AN AMERICAN OPIOID SCANDAL: HOW THE DRUG INDUSTRY FUELED THE OPIOID EPIDEMIC WITH 76 BILLION PAIN PILLS
As the opioid epidemic escalated, the broad outlines of the crisis became generally well known. Pharmaceutical companies marketed highly habit-forming drugs as non-addictive, pharmacies filled prescriptions without question, and doctors wrote excessive opioid prescriptions even for minor ailments such as a sprained ankle. Yet while the trajectory of the epidemic was clear, the full extent of the complicity shared by drug makers, drug distributors and pharmacies has not been entirely transparent—until now.
According to newly released federal data, the major players in the drug industry flooded the nation with roughly 76 billion prescription painkiller pills between 2006 and 2012, fueling an epidemic that led to 100,000 overdose fatalities during these years. This data and related documents reveal the greed and negligence of these companies—while also serving as a warning we must heed if we are to prevent another epidemic.
Pumping pills to America
The previously undisclosed Drug Enforcement Agency (DEA) data that has come to light as part of opioid-industry lawsuits reveal the unprecedented scale of the pill pushing. Enough oxycodone and hydrocodone painkillers were distributed to supply every adult and child in the country with 36 pills per year. In small towns such as Norton, Virginia, the equivalent of 306 pills for each of the 3,900 residents were distributed. As fast as opioid manufacturers produced the pills, pharmacies obligingly handed them out: At one point, a Walgreens in Port Richey, Florida—with a population of only 2,831 residents—was ordering 3,271 bottles of oxycodone each month (or nearly one bottle of painkiller pills per person.)
The system fails, and death rates spiral
Not surprisingly, the death rates from opioids soared in areas saturated with those billions of pills. An analysis by the Washington Post—which, along with the Charlotte Post-Gazette in West Virginia fought to release the DEA data against drug company objections—found that the most fatalities occurred in rural communities in West Virginia, Kentucky and Virginia. But despite the spike in opioid-related deaths, the drug makers, distributors and pharmacies—including such national chains as CVS and Walgreens as well as Walmart superstores—did little to intervene. Compliance and monitoring systems required by law and designed to flag suspicious orders and prescription flows, were routinely overlooked. Company emails suggest that executive were unconcerned about the massive outflows of pills and the number of overdose deaths as they pursued greater profits.
Lawsuits target key drug industry firms
The disturbing data and documents were unsealed as part of roughly 2,000 lawsuits brought by towns and counties against more than two-dozen firms—including Purdue Pharma, which introduced OxyContin in 1990—that have since been consolidated into one case in Cleveland. Meanwhile, another lawsuit filed last month argues that the drug distributors and pharmacies are also to blame for helping move all those pills, opening a new frontline in the legal battle. (The drug companies, for their part, say the epidemic was the result of doctors overprescribing the drugs and customers abusing them.)
As assessed in previous Rosenthal Reports, the lawsuits might end in a master settlement on the same scale as the $206 billion tobacco industry agreement of 1998. Should that come to pass, I will continue to urge all parties involved in the lawsuits to guarantee sufficient funding be allocated directly to substance-abuse initiatives and drug treatment.
However, with an estimated 70,000 overdose deaths in 2018 alone—two-thirds of which were linked to opioids—we cannot rely solely on a potential legal settlement for future funding of substance abuse services. Regardless of what results from with those lawsuits, the federal government should immediately allocate $100 billion over the next decade for programs to expand education, prevention and most importantly, treatment.
Based on what we have recently learned about the inner workings of the drug industry, we must also take the following steps:
-Ensure that prescription-monitoring regimes imposed over the past few years remain in place and are strengthened, if needed. These strict, statewide controls successfully track the number of painkiller prescriptions, and alert officials to possible abuses by doctors, pharmacies and/or patients.
-Improve addiction-medicine education in medical schools, providing students with a solid grounding and practice in the field, and broader awareness of patient issues and concerns. Doctors must continue to speak openly and frankly with patients about all aspects of pain medication if they are to secure informed consent.
-Give the DEA the resources, manpower and authority to effectively enforce the rules that pertain to the manufacture, distribution and dispensing of legally produced controlled substances, such as painkillers.
As these latest revelations have helped blow the lid off the American opioid scandal and expose for the first time the depth of the drug industry’s involvement in this deadly public health crisis, it is time to bring this hideous chapter in our history to a close. With the knowledge and information available to us now, and with the proper regulations and oversight in place, we can end the current crisis and be well positioned to prevent the next.