OpEd
It began with two bedsides—two human beings at life’s edge. One was a young man, gone at age 32, found cold in his bed after fentanyl took its final measure. The other was an older woman in a nursing home, her hands folded neatly under a blanket, her voice stilled by antipsychotics she didn’t need.
We label one “the opioid epidemic,” the other “overuse of psychotropics in long-term care.” We speak of them as separate policy problems, separate moral failures. But they are not separate. They are two faces of the same crisis. Both grew from a system that finds it easier and more profitable to drug people than to care for them. When suffering becomes a management problem, medication becomes the solution. The young man’s despair became a prescription. The older woman’s confusion became a chemical restraint. Both lives were pulled into the same logic of efficiency and control. One was destroyed quickly, the other slowly—but both were transformed into revenue streams.
The opioid crisis was not born in the street, but in the boardroom. Purdue Pharma’s marketing of OxyContin in the 1990s reframed pain as a moral emergency and its relief as a corporate product. Between 1999 and 2023, 806,000 people died from opioid overdose. This is the medicalization of distress, the conversion of human pain into a marketable commodity. Once suffering is redefined as pathology, it enters a system that promises relief but is driven by profit. The language of medicine conceals this transformation. We no longer speak of loneliness, grief, poverty or neglect. We speak of “depression,” “noncompliance,” “agitation.” Each word carries a billing code.
Yet the same logic that fueled that epidemic—turning suffering into a managed commodity—now governs our eldercare system.
Walk through a typical American nursing home, and you’ll see the signs of chemical control everywhere: half-closed eyes, bodies heavy with sedation, the dull quiet that administrators call “stability.” Antipsychotic drugs meant for schizophrenia are now used as behavioral tools for people with dementia.
We need to rebuild our care system from the ground up.
Studies show these medications increase the risk of death, yet they remain the industry’s silent workforce multiplier. A nurse with too many residents to attend to can calm a room with a single pill. The resemblance between these two crises is structural. Both rely upon reframing human need as medical disorder, both extract profit from the illusion of relief, and both depend upon regulatory complicity that mistakes sedation for care. In both cases, the product, whether OxyContin or Risperdal, becomes the substitute for human presence. We have redefined the purpose of care itself. The goal is no longer healing or accompaniment, but containment.
Those who benefit are not the caregivers but the intermediaries: the distributors, the management companies, the private equity firms that buy up struggling facilities, squeeze labor costs, and recode human distress into billable minutes. The “care economy” has become a chain of extractions—each link taking a percentage of the suffering below it.
We are told this is efficiency. We are told this is progress. But what kind of progress ends with a generation sedated into silence and another buried in addiction? This is not a failure of individual morality or even of regulation. It is the moral economy of a system that has replaced compassion with cost control, attention with throughput, and meaning with metrics. Both the opioid victim and the nursing home resident were made invisible. The young man’s death was written off as personal tragedy, the older woman’s muteness as the natural course of decline. In truth, each was a casualty of the same machinery that measures success by the quiet it produces. We do not tolerate pain; we monetize it. We do not honor aging; we medicalize it.
The true scandal is not that some people died, but that their deaths made sense to the system—that every pill, every claim, every sedation order fit neatly into a ledger somewhere. The young man’s overdose and the older woman’s chemical restraint were not aberrations. They were outcomes. Predictable, priced, and paid for. If you trace the line from the opioid crisis to the antipsychotic epidemic, you will find the same fingerprints: corporate capture, regulatory inertia, and a culture that equates care with control. These are not parallel stories but one long narrative of commodified suffering. It is America’s mirror, and we are reflected in both faces.
The way forward is not another task force or another set of guidelines. It is not more training on “appropriate prescribing” or better monitoring of pill counts. These are the solutions of a system trying to reform itself without confronting what it has become. Real change requires something more fundamental: a rejection of the premise that human suffering is a problem to be managed rather than a reality to be met with presence.
This means rebuilding care from the ground up—not as an industry, but as a practice. It means facilities staffed well enough that a confused resident can be walked down a hallway instead of sedated into a chair. It means pain management that begins with listening, not dispensing. It means a healthcare system accountable not to shareholders but to the people it claims to serve.
Above all, it means recognizing that the opioid crisis and the chemical restraint of elders are not separate tragedies to be mourned in turn, but a single, ongoing choice we make every time we value efficiency over dignity, profit over presence, silence over the messy, irreducible fact of human need. The two faces of this crisis ask us the same question: What are we willing to become to avoid the vulnerability of truly caring for one another?
Until we answer that honestly, the prescriptions will keep flowing, the deaths will keep mounting, and we will continue to mistake the quiet we have purchased for the peace we have lost.
James Lomastro, PhD, has more than 40 years’ experience as a senior administrator in healthcare, human services, behavioral health, and home- and community-based services. For 20 years, he was a surveyor at the Commission on Accreditation of Rehabilitation Facilities throughout the United States and Canada. Lomastro chairs the Veterans Services Work Group at Dignity Alliance Massachusetts. The author’s career began with the DEC PDP-1145 interactive computer, then evolved to teaching distributed data processing, to installing information systems, and later to integrating information technologies into operations and strategic directions.
Photo credit: Shutterstock/koldo_studio
