Understanding how the misuse of Opioid prescriptions became a public health crisis
Abstract –
During the 90s pharmaceutical companies advertised that opioid, used for pain relief, was not addictive. This led to more doctors giving out prescriptions and this led to the consumers becoming addicted. Opioids were highly addictive, and this led to a cycle of abuse and soon deaths. Just in 2019, seventy percent of overdose deaths were the result of opioids. Whole towns in the Midwest were reported to be addicted and overdose death is still on the rise. This was the result of false advertising and unnaturally greedy actions taken by corporations. The health crisis led to billions of dollars in damages that do not include human lives. This problem started from somewhere, it was in the making ever since the government deregulated restrictions around medical drugs. To prevent future abuse of the consumer, the standards of medicine and advertising for health must be investigated and changed.
Introduction –
Everyone knows about the usual narcotics and how it is a bane to society. Reagan during the late 80s decided to wage a war on drugs and draconian punishments were put in place for drug abuse. Political messaging determined that Latin America, where the drug lords resided, was public enemy number one. Yet underneath the surface just a couple of years later our own medical companies created their highly addictive opioid to sell for profit. During the moments of distractions, pharmaceutical companies became disguised drug lords.
The opioid crisis became so widespread that Naloxone, an overdose-reversing drug, was the most common tool for firefighters in some communities. The aging population of the United States along with the various obesity problems saw an increase in pain relief medication. What came after the initial addiction to opioids led to many going towards the black market. Drug traffickers promptly arrived on the scene by introducing more heroin and fentanyl. In a way, opioids became the new gateway drug for America.
Normally, opioids are extremely effective at pain relief and when used in small doses the patient usually walks away fully recovered. The problem arises when companies such as Purdue Pharma releases opioids for mass profit. As a matter of fact, during the early 90s, there was opioid phobia among the medical community because it was thought that opioids were extremely addictive. However, that changed when the medical consensus on pain treatment took a complete flip, and treating pain became a priority. Normally opioids are used to ease pain in end-of-life situations such as stage four cancer, but pharmaceutical companies pushed opioids to be used for all types of pain. This sort of marketing surged the number of prescriptions in the country with around 250 million prescriptions each year. In the past decade, over half a million people died from overdoes with millions more addicted and falling into heroin use because of opioids. How do we prevent such deaths and medical oversight from happening before it is too late?
Material and Method –
I read articles extensively on the marketing techniques of pharmaceutical companies especially Insys Therapeutics. Many of these articles came to the same conclusion that there was evidence of false advertising. Documentaries I watched interviewed former workers and those associated with big Pharma. Who admitted to bribery and that it was about the profit margins.
There were documents of bribery with corporations paying doctors to prescribe their products. This is all correlated with an increase in opioid prescriptions and overdose deaths. Data can be seen through charts and graphs. These charts originate from government sources or scholarly articles.
Result –
From 2006 to 2016, there were at least 200 thousand opioid prescriptions per year. This only started to trend down after the media reported on the damage it causes. The number of opioids prescribed was enough for every person to have a bottle of pills with a bit more. (Opioid prescriptions per person do not account for how many pills or the titration of the pills).
Source: CDC, “Total number and rate of opioid prescriptions dispensed, United States, 2006–2019.” Center for Disease Control and Prevention, 7 December 2020, https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html
The huge number of prescriptions resulted in increased death from any opioids year after year. The opioid addiction led many to try heroin because it was cheaper than opioids. Seventy-five percent of all heroin users started from opioids (Oliver, 2016). With the decrease of prescriptions from 2017 to 2019, the rate of overdose-related deaths should have decreased, but instead it increased. The number of deaths from synthetic opioids increased because people opted for illegal opioids smuggled over from other countries. This trend spiked at the start of the Corona Virus with an overall increase of 33 percent across the United States. Opioids were being used to not only satisfy the addiction but also as a means of escaping the loneliness and the darkness of the Covid world.
Source: CDC, “Three Waves of the Rise in Opioid Overdose Deaths”, Center for Disease Control and Prevention, 17 March 2021, https://www.cdc.gov/drugoverdose/epidemic/index.html
Source: Jesse C. Baumgartner and David C. Radley, “The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward,” To the Point (blog), Mar. 25, 2021. https://doi.org/10.26099/gyf5-3z49
This process all started from criminal actions to generate profit. Insys CEO and founder John Kapoor initially founded the company for 80 million dollars. The company’s main product was Subsys, a nasal spray that relieves pain. It was classified as an opioid and was used to treat pain in cancer patients. This was a specialty product and barely generated any profit with a few prescriptions per week from doctors. Kapoor wanted to expand the prescriptions to all types of pain to increase sales. Kapoor hired Alec Burlakoff as vice president of sales and encouraged devious ideas. Burlakoff hired people with little conscience and allowed the sales representatives to have affairs with doctors along with vacations in a private jet. Insys hired doctors to attend and perform at speak programs. These speak programs were used to promote Subsys, and the doctors were expected to produce a profit to the company by increasing prescriptions. In essence, Insys was bribing doctors to prescribe Subsys even when the product was only approved for cancer patients (Jennings, 2020).
In 2010, PPSA (Physician Payments Sunshine Act) allowed the public to view payments given to doctors from drug companies. Just in New York, there were 3.5 million dollars given to doctors by pharmaceutical companies that were opioid related. Most of the payments were disguised as purchases for food and beverages. This tactic hid the fact that the companies were outright bribing doctors with cash.
Source: NYS Health Foundation, “Payments Made to Physicians in New York State by Drug Manufacturers, August 2013-December 2015,” NYS Health Foundation, June 2018. https://nyshealthfoundation.org/wp-content/uploads/2018/06/following-the-money-pharmaceutical-payments-opioid-prescribing-june-2018.pdf
Source: NYS Health Foundation, “Distribution of Opioid-Related Payments by Payment type, August 2013-December 2015,” NYS Health Foundation, June 2018. https://nyshealthfoundation.org/wp-content/uploads/2018/06/following-the-money-pharmaceutical-payments-opioid-prescribing-june-2018.pdf
Furthermore, there is a relationship between payments received by doctors to the number of opioids prescribed. The more opioids prescribed the more the doctors receive. Along with this trend, there is a major division of the 3.5 million dollars. One percent of the doctors received 80 percent of the said 3.5 million dollars. This meant that these drug companies relied on a select few doctors to boost the company’s revenues.
Source: NYS Health Foundation, “Average Expenditures for Opioid Claims for Subgroups of Physicians Based on How much They Received in Opioid-Related Payments, August 2013-December 2015,” NYS Health Foundation, June 2018. https://nyshealthfoundation.org/wp-content/uploads/2018/06/following-the-money-pharmaceutical-payments-opioid-prescribing-june-2018.pdf
While Pharmaceutical companies like Insys bribed doctors to prescribe opioids, Walmart and other retail companies with pharmacies were selling opioids in masse. Pharmacists working at Walmart warned about red flags regarding the people lining up to buy opioids. There were lines of people that have driven far to get these drugs, and Walmart crushed any of these warnings from their physicians. They threatened their pharmacists with their careers warning them not to tell the police or the DEA. Pharmacists working in chain pharmacies had no reason to say no because bonuses were given depending on sales. The graph below only shows the amount from 2006 to 2012 other years are not available. This was before when the opioid crisis bloomed in 2012 (Mann, 2021).
Discussion –
The Opioid crisis stemmed from a long line of events. It might be a shock, but it can be traced back to the DEA who “increased US production of opioids by 10-fold for fentanyl, 4-fold for hydrocodone, and 4.5-fold for hydromorphone. By 2007, it had just begun to establish quotas for OxyContin.” Later President Obama signed the Marino Act which weakened the DEA’s activities against companies who supplied corrupt doctors. The FDA approved multitudes of opioids: Oxycontin, Zohydro, Oxymorphone, and Tramadol. These opioids were instrumental in the current crisis (Manchikanti, 2018).
This long list of events all came from hundreds of millions of dollars lobbied to the U.S Senate. Pharmaceutical companies held unparallel influence in politics. This led to corporate greed and corruption as seen with Insys. There was also no check and balance for these prescriptions as chain pharmacies threatened their pharmacist to not dig deeply into the prescriptions. Poor science and false advertising also misleads a huge number of doctors into believing that opioids were not addictive.
When a drug is created for a certain purpose but marketed for more general use it is up to the doctor to choose if it should be prescribed. Many doctors have the integrity to not harm their patients no matter how much money was offered to them. However, results show that most of the money that drug companies gave ended up in a few doctors’ pockets. It is that small subgroup that makes most of the companies’ profits.
The evidence gathered points to the growing number of overdose deaths due to a high prescription of opioids. Yet even when prescriptions decrease the deaths still grow. This is because addicts move to new products, and it shows that many of these pills are not being used to treat pain and are being abused instead. During all this, new opioids were being approved by the FDA even against the wishes of physicians who reviewed them. New amount of doses were introduced, one larger than the previous. It is a cycle of abuse when patients could only satisfy their urge with larger doses, and eventually, they die because the new doses are lethal.
It is easy to blame corporate greed for causing the deaths of thousands of people, but it is important to recognize the very failure of the system that was designed to protect the consumer. Walmart was sued for negligence, and they turned around to say that it was the system that failed. Walmart is not wrong in that fact, but the moral conscience of companies must be in shambles to ignore warnings in pursuit of profit.
Conclusion –
From my report, I gathered that the Opioid crisis did not merely start from corporate greed. It was the negligence of consumers that allowed corporate greed to prosper. The first step in fixing this crisis is to repeal the Marino Act and allow the DEA to monitor these corporations. Enact a mass education campaign on the effects of Opioids and similar drugs. Limit the number of Opioids prescribed to only those in severe life-ending pain. There are other methods that can be used to treat pain. Use the millions of dollars sued by the corporations to rehab those affected. Limit the interactions physicians have with drug manufacturers. The moral of this plight is to prevent corruption at the very start and every corner. Fixing this crisis will take years and if any lesson is learned trusting a corporation to behave itself by not profiting is naïve.
References –
Jennings, Tom, et al., directors. Opioids, Inc. (Full Film) | FRONTLINE. YouTube, YouTube, 18 June 2020, www.youtube.com/watch?v=WvCld2vKug8.
Mann, Brian. Former Walmart Pharmacists Say Company Ignored Red Flags As OPIOID SALES BOOMED. 3 Jan. 2021, www.npr.org/2021/01/03/950870632/former-walmart-pharmacists-say-company-ignored-red-flags-as-opioid-sales-boomed.
Oliver, John, director. Opioids: Last Week Tonight with John Oliver (HBO). YouTube, YouTube, 23 Oct. 2016, www.youtube.com/watch?v=5pdPrQFjo2o&t=225s.
“U.S. Opioid Dispensing Rate Maps.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Dec. 2020, www.cdc.gov/drugoverdose/maps/rxrate-maps.html.
“Understanding the Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Mar. 2021, www.cdc.gov/drugoverdose/epidemic/index.html.
Manchikanti, Laxmaiah et al. “Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic.” Pain physician vol. 21,4 (2018): 309-326.
“Follow the Money: Pharmaceutical Manufacturer Payments and Opioid Prescribing Patterns in New York State.” NYS Health Foundation, NYS Health Foundation, June 2018, nyshealthfoundation.org/wp-content/uploads/2018/06/following-the-money-pharmaceutical-payments-opioid-prescribing-june-2018.pdf.
