An excerpt from Burden of Pain: A Physician’s Journey through the Opioid Epidemic.
Glide your hand over a piece of velvet and you notice the smoothness. You feel its aggregated smoothness, not the individualized roughness of each fiber. Each fleeting fiber, a prick of truth, is nullified, synthesized, and then magnified into the silky fluency of general perception—propaganda containing within it a concoction of ambiguities and assumptions, cooked with a splash of outright lies and a dash of truth. This is to ensure the intrigue rises to a level that is just right, just unbelievably believable. I experienced this dish, served in all its varieties with all the flair and pomp, until I could eat no more. And then the dish forced its way down my throat.
My first taste came during my last days of seeing patients. On a Friday, I received a call that indicated I was to be indicted. I had to first search the term to verify its definition, and even then, I did not grasp its immense implications. I was not yet able to process that I was being accused of a crime. I continued seeing patients the next day, Saturday—a physician until the very end. I reported to the federal courthouse in Hammond, Indiana, on Monday.
The courthouse is a truly impressive building in an otherwise dilapidated neighborhood. I suppose there is symbolism in that contrast, but I was too consumed with my own symbolism to pay that contrast any mind. The legal proceedings were brief, surprisingly polite, and more ceremonial than judicial, with none of the fanfare one might expect in what was—or perceived to be, at least—a high-profile criminal case. That soon contrasted with the virulent propaganda in which I was immersed—article by article, drop by drop.
The first news article, a harmless drop in an otherwise empty bucket, made its presence known through a transient splash … followed by a moment of silence. And the moment was over, disrupted by another drop and then a rapid series of drops, until they were no longer drops, but a stream. A rumbling, noisy stream of news and hearsay overflowed from the bucket, spreading out with accelerating aggression to permeate the minds of readers, gossips, and rumormongers. Then the stream turned into a flood, a deluge of destruction, ensuring its presence was felt and its impact known.
News reports claimed I gave pills to relatives and acquaintances of federal agents and coordinated a multistate drug operation. Those who followed the flood as closely as I floated in it likely learned what was written about me at the same time I did. We learned I was the top prescriber of opioids in the area I practiced, and one of the top opioid prescribers in the state of Indiana. We even heard I was impersonating another physician.
The articles grew to be so numerous they competed for attention with one another. The crafting of each article became a coordinated dance, a bid for attention between reader and writer. These writers used scandal to attract readers, twisting key facts, deliberately introducing ambiguities to create an air of suspense in an evolutionary process of journalistic adaptation—attention being the competitive prize.
The outright dishonest articles soon went extinct, leaving articles more successfully fit—in the most Darwinian sense—for navigating the ever-blurring distinction between truth and fabrication. Each article’s competitive advantage came from the selective use of sensationalistic terms or buzzwords and phrases appearing regularly as to warrant the familiarity of trust but unique enough to captivate with the thrill of novelty.
Soon the words danced from article to article, displaying different styles and techniques, sometimes subtle, sometimes crude. The dance became as enticing to the reader as the underlying content. In such a dance, some readers create their own perceptions as much as they respond to what they read. The coordination of perception and reaction continued, increasing in fervor, inside the minds of my colleagues, friends, and family—manifesting the most acute responses with utmost subtlety.
I noticed them all: the double looks, the unnatural pauses, the off-kilter body movements, the side-to-side eye sprints, and my favorite—the tight-lipped, blank-faced stare of someone trying but failing to hide emotions, as though by forcing silence, that person can avoid an unwanted conversation. The articles written were rarely discussed aloud; most people maintained a muted silence. But I could feel every word they’d read, line by line, from the looks on their faces.
While most simply avoided discussing the situation, not knowing what to say, some reveled in it, taking liberty to lash out with biting remarks, taunts, and jeers. Others saw opportunity at every twist and self-promotion at every turn.
Many physicians, some within my referral network, turned on me to designate my practice as the epitome of the opioid epidemic in health care gone awry, conveniently substituting allegations for facts and suppositions for hard data. They printed inflammatory materials and wrote scathing articles in local newspapers and on their personal blogs discussing my case, while keenly promoting their clinical practices, hoping their efforts toward social justice would net a pretty penny in the process—holding true to the saying, “Never let a good crisis go to waste.”
One pain specialist I had referred patients to self-published a scathing editorial, contrasting my indictment with the experiences of physicians who had suffered physical attacks from patients for refusing to prescribe controlled substances. Though these attempts at self-righteousness were thinly veiled self-promotions, they still hurt, and the closer the previous relationship, the more personal the wound.
Hysteria emanating from the opioid epidemic affects how we discuss and understand it and causes extreme responses. The more we simplify the conversation about how the epidemic grew to what it is now, the more we gravitate toward extreme, sensationalized interpretations around its beginnings and who is to blame. By now the terms “irrationality” and “misinformation” define the epidemic as much as the words “addiction” and “fentanyl.” When hysteria overtakes rational examination of the epidemic, the conversation is reduced to a never-ending array of accusations.
Jay K. Joshi is a family physician and author of Burden of Pain: A Physician’s Journey through the Opioid Epidemic.