Whose Fault is the Opioid Epidemic?

And Sarai said to Abram, “May the wrong done to me be on you! I gave my servant to your embrace, and when she saw that she had conceived, she looked on me with contempt.” Genesis 16:5

I was trained in medicine during a time when we had much more relaxed attitudes about opioid prescribing. We were taught that, if used correctly to treat pain, no one became addicted to opioids. We were taught wrong. I’ve now met those who’ve told me that my prescription was their first exposure to opioids, launching them down the path of addiction. Did I cause that addiction? I have my own addiction origin story. I had a surgery after which I was prescribed opioids – getting an unnecessary number of pills. This was standard of care at the time, but it was also the birth of my addiction. So, whose fault is that? Can I blame my own self-destructive behavior, opioid diversion, and subsequent job loss on that surgeon from 25 years ago?

Modern medicine considers addiction a brain disease, which it absolutely is. There’s no other more appropriate word to describe the pathologic thinking of the addicted. Occasionally though, in listening to lectures on addiction, I’ll hear something like this – So, because they suffer from the disease of addiction, through no fault of their own, those exposed to opioids become addicted. Back when I was trained though, physicians didn’t accept responsibility for addiction. So, which is it? Is the physician responsible? Or are those addicted responsible?

No one likes to accept responsibility for disaster. Refusing to accept appropriate responsibility though, simply makes matters worse. That’s the lesson of today’s passage. In it, Abrams’ barren wife Sarai hatched a plan to provide the son that God had previously promised. Have sex with my servant. Impatient and unwilling to wait for God’s plan, Abram went along with Sarai’s plan, impregnating the servant. When the servant, Hagar, became pregnant, conflict erupted as Hagar looked on Sarai with contempt. Did Sarai accept responsibility for her plan? No. Instead she took her frustration out on Abram, who was just as guilty. Did he accept responsibility? No. Instead he deflected punishment back on Hagar, the only innocent one in the story. With those responsible failing to accept responsibility, the situation only got worse.

So, who’s responsible for my addiction? The medical community (including me) must – and I think has – accept that we’ve played a significant role in the opioid epidemic. That, however, does not absolve me of responsibility for my own addiction. My brain may have been hijacked by those opioids, but I was still a willing participant, responsible for my own choices – including the choice to get help or not. If I have no responsibility, then I’m helpless and there’s no hope unless someone else comes along and saves me. I’ve always got a choice though, and I’m always responsible for my own addictive, self-destructive behaviors. It may be true that modern medicine contributed to my addiction but from my perspective, blaming that surgeon does me no good. If I have type 2 diabetes, I may have a genetic predisposition to the disease, but I’ve also made poor choices that have contributed to it. It does me no good to blame the baker of all those donuts. I alone have the responsibility to leave the bakery and seek the treatment that can save my life.

I’m responsible for my own actions, despite the influences in and around me. Yes, I once did what I was taught as a physician, but I now must practice responsible prescribing in caring for others. Yes, as one who’s struggled with addiction, I have a brain disease, but I’m responsible for my own recovery. It does me no good to blame others. I’m responsible for my behavior and if I want to experience faith and recovery then I must daily do whatever it takes to find those things.