Karl Marx called religion the opium of the people, its drug-like influence blinding them to the realities of the world, and therefore advocated atheism. Also fearing an opiate effect on his audience, Bertolt Brecht used entfremdungseffekt, or alienation, in his theatrical productions in order to avoid sweeping the audience into a make-believe world. It might be argued whether religion or theater was closer to an addictive drug historically, but in recent times, the opioid of the people turns out to be much more literally so. It is the drug OxyContin, manufactured by Purdue Pharma.
Starting in medical school (I graduated in 1981), it was drummed into students that opioids are addictive, dangerous, life-changing, not to be prescribed lightly, a last resort only. We grew up disciplined, ready to tackle the tough decisions, morally rigid and a bit self-righteous. We were automatically skeptical whenever patients demanded stronger pain meds, and in steadily escalating quantities. Of course we knew real pain existed, and we were sympathetic– but at the same time, there were sure to be malingerers, addicts, and those who would resell prescribed narcotics for a huge profit. The fear of treating pain insufficiently was often eclipsed by the fear of being taken advantage of, as health care providers. As we gained experience, some became better judges of character, but no one ever knew for sure; I remember a couple of seemingly reliable patients forging my signature for Demerol injections in the Urgent Care Clinic.
Then came a blizzard of editorials in medical journals and the lay press– sometime in the ’90s, as I recall– excoriating doctors for their callous under-treatment of chronic pain and pressing for a liberalized approach to the prescription of opioids. It felt like a public shaming of our profession for its paranoia and lack of compassion, and was taken by many as welcome permission to loosen up our self-imposed standards. But despite a universal sense of relief, a rational approach to opioids remained elusive. It made sense that terminal cancer patients should never be denied a narcotic for their excruciating pain, but elsewhere on the spectrum of pain, the same uncertainties prevailed.
Now with the opioid crisis making daily headlines, the pendulum has swung all the way back. The public is outraged about the ubiquity of opiates and resulting societal problems; over-prescribing doctors and the pharmaceutical companies share the blame. And it seems that Purdue Pharma had knowledge of the dangers and abuse of their product long before admitting it to drug regulators. Huge profits and corporate greed attached to OxyContin, not surprisingly, outweighed public health concerns.
In my Fourth World novels, the drugs in question are psychopeptides, the proteins made by translating recombined multispecies DNA– including DNA discovered in Martian fossils. The giant pharmaceutical company Eunigen discovered those fossils and secretly manufactures these products. Here’s an excerpt from Fourth World:
“Thor Ibsen, my name is Dr. Walther Beame.” He was speaking more rapidly now. “I am about to give you a higher dosage of a drug very similar to Deep Coma. Is that all right with you? I should tell you that there may be a substantial risk of serious side-effects at this high a dosage, including rash, headache, fever, abdominal pain, death, incontinence, loss of taste, and loosening of the nails. All right then?” Beame smiled thinly at Trip and nodded encouragingly as he spoke.
“Note that informed consent was obtained,” Beame murmured to 0749, who duly marked a box on his datadisc. Without further ado (except for an audible gasp from 0749), Beame then applied the Dermamist injector and emptied the entire contents of the white vial into the subject’s carotid artery.
It took only a few seconds for the effects to begin. Trip’s eyes slammed shut, his jaw clenched, his lips pulled tightly back in a grimace reaching almost ear-to-ear and revealing gold-capped molars on either side. Nice, thought 0749: designed to match his gold chin cup and nostril ring. Trip’s tremulous hands grabbed onto the seat, knuckles white; his back arched against the plastic restraints pinning down both shoulders; his feet kicked violently against securely tightened leg straps.
That wasn’t quite a seizure, thought 0749, but it was close. He searched his datadisc. Seizures were not listed among the side-effects.
“Dr. Beame, just what are we observing here? I mean, what are we expecting to happen to the subject? Do you think the higher dose of drug will result in a more prolonged extra-corporeal experience? And will the withdrawal therefore be more painful than the previous?” 0749 tried to suppress the rising anger so familiar by this point in his short career at the Repro Division. He really should get around to filling out a transfer application, and soon.
Beame continued to stare at Trip’s contorted face, as he considered the question. 0749 was struck by the resemblance between Beame’s face and that of the subject: the tightness of its expression, the mouth drawn back, the look of one greedily searching for something in the obscure distance. Finally, the director explained matter-of-factly to his conscience-plagued lab technician, “Don’t worry yourself, 0749; he will not experience any painful withdrawal this time. Extrapolating from results so far in our titration protocol, you can rest assured that this time the subject will successfully expire.”