At 21 years of age, Lil Peep had not grown old enough to truly understand himself. The late teens and early 20’s are a time of confusion wrapped in a cloak of naïve confidence. At that age, you live in the moment for better or worse, and you own that mindset with unwavering conviction. Part of living in the moment includes having a good ass time. For some, that good time comes with drugs and alcohol. Usually, a little weed, a few cans of cheap beer, or maybe an even cheaper bottle of liquor was the recipe for a turn-up. Somewhere along the line party favors got harsher and the lines got blurred between partying and addiction.

In 2017, the community of Hip-Hop has seen prescription drug usage spread like wild-fire with pills and promethazine becoming staples in the content of popular artists. If 2015 and 2016 saw a rise in the popularity of prescription drugs, 2017 is when those drugs became staples in the culture. It was hard to hear a song or watch a music video that didn’t include prescription drugs. Critics have been quick to blame artists for popularizing the use of prescription drugs, but it’s time for a deeper look at what’s really happening.

It’s Not Hip-Hop, It’s America

The increased prescription drug usage we see in Hip-Hop is not an epidemic specific to the genre, but a microcosm of an epidemic sweeping the United States. Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others. Let’s start with the widespread use of the coveted purple drank, otherwise known as codeine. In 2011, the most recent year for which data is available, codeine (in all forms) was the reported cause of 11,000 U.S. emergency room visits.

By 2013, the U.S. government’s National Institute on Drug Abuse said promethazine codeine cough syrup had become “increasingly popular among youth in several areas of the country.” By 2016, opioid overdoses killed about 64,000 people, taking more lives than guns and car accidents, while causing death at a faster pace than the HIV epidemic at its peak. That same year, a national study revealed that deaths involving synthetic opioids jumped by 540% in just three years.

While doctors must take a Hippocratic Oath promising to “first, do no harm,” the health and pharmaceutical industries are still businesses at the end of the day. According to a CNN report from 2016, America’s prescription drug trade is a $24 billion industry with roughly 80% of the global opioid supply consumed in our country alone. Roughly 250 million prescriptions are being dispensed by doctors every year. It’s common knowledge that opioids are harmfully addictive, so why are doctors prescribing them and why are people opting for medication that can cause harm in the long-run?

In a time of economic strain, opioids have become the cheapest option through most leading insurance companies. According to Christopher M. Jones, a senior policy official for The Department of Health and Human Services, insurance companies are placing fewer restrictions on opioids than less addictive, non-opioid medications, and non-drug treatments like physical therapy. As insurers leave patients with little to no alternative for opioids, there are some doctors who tend to prescribe drugs depending on the payments they receive from pharmaceutical companies.

In 2014, ProPublica matched payment records from pharmaceutical and medical device makers, with data on doctors’ medication choices. Typically, these payments are made for consulting services in which physicians are paid by pharmaceutical companies to convince colleagues that specific medications are more effective, and should be prescribed more. The doctors who received money from pharmaceutical companies did indeed prescribe more brand-name drugs than those who didn’t receive money. In cardiology alone, 90% of doctors who wrote at least 1,000 prescriptions for Medicare patients, received payments from drug or medical device companies in 2014. ProPublica’s research doesn’t prove that payments sway doctors to prescribe specific drugs, but it most certainly shows that payments are a part of the approach to benefiting drug companies’ profit.

According to a recent study conducted by researchers at the University of Arkansas for Medical Sciences, 20% of patients who receive an initial 10-day prescription for opioids will still be using the drugs after a year. Long-term opioid use is associated with addiction. If nearly 250 million opioid prescriptions are being dispensed by doctors yearly, we can assume that 20% kept using them. That’s 50 million people who are addicted to opioids. Now, three years later we have leading insurance companies making these same addictive drugs, the cheapest option for their patients. Most opioids are prescribed to folks age 50+, but as they continue to be manufactured and prescribed in excess, the potential for them to fall into the wrong hands for recreational use and illegal sale has increased. That, my friends, is how an epidemic occurs.

Mental Illness, Self-Medication and Normalization of Recreational Use

The American Psychological Association says that today’s young adult (18-33) suffers from higher levels of stress than any other living generation. This is due to facing an oversaturated workforce, economic strain, and overuse of technology. Jean Twenge, PhD, the first to truly examine the wealth of data that exists on generational studies, said that “today’s young people face a competitive workplace and the economic squeeze created by sky-high housing prices and rapidly accelerating healthcare costs.” After a childhood pumped full of optimism, we millennials are working harder to get less in an economy that does not provide the same opportunity as it did in the 90’s and early 2000’s.

Simply put, late 80’s and early 90’s children were prepped for an adulthood that is no longer the reality in America. Under the pressure of student loans and strained job markets, our options for starting families, saving money, and home-buying have been delayed. That delay clashes with self-expectations built around the ideals of success bestowed on us by parents and teachers, based on an economy that at the time was thriving with resources and opportunity.

Millennials rank first in America as 63% of the population that feels like they are always attached to their phone or tablet. Consequently, 36% of millennials say that social media has helped them find their identity. Additionally, 45% of Millennials report that because of technology, they feel disconnected from their family even while they’re together. The combination of not meeting self-expectations, coupled with the tendency to define identity and compare progress with others on social media, and the disconnect from loved ones, has created a mental illness cocktail full of stress, anxiety, and in some cases, ultimately depression.

Maybe that’s why, according to the American Society of Anesthesiologists, nearly 30 percent of millennials thought it was OK to take an opioid without a prescription. Drugs like Xanax, Percocet, and Promethazine have become the drug of choice for recreational use. How do prescription drug use and addiction become normalized? Well, when you have an entire generation of young adults suffering from depression and anxiety, combined with a pharmaceutical industry making opioids the easy option for treatment, you end up with a bunch of 18-33 year olds primed for self-medication.

The Cross-Over To Hip-Hop

Most current popular artists are Millennials. They are from the same demographic that suffers from mental illness. On top of that, artists live uniquely intense lives. They don’t sleep enough, they travel too often, and mentally they are constantly straining themselves to create at the highest level. They’re success depends on relevance, so they consume themselves in social media just as much as your average joe, if not more. It’s actually not surprising that many artists are prescribed painkillers, sleeping pills, and medication for anxiety and stress.

However, there are also plenty of artists who take those drugs and convert them into unauthorized recreational use as part of that 30% of millennials who think it’s ok to take opioids without prescriptions. Either way, artists reflect their experiences in their music. As a result, prescription drugs appear regularly in videos and photo shoots, translating to the audience that these drugs are symbols of a good time, that they are normal. Impressionable fans then indulge in the usage of drugs that can become addictive, in attempts to mimic what they see on their screens. While artists like Future, Wayne, etc. may very well need the prescription drugs they take, the 18-year old kid mimicking them doesn’t, but he’ll still find them in his parent’s drug cabinet because chances are, mom and dad are part of the 250 million patients prescribed opioids yearly.

What we have is a domino effect, resulting in the false conclusion that Hip-Hop is experiencing its own opioid epidemic. Contrarily, Hip-Hop has become the voice and aesthetic to the America’s pop cultural identity. Its content is as much a reflection of generational life and times, as it is an influence. That reflection is filled with the combination of the mental health issues of today’s youth, an opioid epidemic sweeping America. Hip-Hop might be guilty of normalizing prescription drug abuse commercially, but it damn sure isn’t the birthplace of the problem.