By Clark Miller

Published January 1, 2020

Updated April 15, 2021


Not a single opioid pill provided to living or dead Americans came to them from the Sackler family or from Purdue Pharmaceuticals.


Nor from any employee of a pharmaceutical or opioid manufacturing company.

opioid pills

The only originating suppliers to consumers – that is, patients – were licensed medical professionals

meeting with patients in exam rooms, providing medical services to them, then writing prescriptions that supplied them with the opioids. Without their signatures, no opioids were dispensed.

Mass media, with the same degraded, compromised capacity for thought, analysis, critical inquiry, and integrity enlisted in their collusion with American Medicine to fabricate and promote fake evidence to support runaway prescription of opioids generating today’s lethal crisis, now shields from accountability and correction that collusion and the forces driving worsening epidemics with the protective fabrication that drug manufacturers somehow caused the epidemic.

Caused not by the trusted, authoritative medical prescribers, public health authorities, governmental oversight and safety regulators, and academic and research institutions reassuring a trusting, vulnerable public that addictive Schedule II opioids were just what they needed for the non-medical condition of common chronic pain, with an impotent, compromised mass media along for the ride -no, but instead caused under this fabricated, protective narrative, by the drug companies meeting the manufactured, predictably lethal demand.


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Not a single opioid pill provided to living or dead Americans

was supplied  to them by a member of the Sackler family, from Purdue Pharmaceuticals, from any employee of a pharmaceutical or opioid manufacturing company.

Apart from anomalous exceptions, like Sam Quinones’ unflinchingly “True Tale” in Dreamland – and a new piece in Journalist’s Resource, below – you wouldn’t get that from the necessary fabricated distortions and media focus on Big Pharma as criminal accomplice in the epidemic. As if those representatives and executives themselves were distributing the addictive Schedule II opioids, against evidence – all longstanding lines of relevant evidence – predicting harm, as if the pharmaceutical reps and execs were in the exam rooms, coercing MDs and other licensed medical providers, or forging their signatures on the prescriptions.

As if those licensed medical providers, over the course of an American medical education, would not have necessarily become aware of the evidence and their clinical and ethical obligations to practice accordingly, based on the longstanding indications against the runaway provision of those Schedule II opioids: the potential for hyperalgesia; the addictive potential of opioids; the lack of evidence for effectiveness; the psychogenic nature of common chronic pain; and the effective, durable, indicated use of cognitive behavioral therapy (CBT) for common chronic pain.

All lines of evidence that were established prior to generation of the opioid crisis and would have been part of any legitimate medical training, training that would have – one presumes – been taken as more compelling than the assurances of pharmaceutical representatives. Or not.

Lines of evidence that give no credence to the weak excuses of Obama Surgeon General Vivek Murthy.

SG Murtha speaking

In a series of TV news interviews on the opioid crisis, Murthy repeatedly blames the runaway over-prescribing on: 1) doctors’ beliefs that the opioids – which have been listed since 1970 as Schedule II Controlled Substances due to risk of abuse and addiction – “are not addictive when prescribed for pain” and 2) “marketing” by drug companies – questioning the medical profession’s ability to independently use clinical and ethical judgment to protect patients.

The remarkable series of interviews includes the nation’s former chief medical officer and public health authority explaining the runaway over-prescription of opioids that created the opioid crisis by asserting that “practitioners were urged to treat pain aggressively” (at 1:00 in the CBS This Morning clip) and that “many of us were even taught – incorrectly – that opioids are not addictive” (starting at 4:10 in the CBSN clip).

In another interview, also from 2016, the Surgeon General repeats (starting at about 2:38 in the MSNBC clip) that “clinicians were urged to treat pain aggressively”, that he personally was trained, 20 years ago, that opioids “were not addictive so long as they were given to someone with legitimate pain”. He adds, “Even today I encounter doctors who still believe that [that opioids are not addictive] because they haven’t been taught any different”

Because they haven’t been taught any different.

[Competent journalist lacking cowardice: “Dr. Murthy, you seem to be suggesting that medically trained professionals have been and are unable to independently use clinical training, capacity to research information independently, clinical and ethical reasoning, and clinical judgment – that is, to use their training – to protect their patients from harm and risk of death. Is that right?”]


Reporting by Chloe Reichel of Journalist’s Review is an anomalous deviation from American media collusion with American Medicine to disguise and distract away from the forces that generated the opioid crisis.

opioid overprescribe JR longread3

From the JR piece –

Blame for the opioid crisis in the U.S. often falls squarely on pharmaceutical companies, pharmacies or rogue prescribers — like the Virginia doctor who prescribed more than half a million opioid doses in two year

But the whole story is more complicated, and it implicates a large portion of health care providers. Research shows that many doctors, nurse practitioners and physician assistants across the nation have oversupplied patients with opioids, spurring a national crisis that each year claims tens of thousands of lives.

“This isn’t just a story about rogue prescribers and pill mills,” says Caleb Alexander, co-Director of the Center for Drug Safety and Effectiveness at the Johns Hopkins School of Public Health. “A much broader swath of the medical profession is responsible for the oversupply of opioids in clinical practice.”

. . . .

Sam Quinones, Chris McGreal in American Overdose, and some others have outlined the sordid confluence of forces –

deception, fabrication, submission to pressure from patients and medical organizations, and failed responsibility to vulnerable, trusting Americans – driving generation of the lethal opioid epidemic: a remarkable abdication of competence, integrity and ethical behavior by players including big pharma, America’s top medical, oversight, and research institutions, and the medical profession, with mass media along for the ride.

As McGreal describes in American Overdose, the clinical environment in medical practice settings became coercive and toxic – a collusion of patients trained by decades of programming to seek a pill for every distress including opioids, supported by the medical/hospital/insurance industrial complex to report doctors who would resist providing opioids inappropriately and threaten them with complaints and action by professional and licensing boards.

McGreal talked to Dr. Charles Lucas, a surgeon in Detroit who resisted growing pressure to overprescribe opioids, ended up being subject to a complaint and summoned before a hospital ethics committee for failure to provide adequate pain treatment.

(from American Overdose pp 88 – 89)

The case was dropped, but it was not an isolated incident. Luca has worked closely with another surgeon, Anna Ledgerwood, since 1972. She too was hauled before the ethics committee on more than one occasion on the same charge. One of the investigations, for alleged inadequate pain management after a hernia operation, went all the way up to the state medical board. It cleared Ledgerwood, but Lucas said more junior surgeons buckled to the pressure to administer opioids just to stay out of trouble. “If they will give me a hard time, then they will surely give a young resident a harder time,” he said. “I tend to be a fighter. That’s my nature. But somebody who just wants to take care of patients, they want to be a professional physician, they don’t want to put up with all this crap; they’re intimidated. They’re also frustrated by it. The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”

Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.

Of course they knew. Or should have, or should not be practicing medicine.

But the forces driving runaway, medically inappropriate dispensing of opioids were not knowledge, competence, integrity or professional courage. There were other forces at play.

It is much less discomforting – especially for America’s journalism institutions instrumental in helping to fabricate out of nothing a bogus scientific rationale for runaway use of opioids against all evidence – to focus on Big Pharma (another example of the unfortunate excesses of corporate greed) as the reason for the lethal crisis, than to accurately indict America’s most trusted institutions including the impotent and enabling watchdog press that helped to create the needed fabrications. The more attention diverted to Big Pharma, the less on the necessary roles of media, the medical profession, research and oversight institutions. Corporate greed is a given; incompetence and betrayal by the core democratic and public health institutions trusted to protect American well-being and lives must be disguised, distracted away from.

And just as blanket Medical-Media messaging has constructed pill manufacturers, somehow, as responsible for the runaway dispensing – against all longstanding lines of evidence – of addictive opioids for the non-medical condition of chronic pain, generating the increasingly lethal opioid crisis – the same collaborating forces successfully fabricate a STORY of street fentanyl as explaining continuously mounting opioid-related deaths, those deaths correlated with increasing provision of the Medical-Media “treatment”.

Consistently and predictably: there has never been credible evidence to support OST as effective in reducing high-risk opioid use and preventing opioid-related deaths, instead relevant lines of evidence disconfirm that presumed effectiveness.

Instead, available evidence points consistently to OST (MAT, MOUD) driving economies of illicit opioid abuse and worsening the lethal crisis. 

That’s not a problem for pharmaceutical industries desperate to protect profits, or for a medical industry desperate to distract attention away from the medically-generated opioid crisis and associated deaths and to create and protect a sheen of competence and relevance, authoritative status, and the lucrative “addiction medicine” entitlement system. Popularizing, research-illiterate writers without competence and capacity to critically evaluate the relevant research are willing, as in generation of the opioid crisis, to spin and help brand OST as effective “treatment”, a “fix” for the opioid crisis from entirely inconclusive evidence, in an unfortunate confluence of group think, ignorance, and the power of cultural capital in a post-factual world to create meaning as needed.

It’s in that lethal history and context that the synthetic opioid fentanyl has become a new Purdue Pharma,

the necessary confabulation distracting away from the driving forces and failure and predictable harm generated by the medical fix for the medically-generated lethal opioid crisis.

The evidence is clear, explained here and here

Evaluation of epidemiological trends and of direct measures of prevalence of high-risk use of opioids that are not explained by trends in fentanyl presence and use on the street – among other factors – disconfirm presence of fentanyl in illicit opioid economies as explaining away established failure of the medical fix.

Mounting deaths, worsening epidemics, generated and enabled by a medical-media collaboration

unchecked over decades of fabricating and selling medical fixes for non-medical public health problems.

Nothing has changed. In a recent egregious example, writers at Vox, the New York Times, other outlets in ignorance of the most basic of research interpretation errors promoted entirely unsupported conclusions promoting false confidence in effectiveness of use of electronic cigarettes or nicotine replacement therapy (NRT) products as treatments for the highly lethal condition of compulsive use of tobacco by smoking. As in the media/pharma/medical industry collaboration that created the lethal opioid crisis, significant harm is predicted by the distortions and false messaging, by promotion of false confidence in unsupported treatments for smoking. The harms include tobacco-related mortality and morbidity that eclipse that related to other drugs, and harms due to smoking linked to incidence of chronic pain syndromes and exacerbated pain perception, both factors driving opioid misuse and the opioid crisis.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.”

– Pierre Bourdieu  Outline of a Theory of Practice (1972)

In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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