HHH column: Painkillers as Friends by Gemma Blok

The HHH column is a monthly blog in which History, Health & Healing members share their thoughts on research, current affairs, or anything to do with medical history. Each edition is written by a different member – in due time, we hope to offer everybody a chance to publish a contributionThis month, the floor is for Gemma Blok, Professor in the History of Psychiatry at Utrecht University and in the History of Mental Health and Culture at Open University. Gemma has recently started a NWO project investigating the meaning of intoxication for (former) drug users. In this column, she writes about the life of Friends actor Matthew Perry, and about how his user story can help us to understand addiction and the opioid epidemic.

Painkillers as Friends

Gemma Blok

The recent death of actor Matthew Perry (1969-2023) renewed media attention for the devastating opioid crisis in the US. Though no drugs were found in his apartment, many immediately speculated about a link with his addictions to alcohol and opioids. In December 2023, medical examiners determined that Perry had died of the acute effects of ketamine. Around one year ago, Perry published his memoirs Friends, lovers and the big, terrible thing (2022). The big, terrible thing was his addiction: his “best friend and evil friend”, his “punisher” and “lover, all in one”.

Perry fell in love with Vicodin immediately after taking it for the first time in 1996. He drove a car through the Nevada desert when he swallowed the synthetic opiate that was handed to him by a doctor, to numb the pain after a Jet ski incident the day before. “As the pill kicked in, something clicked in me”, Perry wrote. “And it’s been that click I’ve been chasing the rest of my life”. He felt safe, warm and “very close to God”.

Perry was part of the first phase of the opioid crisis, around the year 2000, when synthetic opioids like Vicodin and Oxycontin gained popularity as painkillers. Around 2010, a second phase in the epidemic saw a tightening of opioid prescribing regulations, and a shift to heroin consumption. The third phase included a move towards the use of fentanyl, a very strong synthetic opioid. Despite the growth of harm reduction policies, in 2021 the number of opioid-involved overdose deaths in the US numbered 80,411.

The story of the first phase of the crisis is by now quite well-known, thanks to documentaries, films, and TV-series like Dopesick (2021), Painkiller (2023) and Pain Hustlers (2023). The focus is mostly on pharmaceutical companies like Purdue Pharma, which pushed opioid pain medication with aggressive marketing techniques. Dramatized versions of the story often involve a sexy young female pharmaceutical representative, hired to seduce middle-aged male doctors into prescribing this new, recently FDA-approved and “non-addictive” opiate medication. While the doctors are treated to lavish parties thrown by the pharmaceutical companies, patients start lining up daily at their practices looking for a fix. And they start to die in great numbers. In the end, however, in most series – as in real life – Big Pharma is brought to justice.

Opioids for mental pain

At first sight, Perry’s story fits well within this dominant narrative of evil capitalists and their innocent victims. His first pill was handed to him by a doctor for physical pain, and other doctors were easily convinced to prescribe him more. Perry’s story also makes clear, however, that users have an agency of their own, and use opioids for mental pain as well. He writes that he was drinking heavily from the age of 15 onwards, to cope with feelings of stress, depression, and insecurity. Alcohol took away the pain of “feeling lonely all the time”, even when he was with people. “Like a friend, it was there for me”. Vicodin became another best friend to lean on.

There is no doubt about the fact that Big Pharma played a crucial and perverse role in fuelling the current opioid crisis. However, the permeation of psychoactive substances, legal and illegal, in individual and social life in Western societies is also, at least in part, consumer-driven. Research on drug use in past and present shows people who robbed pharmacies or the medicine cabinets of their (grand)parents to find substances to experiment with, who trade or use substances in high school or at university to enhance studying, socializing, or relaxation, who look for a high to self-treat mental health issues; and who manipulate doctors with fake prescriptions or exaggerated physical maladies. In many cases, like with Matthew Perry, stories of intoxicant use start with alcohol.

As his story highlights, intoxication can be functional in treating mental as well as physical pain. In this way, Perry’s story is more in tune with TV-series Euphoria, which takes a user perspective on the opioid crisis. The shows main character Rue’s drug use starts at age 13, following her father’s cancer diagnosis. As he undergoes treatment, and eventually dies, Rue steals her father’s pain medication to cope with her grief and becomes addicted. At her high school, drug use is an important aspect of social life as well. The creator of Euphoria, Sam Levinson, who struggled with opioids and other drugs himself, stating “I just wrote myself as a teenager”. Tragically, one of the actors on Euphoria, Angus Cloud (1998-2023) recently died of an overdose. Like Perry and Levinson, Cloud stated that he used drugs to cope with mental health issues.

As Perry’s memoirs and the TV-series Euphoria illustrate, the boundaries between medical and non-medical use of psychoactive substances are fluid. America, however, has a strong tradition, dating back to the early days of the War on Drugs around 1900, of “defining white market drug consumption as fundamentally different than informal-market drug consumption”, as historian David Herzberg states in White market drugs. Big Pharma and the Hidden History of addiction in America (2020). Consumers of psychoactive pills prescribed to them by doctors are seen as decent people. Those who take illegalized psychoactive substances are framed as hedonistic ‘dope-fiends’. This is probably why the narrative of evil capitalists corrupting and harming innocent citizens is an attractive framework for making sense of the opioid epidemic. It takes away the blame for problematic substance use away from the individual.

Uneasy truths about people actively looking to get high, however, should still be part of making sense of drug crises as well. Like with any form of consumerism, intoxicant use is the result of a complex interplay between supply and demand.