I

n the latest sign of how the opioid crisis is permeating popular culture, the rapper Macklemore this week put out a remarkable new song about prescription painkillers and other addictive drugs.

Titled “Drug Dealer,” the song parcels out blame for an opioid crisis that kills 78 Americans a day, up fourfold since 1999. It forcefully calls out Congress (as doing the business of billionaire chiefs of pharmaceutical companies), drug companies (including OxyContin manufacturer Purdue Pharma), and doctors who prescribe potent painkillers and enable refill after refill. (In the song, featured artist Ariana DeBoo refers to a doctor as “my drug dealer” who “had the plug from Big Pharma”).

Macklemore, it’s worth noting, has spoken publicly about his own experience abusing the opioid painkillers OxyContin and Percocet. He released the song in conjunction with this week’s television premiere of an MTV documentary in which he interviews President Obama about the opioid epidemic.

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Read on for STAT’s annotations of Macklemore’s lyrics — which are peppered with references to the faces and drivers of the epidemic — and the backstory on the problem that’s “got a nation on the verge.”

They said it wasn’t a gateway drug
My homie was takin’ subs and he ain’t wake up

“Subs” is a reference to Suboxone, an opioid medication that’s used to treat opioid addiction. It’s become a key tool in combatting the opioid crisis; the Obama administration over the summer raised a prescribing cap to widen access to Suboxone and other buprenorphine medications.

But the drug has also been abused in and of itself, fueled by a vibrant black market and cash-only clinics that dole out the pills without proper counseling. The Centers for Disease Control and Prevention does not tally deaths caused by these treatments for addiction, but there have been plenty of reports of deadly overdoses from Suboxone.

Still, many addiction experts say the bottom line is that Suboxone saves far more lives than it takes.

The whole while, these billionaires, they caked up
Paying out Congress so we take their drugs
Murderers who will never face the judge

Hey, look, a (blistering) reference to federal lobbying made it into a rap song.

The makers of prescription painkillers wield significant clout on Capitol Hill and in statehouses all over the country. Over the past decade, they spent more than $880 million on federal and state lobbying, often seeking to block measures meant to curb the opioid crisis. That’s more than eight times what the gun lobby spent over the same period, according to a recent investigation from the Associated Press and the Center for Public Integrity.

Executives at two of the companies that have been blamed for fueling the opioid crisis — John Kapoor of Insys Therapeutics and members of the Sackler family of Purdue Pharma — are indeed billionaires.

And we dancin’ to a song about our face goin’ numb
But I seen homies turn gray, noses draining blood
I could’ve been gone, out 30s, faded in that tub

“30s” is a reference to what has become among the most vexing street drugs in the last few years: pale blue oxycodone pills, in a 30-milligram dose.

The opioid tablets typically go for $20 to $30 a pop on the black market, and people who get hooked later often turn to heroin. Law enforcement officials have recently reported a disturbing trend: Fake “30s” that look like oxycodone but actually contain far more deadly opioids, such as heroin or fentanyl.

That’s Prince, Michael and Whitney, that’s Amy, Ledger and Pimp C
That’s Yams, that’s DJ AM
God damn they’re making a killing

Macklemore’s recitation of the litany of celebrities whose deaths have been linked to prescription drug and alcohol use is a familiar one.

The most recent such example, and perhaps the most potent symbol of the opioid epidemic, is the musician Prince, whose autopsy indicated that he accidentally overdosed last spring on the powerful painkiller fentanyl. Prescription opioids were also implicated in the overdose deaths, spread out over the past decade, of the hip-hop executive known as ASAP Yams, the DJ known as DJ AM, the actor Heath Ledger, and the rapper known as Pimp C.

Alcohol or other non-opioid prescription drugs were blamed in the deaths of the singers Whitney Houston, Amy Winehouse, and Michael Jackson.

Now it’s getting attention ’cause Sara, Katey and Billy
But this shit’s been going on from Seattle out to South Philly
It just moved about the city
And spread out to the ‘burbs
Now it’s everybody’s problem, got a nation on the verge

Macklemore’s message here — that the opioid epidemic does not discriminate in the type of communities it ravages — is strikingly similar in vision (if not in language) to the alarm being sounded by the public health community and the Obama administration.

Just last week, in fact, the White House hosted Macklemore for a panel discussion on the crisis with federal drug czar Michael Botticelli.

While drug abuse has historically been clustered in urban areas, it’s clear that this epidemic doesn’t fit that pattern, though there’s little good data about the breakdown. Suburban and rural communities in many swing states, including Ohio and New Hampshire, face few more pressing issues than how to fight the epidemic.

The issue hasn’t come up so far in the presidential debates, though voters in some of the most devastated communities don’t think either Hillary Clinton or Donald Trump will save them.

Take Actavis off the market, jack the price up on the syrup
But Purdue Pharma’s ’bout to move that work

Here’s a somewhat opaque reference to a prescription opioid cough syrup, prominently abused in the hip-hop community a few years ago as a way of getting high. In 2014, the drug’s maker, then known as Actavis, pulled it from the market in response to the abuse, a move that sent the street price of the suddenly scarce drug through the roof.

And then, right before the chorus begins, there’s a reference to Purdue Pharma, which has been vilified for sowing the seeds of the opioid crisis by aggressively marketing OxyContin.

Dom Smith/STAT

My drug dealer was a doctor, doctor
Had the plug from Big Pharma, Pharma
He said that he would heal me, heal me
But he only gave me problems, problems
My drug dealer was a doctor, doctor
Had the plug from Big Pharma, Pharma
I think he trying to kill me, kill me
He tried to kill me for a dollar, dollar

The song’s haunting chorus, with vocals from DeBoo, holds doctors accountable for their role in fueling the opioid crisis. Research has demonstrated that widespread overprescribing of opioids for routine medical conditions got many people hooked and sent them down the path towards heroin.

It’s clear that pharma companies targeted doctors with aggressive sales pitches to get them to prescribe potent painkillers. Some of the marketing material deliberately downplayed the addictive nature of the drugs. A trove of pharmaceutical company documents uncovered by STAT, for instance, shows how sales representatives used dinners, gifts, and even doughnuts to sway doctors to switch patients over to OxyContin.

And these devils they keep on talkin’ to me
They screamin’ “open the bottle,” I wanna be at peace
My hand is gripping that throttle, I’m running out of speed
Tryin’ close my eyes but I keep sweatin’ through these sheets, through these sheets
Four horseman, they won’t let me forget
I wanna forge a prescription, cause doctor I need some more of it
When morphine and heroin is more of your budget
I said I’d never use a needle, but sure, fuck it
I’m caught up, I’m on one, I’m nauseous
No options, exhausted
This is not what I started
Walkin’ carcass, I lost everything I wanted
My blinds drawn, too gone to leave this apartment

Macklemore’s harrowing description of what it’s like physically to be dependent on opioids speaks to just how excruciating it is to get clean. Another survivor described the experience to STAT as “like you’re living in hell.”

Forged opioid prescriptions have also exacerbated the epidemic. Though there doesn’t appear to be good data on their prevalence, it’s widespread enough to have sparked interest in electronic prescription and spurred drug stores to adopt stricter policies to avoid filling such prescriptions.

Macklemore also gestures at some of the ways that prescription painkiller addiction can escalate. Take his reference to heroin: 80 percent of new users report that they got started on prescription painkillers. As for injection needles, sharing them can put users at risk of HIV.

Dom Smith/STAT

Death certificate signed the prenup
Ain’t no coming back from this Percocet
Actavis, Ambien, Adderall, Xanax binge
Best friends with the thing that’s killing me
Enemies with my best friend, there’s no healing me
Refilling these, refilling these
They say it’s death, death
Institutions and DOCs
So God grant me the serenity to accept the things I cannot change
Courage to change the things I can
And the wisdom to know the difference
And the wisdom to know the difference

While much of the concern is focused on opioids, addicts often use them in combination with other types of drugs — worsening the consequences. Sedative drugs like Xanax, known to scientists as benzodiazepines, are involved in nearly a third of accidental overdose deaths from prescription opioids.

The prescription refills that Macklemore references are another key driver of the problem. A study last year found that more than 90 percent of patients continued to get refills even after overdosing on opioid medications.

Five northeastern states have passed legislation aimed at limiting the number of pills doctors can prescribe. (Preliminary findings also suggest that increased awareness among doctors is helping stem prescriptions).

Macklemore concludes with a reference to the Serenity Prayer, which became a popular fixture at Alcoholics Anonymous meetings and has since migrated to recovery groups for opioid addiction. His new documentary, in fact, includes a scene at the Seattle recovery group that Macklemore attends, where the group recites the prayer.

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  • No, it wasn’t pushed under the rug as a “black, city” problem. It was pushed under the rug when junkies would rob and hurt people for money/drugs. Junkies like me (now clean, not long) white and privileged, don’t normally “steal or hurt”, except from family. Very messed up but really? Same problem?? Violent drug offenders still go to jail. Hopefully minority/city addicts will be given a better chance now. Still a choice. I’m just a lucky POS. 6 buns a day for 3 months at peak. Never heard of anything close to that. Still never hurt (physically) anyone. Taking from family is my permanent shame.

  • All of this means a lot to me. I have NEVER come across something so strong. I lost my grandson from opioids a year ago, he was only 22. That was one of the hardest things my family ever had to go through. A big thank you. Macklemore keep up the good work.

  • Loved how thorough this was, but wanted to note that his message with the “Now it’s getting attention ’cause Sara, Katey and Billy” isn’t that this is indiscriminate. His message there was that when it was “something Black people did” and was an issue found in the urban areas, it was considered JUST a “those people” problem. Easy to sweep under the rug – out of sight, out of mind, with the simple solution of “put ’em in the slammer.”

    But now that, “Sara, Katey and Billy,” who live in the suburbs, have the problem, it’s getting attention (and of course, now there’s a call for a gentler war on drugs, when the same consequences of life-long jail time for non-violent offenses should apply to them, but don’t). Now it’s everyone’s problem because all of a sudden, it’s a “white epidemic” and “white” is the brainwashed default for “American” and “normal.”

    If we miss the racial aspect of this issue being pointed out, we end up reinforcing and pushing the same actions and “sweep white supremacy under the rug” mentality he’s speaking out against.

  • Its great that someone exposed big pharma for what it is, but the hard truth is no one forced the pills down anyones throat.
    It seems its always someone elses fault for someones actions nowadays.
    Now we have a crisis because a bunch of people with no self control are dying and the true losers are the people who have legitimate pain that cant get treated properly anymore because the doctors fear losing their licenses.
    Try living with the pain of a deteriorating spine and being told they wont give you the pain relief you need anymore so go suffer.
    Its the same old story of the governments solution to every problem they encounter, by punishing the many for the irresponsible actions
    of the few.
    Rant off..

    • There wouldn’t be this issue if doctors and big pharma hadnt made it so easy to obtain opiates, benzos and stimulants.. then suddenly stop filling their scripts and never warn patients about withdrawing or addiction. Once you stop getting the scripts is when the real terror and addiction happens.. the flu symptom’s, confusion as to why you feel this way, trying figure out how to fix it, anxiety, the list goes on and on. Yes everyone is responsible for their own actions, but shit wasnt like this a few decades ago, and that isn’t because of people’s poor self control and irresponsibility… people have always had these qualities, big pharma and doctors just took advantage of people’s flaws and weaknesses. And it is unfortunate for people who have been in car accidents, back problems, surgery, etc who suffer because of the epidemic.. however there is physical therapy, holistic, natural and herbal approaches.. hell MOST illnesses, diseases and pain can be cured if one changes their diet and eliminates sugar, and exercise. So we can all agree to disagree, to each his own opinion. Now my rant is over lol

    • Seriously. The medical wants people to take medications they’re prescribed. All you have to do is take all the pain killers that your prescribed like you’re supposed to and you probably hooked.

      It isn’t a matter of being weak willed. It could easily happen to you.

    • Seriously. The medical community wants people to take the medications they’re prescribed. All you have to do is take all the pain killers that you’re prescribed like you’re supposed to and you are probably hooked. I have seen members of my family prescribed big bottles of this stuff, with no warnings given at all, for relatively minor conditions that did not require it. I suspect mostly because the HCPS do not want anyone complaining about pain.

      It isn’t a matter of being weak willed. It could easily happen to you.

    • Why can’t people just take the song for what purpose it stands for and quit analysing. Don’t make a racist concern. And as far as no one forces the drug down their throats, well if the prescription wasn’t handed out so freely by doctors that would help. My daughter went back to her pain management Dr the other day for the first time in almost a year and guess what he did, he wrote her a prescription for the same 3 narcotics at the same mg she was taking almost a year ago. I find the very disturbing.

    • It’s not always about self control….I have major back issues when prescribed o er 150 pain meds per month I was never set down and told about the physical addiction that it would cause. If I had been properly educated I would ha e never touched them. My family and I went through a 6 yr battle and I put myself in an outpatient treatment that cost 12 thousand. I was treated with subs and let me tell you it was worse then what I was prescribed. I was ashamed of myself and thought at times it would be easier to be dead. I felt like a horrible, mother, wife, sister and daughter. No one sets out to have an addiction and I mean know one. It sneaks up on you and in the long run it caused more problems then it ever solved. Dr are responsible in letting each patient know the exact issues it will cause over time. I don’t wish this on anyone. I’ve now found a clean way of dealing with my broken body. Almost everyone I know who is addicted was due to being over prescribed. This may not be all cases but let’s leave God to judgement​. God bless

    • I can see that “Alli” is Not chronic pain patient. If this person was, they would know that someone with chronic pain has typically tried most everything available to them, including PT, Herbal treatment, etc. And No, chronic pain doesn’t have a “Cure”. I don’t care what diet changes or lifestyle changes one makes, it will not cure chronic pain! When someone’s spine is damaged and it continues to degenerate, there is no stopping it. It will continue degeneration and continue to cause that person pain. Not even surgery will stop the process of this. Please do some research before you tell someone they can “cure” their pain, or chronic painful conditions / diseases.
      Most chronic pain patients use opioids as a last resort, because all other forms of treatment have failed to help them. Opioids have been around for thousands of years and have helped people with their pain. It’s only when one has lack of self control when Opioids become a negative in their life. Opioid Misuse, (mixing medicine and/or alcohol), and Abuse, (using it to get a “high” or for emotional distress), is what causes overdoses and death. Less than 2% of chronic pain patients who use Opioids routinely and responsibly, do not overdose or die. Of the 2% who do, alcohol is usually the factor in the deaths or overdoses.
      No one is immune to pain. No one knows their future. At any given moment in one’s life, anything can change. One could be diagnosed with cancer, or any other painful disease or have some type of accident which causes permanent injury. Then wind up developing chronic pain. Think about this before you judge and stigmatize others and before you tell them how to deal with “Their Pain”. Like I said, no one is immune… It could be you, a parent, brother, sister, aunt, uncle, spouse, or even your child that develops chronic pain that they have to live with each and every day of their lives.
      Would you want some relief from your pain and not be stigmatized? Would you want your family members to get pain relief and not be judged?
      For anyone who reads this… Please think about this before you jump to the conclusion that all opioids are bad. There is a difference between use, misuse and abuse. There is also a difference between someone who really needs Opioids for legitimate use and someone who misuses / abuses them for the side effects they can cause.

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