Medicalisation
The trend towards the medicalisation of social problems is suspected by critics to be an unholy alliance between doctors and the medical industry. The pharmaceutical industry in particular is accused of inventing new diseases ("disease mongering") in order to create additional sales opportunities for its products. The validity of such allegations is usually difficult to verify. However, a well-documented example of a skillfully planned marketing campaign is the so-called Sissi syndrome (alternative notation: Sisi syndrome), supposedly a special form of depression for which Empress Elisabeth of Austria was the inspiration. The allegation of medicalisation is particularly serious when it comes to children, and especially to interventions in their psyche or brain development. Examples here include the much-discussed attention deficit/hyperactivity disorder (ADHD) and, more recently, bipolar disorder (formerly known as "manic-depressive illness") in childhood. The benefit of a new clinical picture can only be assessed on a case-by-case basis and is often highly controversial, even among experts. Popular media usually readily accept revenue increases that pharmaceutical companies achieve thanks to new diseases as proof of their manipulations. This sweeping judgment seems unjustified, as economic success could alternatively also be explained by the fact that a new clinical picture is based on a real therapeutic need that is actually satisfied by a new drug.
Moynihan, Ray / Henry, David (2006): The Fight against Disease Mongering: Generating Knowledge for Action. In: PLOS 3 (4), 1–4. Online Version (German)
This article in the journal "Nervenarzt" played a decisive role in unmasking Sissi syndrome as a targeted marketing campaign:
Burgmer, Markus / Driesch, Georg / Heuft, Gereon (2003): Das „Sisi-Syndrom“ – eine neue Depression? In: Nervenarzt 74(5), 440–444. doi:10.1007/s00115-003-1489-2 . Online Version (German)
The US opioid crisis
On 26 October 2017, U.S. President Donald Trump declared a state of national emergency after the opioid crisis had worsened dramatically. According to the Centers for Disease Control and Prevention (CDC), 67,367 people died from a drug overdose in the U.S. in 2018, nearly 70 % of which involved opioids. Opioids are strong analgesics and narcotics referring to all morphine-like substances, whereas opiates refer to substances which in fact contain opium or opium alkaloids.
The CDC divides the rise in opioid overdose deaths into three waves. The first wave began in the 1990s and was caused by prescription opioids. The second wave began in 2010 and was mainly due to heroin overdoses. Synthetic opioids (especially fentanyl) and natural or semi-synthetic opioids (especially oxycodone and hydrocodone) are responsible for the third wave since 2013.
The CDC attributes the spike in drug-related deaths mainly to illegally produced fentanyl, which is 50–100 times stronger than morphine. Fentanyl is prescribed for severe pain (e.g. advanced cancer pain). In addition, pharmaceutical companies (such as Purdue Pharma, which distributes Oxycodone under the brand name OxyContin) have undertaken massive marketing efforts, prompting doctors to increase oxycodone prescriptions. Since 2012, the prescription rate has been declining slightly, nevertheless, there were still 58 opioid prescriptions per 100 Americans on average in 2017; 17 % of Americans had at least one opioid prescription filled. The CDC estimates that in 2018 roughly 10 million people (aged 12 years or older) abused opioids.
However, the increasing abuse of opioids can be observed not only in the US but also worldwide, although the crisis in the US is particularly severe. The United Nations Office on Drugs and Crime (UNODC) estimates that roughly 53 million people worldwide had used opioids in 2017, 56 % higher than the 2016 estimate.
CDC information on the opioid crisis Online Version
CDC Annual Report 2019 „Annual Surveillance Report of Drug-Related Risks and Outcomes“ Online Version
UNODC Annual Report 2021 „World Drug Report“ Online Version
Comprehensive reporting in the Washington Post „The Opioid Files“ Online Version