false and damaging conclusion to portray.
Documentary Propagates Misinformation
Crime of the Century had the opportunity to debunk myths about addiction. Instead, it confuses the terms addiction and physical dependence and propagates misinformation. To make matters worse, the documentary was based in part on reporting from The Washington Post. The newspaper’s stature lends authority and credibility to a project that it does not deserve.
The documentary overlooks the critical issues that cause addiction while it captivates and misleads viewers with a fable of greed, villains, and heroes. In short, the documentary only succeeds in generating heat rather than shedding light on the deeply misunderstood, alarmingly widespread problem of addiction in America.
What we know about addiction to opioids is that it is 50-60 percent genetically determined. The remaining 40-50 percent is environmental. Noted psychologist Bruce Alexander has shown that addiction “emerges universally as a response to the disruption of normal social interactions.” Of course, social disruption does not create addictions universally. However, we have seen a surge in opioid addictions during the pandemic which supports the concept that isolation and lack of social connection fuel addictions.
In fact, a growing body of science suggests that when negative forces are present in a person’s life, drugs such as opioids become a means of eluding life’s painful memories. This helps explain why most addictions develop in people who have emotional pain from which they want to escape.
America’s Opioid Addiction Problem
Crime of the Century leads viewers to believe that America’s opioid addiction problem is due to unscrupulous corporations and providers. Certainly, aggressive marketing and pill mills provided a sea of drugs that led to destruction and death. But for the majority of people prescribed opioids, the risk of developing an addiction or overdosing is far less than the documentary would lead us to believe.
The story the documentary tells about overdose deaths caused by corporate greed has some basis in truth. But there is a greater truth: people in pain are repeatedly victimized by a system that is supposed to help them. Yet one story becomes the basis for policy while the other assumes a burden of proof.
The documentary argues that an excessive supply of opioids fueled the opioid crisis. However, there was a 40 percent decline in opioid prescriptions from 2012-2019. During the same time, there was an approximately 138 percent increase in overdose deaths. If the opioid crisis were due to the volume of opioids prescribed, we would expect the number of people becoming addicted or overdosing to have decreased when the number of prescriptions plummeted. However, the opposite occurred.
Most people who become addicted to opioids begin using other drugs in adolescence for social and environmental reasons. Childhood trauma, anxiety, and social isolation are far greater determinants of who develops an addiction than simple exposure to opioids.
Addiction happens because of an interaction between neurobiological and social-environmental conditions. Exposure to an opioid alone is insufficient for the disorder to develop. Addiction is not resident in a drug, but rather in individuals.
The solution to reducing addiction is to improve socio-environmental conditions and provide a non-punitive response to drug use. If this happens, people will not seek opioids, regardless of how much inappropriate marketing there is.
The Crime of the Century documentary is the 21st century equivalent of a witch trial. Rather than examining the real roots to the opioid crisis, it stirs up outrage while focusing on corporate misbehavior—a focus that, while partially true, does little to address the dilemma. Worse, it provides misinformation that actively exacerbates this national tragedy.
Lynn R. Webster, MD consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find him on Twitter: @LynnRWebsterMD.