America is currently immersed in an opioid crisis brought on by the overprescription and misuse of oral outpatient opioids. The Centers for Disease Control and Prevention (Atlanta, Georgia) current data report reveals that “More than 932,000 people have died since 1999 from a drug overdose. Nearly 75% of drug overdose deaths in 2020 involved an opioid.”  The Substance Abuse and Mental Health Services Administration’s (San Antonio, Texas) annual report noted that, “Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids [and]…an estimated 667,000 people misused prescription pain relievers and used heroin in the past year.” Some physicians and specifically anesthesiologists may think they fully grasp this calamity because they prescribe opioid analgesics. Unfortunately, some have firsthand experience with the devastating consequences of the opioid crisis. Others may not fully grasp this or are somewhat blind to the depth and breadth of the opioid crisis. I have a suggestion for all of us that is bound to aid understanding of the opioid crisis.

American poet John Godfrey Saxe (1816 to 1887) graced us with his retelling of the Indian parable, “The Blind Men and the Elephant.”  This tale reveals the very different accounts of what the elephant is as explained by the blind men who each touched a different part of the mammoth creature and described their impressions. Each was sure, yet none had seen the elephant. There certainly is some truth that beauty originates from the eyes (more than touch) of the beholder. I encourage you to read two current books about the opioid crisis to realize some of the parts of this multifaceted crisis.

If you were the blind man feeling the economic arm of the opioid crisis, reading Patrick Keefe’s “Empire of Pain: The Secret History of the Sackler Dynasty” will open your eyes. This book recounts the saga of siblings, Arthur, Mortimer, and Raymond Sackler, all well-educated physicians, who bought a small somewhat insignificant pharmaceutical company and cultivated it, with their children and faithful employees, into Purdue Pharma. Mortimer and Raymond focused on growing the company into a money-making powerhouse, peddling powerful analgesics, with the aid of Arthur’s expertise in medical advertising, a potent combination. Relaunching OxyContin treatment, Purdue Pharma executives instructed the company sales representatives to characterize its clinical properties as nonaddicting and more effective with increasing dose regimes. Reading on, the story recounts unscrupulous sales force strategies, such as those brought to the clinical community’s attention in 2009  that exploded OxyContin prescriptions yielding total sales of 35 billion dollars from 1996 to the present. As visible through Keefe’s book, the opioid crisis is a catastrophe attributable to the avarice of a family, who rationalized their behavior through their benefactor largesse, working side-by-side with lawyers and corporate executives who prioritized the bottom line, rather than patient benefit priorities.

Beth Macy’s “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America” offers a different glimpse of this elephant. This tome recounts the emotionally disturbing saga of people impacted by opioid use disorder. Dopesick is a collection of narratives of the patients and their families and friends who lived and grieved the consequences of the opioid abuse. The narrative expounds the personal stories chronicling the development of the crisis in rural Appalachia, a story universal to all communities attempting to cope with this malady. “Because many die [from opioid abuse] prematurely…surviving family members and communities lose out on benefits from an individual’s lifetime earnings. Opioid use disorder also results in costs associated with added health care expenses, criminal justice, lost productivity, and reduced quality of life. In 2017, these costs totaled an estimated $1.02 trillion—54% was attributed to overdose deaths and 46% to opioid use disorder…”

Keefe writes his text sensing the opioid crisis in a manner focused on and critical of the pharmaceutical industry; Macy writes her text focused on sensing the opioid crisis as a sadly disturbing empathetic concern about the personal stories of the victims. Elements of each author’s perspective appear in each other’s book. It is the emphasis on the economic versus human fallout that urges one to read both books to gain a more complete understanding of the elephant. “Empire of Pain” and “Dopesick” are written to provide astonishing detail that enables the blind man to see the elephant in the room, the opioid crisis.