The Government-Driven Opioid EpidemicJanuary 2018
By Jon Vanzile
America has been trapped in a losing drug war for decades, despite having spent over $1 trillion combatting it.1
Experts say the availability, addictive nature, and potency of opioid drugs has led to the worst narcotic crisis in American history—one that has killed hundreds of thousands of people and destroyed lives, businesses, and families.2
Its victims range from the chronically poor in small-town Appalachia to middle-aged suburban moms, to a host of celebrities including the musician Prince and the actor Philip Seymour Hoffman.
Whether people are getting their fix from cheap heroin/fentanyl smuggled from other countries or through prescription drugs like OxyContin®, the results are too often the same: broken families, shattered lives, addiction, and death.
How did we get here? How did we end up in a place where, on a single day in early 2017, authorities in Louisville, Kentucky, responded to 43 overdoses in a 24-hour period? Where 50 overdoses were recorded in a 24-hour period in Philadelphia in late 2016?3 The answer is depressing, but not surprising.
The seeds of the opioid crisis were sown by FDA collusion with a pharmaceutical industry that subordinated humanity in exchange for the massive profits garnered by addicting millions of Americans to their opioid-based drugs.
Opioids go Mainstream
Not too long ago, opioids were relatively uncommon, both in the illicit drug trade and in the treatment of chronic pain.
Medically, they were mostly used to control cancer pain or trauma.4,5
As street drugs, opioids were long ago overshadowed by cocaine and crack, and then later by methamphetamines. Heroin, the most common street opioid, was heavily stigmatized.
That began to change in 1995, when a pharmaceutical company called Purdue Pharma was able to lay the groundwork for today’s epidemic, as a result of inefficient, inept oversight by the federal government.
That year, the Food and Drug Administration (FDA) approved oxycodone for chronic pain. Oxycodone, sold under its trade name OxyContin®, was a semi-synthetic, time-released opioid, similar in structure and function to heroin and other opioids.
From the moment it was approved, OxyContin® was backed up by an unprecedented, aggressive, and poorly regulated marketing campaign.
First, Purdue Pharma targeted busy primary-care physicians because they were less likely to be trained in safe pain management, and had little time to manage complex pain cases.
Purdue also trained their sights on doctors who already prescribed the most opioids and saw the most chronic pain patients.
Next, they expanded the range of conditions, thereby selling doctors on the idea that it was an acceptable solution for virtually any type of pain. Finally, they made the false claim that the drug was less addictive than other opioids because it was offered in a time-release capsule.6
The campaign worked. Sales of the blockbuster painkiller skyrocketed from $48 million in 1996 to $1.1 billion in 2000.6 By 2003, nearly half of OxyContin® prescriptions were written by primary-care physicians.6 One year later, it became the most widely abused opiate in the United States.6,7
Eventually, Purdue Pharma’s tactics came back to haunt it. In 2007, the company and three executives pleaded guilty to criminal charges. According to prosecutors, Purdue Pharma had intentionally lied about the addictive risk of OxyContin®. The company was slapped with $634 million in fines.6,8 These executives responsible were not sentenced to serve any jail time.9
The convictions did little to stop the flow of powerful opioids into American communities. By 2015, Purdue Pharma was pulling in $2.4 billion annually from the sale of opioids, including OxyContin®.10
Today, synthetic opioids like fentanyl—which are much more powerful than pure heroin—are tearing through American communities.11 According to the CDC, the death rate from synthetic opioids increased by 72.2% in a single year, from 2014 to 2015.12
Fentanyl is the drug that killed the pop star Prince.13
Corruption in the Open
When it comes to the current opioid epidemic, no one is taking responsibility for flooding towns and cities with powerfully addictive drugs.
Based on the hard facts that began 23 years ago, the opioid epidemic is a crisis of greed as much as addiction. And the pharmaceutical industry has found a willing partner in Congress to help protect the annual $9 billion trade in FDA-approved opioid drugs.
Here’s what Joseph Rannazzisi, the former head of the Drug Enforcement Agency’s office responsible for preventing prescription medicine abuse, told The Guardian about the relationship between the opioid lobby and the government:
“Congress would rather listen to people who had a profit motive rather than a public health and safety motive. As long as the industry has this stranglehold through lobbyists, nothing’s going to change.”14
Rannazzisi was specifically talking about a 2016 federal law called the Ensuring Patient Access and Effective Drug Enforcement Act.
Despite its benign name, Rannazzisi charged that this law effectively gutted the DEA’s ability to regulate the dumping of opioids into disadvantaged communities.
According to this law, the DEA has to issue a warning to clinics and distributors who are suspected of diverting opioids into the illicit drug market.15 All this does is give the distributors a chance to redirect their flow of drugs through new channels, with no accountability.
“This was a gift to the industry,” he said.
This “gift” hasn’t stopped states from trying to stem the flow of opioids into their communities. In 2017, Mississippi, Missouri, and Ohio sued multiple pharmaceutical companies, alleging that the companies downplayed the dangers of opioids while engaging in deceptive marketing.16,17 Other states followed.
In filing these lawsuits, the states are running up against an entrenched and incredibly powerful lobby.
A 2016 joint investigation between the Center for Public Integrity and the Associated Press found that the pharmaceutical lobby spent $880 million over a 10-year period to roll back laws that make it harder to overprescribe opioids, limit distribution, and hold irresponsible manufacturers and distributors accountable.18
Overall, the industry is active in all 50 states and contributed to about 7,100 candidates for state-level offices. It operates through organizations like the Pain Care Forum and International Pain Foundation.10,18
Tragically, parents and activists are no match for this lobby—and few people have tried harder to inject some sense into opioid laws than a mother from New Mexico named Jennifer Weiss-Burke. Her son Cameron died of a heroin overdose just before his 19th birthday in a story that has become too familiar.10
Cameron first used opioids when they were prescribed at a hospital when he was 16, after he broke his collarbone in wrestling practice. He was sent home with a prescription for Percocet®, with enough pills to last for weeks.
Like many people who use opioids, even for a short period, Cameron developed an increased tolerance. As his body continued to rapidly adjust to the drug, he developed a dependency.19 At this point, he couldn’t quit using opioids without suffering from physical withdrawal symptoms, which may include hallucinations, diarrhea, vomiting, fever, shakes, paranoia, and other painful symptoms.20,21 Soon after this, despite having been an excellent student, he became addicted to heroin, and he and his family spent the next two-plus years seeking treatment and trying to battle his addiction.
After Cameron’s death, his mother started a grassroots campaign to pressure the New Mexico state legislature into passing a bill that would limit initial prescriptions of opioids for acute pain to seven days. The idea was to limit non-chronic patients’ exposure to opioids to reduce the risk of tolerance and dependency.
But the pharmaceutical lobby wasn’t going to let this happen. While Jennifer Weiss-Burke publicly lobbied state legislators and appeared in local media, lobbyists representing drug companies began a stealth campaign to undermine her bill.
“They were going individually, talking to senators and representatives one-on-one,”10 she told the Center for Public Integrity.
Ultimately, the bill died in committee, joining failed bills in a host of other states. The common thread in each case? Intense, behind-the-scenes industry lobbying through groups like the Pain Care Forum or even patient advocacy organizations including the American Cancer Society’s lobbying arm.
The result is a virtually unchecked flow of powerful opioids and continued carnage among patients and victims of addiction.
America is in the middle of an addiction crisis.
The epidemic is fueled by opioids like OxyContin® (including generic oxycodone versions approved by the FDA), along with imported heroin and fentanyl.
The easy availability of these drugs is no accident. Makers of these powerful opioids convinced government regulators that these oxycodone (synthetic heroin) drugs had a lower potential for abuse.
These dangerous/addictive medications were approved by the FDA on that basis. The drug companies then embarked on an unprecedented marketing campaign to identify doctors who would prescribe opioids and expand the list of conditions for which opioids are prescribed.
The human cost of this government/industry campaign has been devastating: almost 100 people die every day from opioid overdose, and thousands more suffer from broken families, destroyed careers, and shattered health.
In the face of this devastation, grass-roots campaigns—largely driven by grieving parents—have sprung up to push for common-sense laws at the state and federal level to regulate the prescribing and distribution of opioids.
These campaigns have proven no match for the pharmaceutical lobby, which has spent roughly $880 million over the past decade to squash any law regulating the industry.
A long book could be written about the startling nuances of how opioids have made such a dreadful comeback in the form of powerful addicting drugs that are prescribed by physicians.
This crisis has its genesis in the FDA approving OxyContin® in 1995, which enabled pharmaceutical companies to promote a range of oxycodone drugs as less prone to addiction and abuse.
As soaring overdose deaths made headline news, the FDA has taken steps to reduce oxycodone availability. That has caused addicts to switch to heroin and fentanyl, which are more lethal because potency varies so widely.
- Available at: http://www.rollingstone.com/politics/news/why-america-cant-quit-the-drug-war-20160505. Accessed October 23, 2017.
- Available at: https://www.nytimes.com/2017/01/06/us/opioid-crisis-epidemic.html. Accessed September 29, 2017.
- Available at: https://www.usatoday.com/story/news/nation-now/2017/02/10/heroin-epidemic-overdoses/97745102/. Accessed September 29, 2017.
- Meldrum ML. The Ongoing Opioid Prescription Epidemic: Historical Context. Am J Public Health. 2016;106(8):1365-6.
- Fields HL. The doctor’s dilemma: opiate analgesics and chronic pain. Neuron. 2011;69(4):591-4.
- Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009;99(2):221-7.
- Cicero TJ, Inciardi JA, Munoz A. Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002-2004. J Pain. 2005;6(10):662-72.
- Available at: https://www.cnbc.com/id/18591525. Accessed September 29, 2017.
- Available at: https://www.nytimes.com/2007/07/21/business/21pharma.html. Accessed October 11, 2017.
- Available at: https://www.publicintegrity.org/2016/09/18/20200/politics-pain-drugmakers-fought-state-opioid-limits-amid-crisis. Accessed September 29, 2017.
- Available at: http://www.cnn.com/2016/05/10/health/fentanyl-opioid-explainer/index.html. Accessed September 29, 2017.
- Available at: https://www.cdc.gov/drugoverdose/data/fentanyl.html. Accessed September 29, 2017.
- Available at: http://www.cnn.com/2017/04/17/health/prince-death-investigation-documents/index.html. Accessed September 29, 2017.
- Available at: http://www.theguardian.com/us-news/2016/oct/31/opio
- Available at: https://www.congress.gov/bill/114th-congress/senate-bill/483/text. Accessed October 2, 2017.
- Available at: http://www.npr.org/sections/thetwo-way/2017/05/31/530929307/ohio-sues-5-major-drug-companies-for-fueling-opioid-epidemic. Accessed October 2, 2017.
- Available at: https://www.cbsnews.com/news/opioid-crisis-missouri-attorney-general-josh-hawley-sues-pharmaceutical-companies/. Accessed October 2, 2017.
- Available at: https://www.publicintegrity.org/2016/09/18/20203/pharma-lobbying-held-deep-influence-over-opioids-policies. Accessed October 2, 2017.
- Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20.
- Available at: https://www.drugs.com/sfx/percocet-side-effects.html. Accessed October 2, 2017.
- Available at: https://www.si.com/more-sports/2015/06/18/special-report-painkillers-young-athletes-heroin-addicts. Accessed October 11, 2017.