How the System Prescribes Addiction

I’ve written elsewhere about how my own addiction started: six months in a hospital bed on morphine and pethidine, handed out without much question, and then a discharge with the infection and not one word of help for the dependency that half a year of opioids had built. I went looking for that feeling for years afterwards.

For a long time I told that story as my failing. I’ve since come to see it differently — not as an excuse, but as a pattern. Because what happened to me happened to a lot of people, in more or less the same way, and it wasn’t an accident. It was a system working roughly as it was built and incentivised to work.

The molecule isn’t the villain

Let’s be clear up front, because this is where these conversations usually go stupid. Opioids are not evil. After surgery, in palliative care, in genuine acute agony, they’re a mercy, and a world without them would be crueller. The problem was never the molecule. The problem was the machine that grew up around it.

How the machine works

Strip it back and it’s depressingly simple.

First, the risk got sold short. Drugs that everyone in medicine had once treated with great caution were marketed to doctors, for years, as carrying little addiction risk for ordinary long-term pain. That claim was wrong — disastrously wrong — and companies later paid out in the billions, some pleading guilty, once the damage was undeniable. By then the prescribing culture had already shifted. Pain became “the fifth vital sign,” something to be medicated down to zero, and the script became the fastest tool in a ten-minute appointment.

Second, dependency was created at scale. That’s not a moral statement about the patients; it’s pharmacology. Put enough people on enough opioids for long enough and a predictable fraction will become dependent. The system knew the maths and prescribed anyway, because the incentives all pointed one way: volume, speed, and a pill for every complaint.

Third — and this is the cruel hinge — the system created the dependency and then abandoned the dependent. When the prescribing finally tightened, the people already hooked didn’t evaporate. They were cut off, often with no taper and no aftercare, and a good many went looking for the same relief on the street, where heroin and then fentanyl were cheaper and stronger and far more lethal. The pipeline from clinic to gutter is not a coincidence. It’s a design flaw nobody was punished enough to fix.

The clever part: blame the patient

Here’s the move that lets everyone upstream off the hook. Once you’re dependent, the system stops calling you a patient and starts calling you an addict. And “addict” is a moral word, not a medical one. It relocates the entire problem into your character — your weakness, your choices — and quietly absolves the prescriber, the company, the regulator, the incentive structure that delivered you there.

It’s a brilliant bit of accounting, if you’ve no conscience. The institution causes the harm and the individual carries the shame. The label does the work of hiding the cause.

Holding both halves, like always

I’m not interested in the version of this where nobody is responsible for anything. I made my own choices, including bad ones, and getting clean meant owning them. Personal responsibility is real, and “the system did it to me” is a trap if you live there.

But it’s equally a trap to pretend the individual is the whole story, because that’s exactly the lie that protects the people who profited. Two things are true at once: I’m accountable for what I did, and I didn’t start the fire, and neither did most of the people we’re so quick to write off. A society that can only see the first half will keep manufacturing casualties and then sneering at them.

What doing better looks like

It isn’t complicated, it’s just unprofitable. Treat dependency as the medical condition it is, not a character flaw. Never create it without a plan to get someone off it — proper tapering, real aftercare, follow-up that doesn’t end at the hospital door. Aim the incentives away from volume prescribing. Hold the institutions that mislead to account in ways that actually sting, not as a line-item cost of doing business. And, at the human level, swap the sneer for some humility, because the bloke you’re judging may have been handed his first dose by a person in a white coat.

I chased a high for years that a hospital started in me and then walked away from. I own my part in what came after. But I’ll never again accept that the whole of it was mine to carry — and neither should the millions quietly told the same lie.