There has been much said in the news lately about the opioid crisis. When Donald Trump made his speech last month about the issue, you’d think he discovered the problem. Well, that’s only about 180 degrees off the mark.
The opioid problem in the United States has been recognized by experts in the field for years. And it was his predecessor, President Obama, who first issued a proclamation declaring “Prescription Opioid and Heroin Epidemic Awareness Week.” Prior to that proclamation, Obama proposed a $1.1 billion funding initiative to address the issue. Now President Trump comes along, and of course with great fanfare, announces that there’s a problem. No new funding. What he did in his speech was to point the finger at Chinese drug traffickers, mention in passing increased training by the manufacturers of drugs, and going after those who illegally prescribe drugs.
These are, in all fairness, issues that should be addressed. But what is sorely lacking in the speech is any notion that the drug manufacturers themselves have had a huge role in creating and maintaining the epidemic. Interestingly, he announced an “ambitious” partnership with pharmaceutical manufacturers to develop non-addictive painkillers and new overdose treatments. But does this really reach the heart of the problem?
Here are some of the allegations concerning the role of the pharmaceutical companies in fueling the opioid epidemic:
- Aggressive marketing tactics. This includes advertising promotions directed toward physicians touting the benefits of opioid treatment options, and providing funds to non-profits (including the American Academy of Pain Management) to promote the prescribing of narcotics. At least one state has sued alleging that the drug makers pushed “off-label” use of the drugs. In that case, a drug approved for end stage cancer patients was being pushed on doctors who did not see such patients, including podiatrists.
- Lobbying. The Pain & Policy Group was paid $2.5 million to discourage passage of regulations limiting opiates in medical practice.
- FDA. The FDA regulations require approval of promotional activities for controlled substances, but prior approval is not needed to offer a product for sale on the market. As a result, the opioid drugs were marketed and sold while FDA approval was pending.
So, what does this all mean? As an example, according to the DEA, the “Big Three” (that’s the group of the three largest prescription drug makers in the Unites States) pumped enough hydrocodone and oxycodone into the state of West Virginia over a period of six years to provide 235 pills for every person (including children) who live in the state. Opioid overdoses led to 1,700 deaths in the state during that same period.
What the problem needs is a solution. One aspect is to provide money to fund the FDA, so it has enough resources to review the ads that the drug makers are using. Another is to provide funds for treatment, not just talk about it. And finally, and perhaps more importantly, to go after the drug manufacturers who really are the source of the problem. In this regard, one of the Big Three, McKesson Corporation, settled claims that it failed to report hundreds of suspicious orders which it received from online pharmacies, and which fueled an explosion of the prescription drug problem. The settlement cost McKesson $13.25 million. Since McKesson’s revenue is almost $200 billion annually, that would be like a millionaire paying about $65 to settle a fraud/death claim. Not much of an incentive, is it!
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