Purdue Pharma is rightly reviled for pushing ‘heroin in a pill’ to those who didn’t need it – but the problem is industry-wide
Few will mourn Purdue Pharma if the drug maker is buried by the flood of lawsuits over its cynical and calamitous push to sell its powerful narcotic painkiller, OxyContin, to people who didn’t need it.
The company that fired up and fuelled the opioid epidemic now claiming around 150 lives a day is considering bankruptcy in the face of hundreds of lawsuits by cities and states devastated by its creation of a “blizzard of prescriptions” to sell a drug described as “heroin in a pill”.
But it would be a mistake to pin the worst drug epidemic in US history on a single firm. As much as the rest of pharma might like to blame this colossal tragedy on one bad apple in order to obscure its own part, the failure to address the industry’s capture of medical practice and regulation will keep this epidemic rolling for years to come. Even now, the drug makers are working to undermine efforts to curb the mass prescribing underpinning this tragedy – and winning.
Purdue may have kicked open the door to a crisis officially estimated to have claimed 350,000 lives but the epidemic escalated over the past two decades because the medical industry in control of America’s healthcare system made it happen.
Once it was clear to some of the biggest drug makers what a bonanza there was in selling opioids, they used their money and lobbyists to influence medical policy and push narcotics as the default treatment for pain. The industry co-opted federal regulators, a medical establishment too often focused on the interests of doctors over patients, and indifferent and corrupted politicians more willing to listen to the word of lobbyists than physicians. Pharma kept the door wide open to prescribing even as the evidence mounted of the human devastation.
It was not alone. Hospital corporations and health insurers bought into the push to opioids because it was in their financial interests. Drug distributors, among the largest companies in the US, delivered opioid pills by the millions into the heart of the epidemic without any attempt to fulfil their legal, let alone moral, obligations to monitor and report glaring evidence that rogue pharmacies were feeding and profiting from addiction.
By 2012, doctors were writing 250m opioid prescriptions a year, enough to supply every adult for a month – greatly widening the number of people exposed to the risk of addiction and leaving the country awash in surplus drugs to feed experimentation and the underground market.
When a few doctors raised the alarm in the early 2000s, warning that opioids were more dangerous and less effective than the makers claimed – and particularly that they did not work well as long-term treatment for chronic pain – the drug industry turned on the victims. It disparaged the addicted and the dead as “abusers” even if they became hooked by following their prescriptions. The problem was the person not the pills, the drug makers claimed. It was pharma’s equivalent of the NRA slogan “Guns don’t kill people, people kill people”.
Donald Trump’s opioid commission also blamed what it called the US’s “national nightmare” on the public institutions supposed to protect Americans. Foremost was the Food and Drug Administration (FDA) which opened the door to the wide prescribing of powerful opioids in the first place and then made no real effort to close it again. The FDA, its independence increasingly compromised by its dependence on income from the pharmaceutical industry, consistently subordinated public health to the financial interests of the drug makers by permitting ever more opioids on to the market. Has the US learned the lessons?
The head of the FDA, Scott Gottlieb, has acknowledged “many past mistakes” by the agency and that it and others “missed opportunities to stem the crisis”. He promised “a much more aggressive approach” to regulation and to greatly reduce the rate of prescribing. But FDA chiefs have for years made similar pledges to put broader public health considerations foremost, including studies on whether the drugs even work for long-term treatment of chronic pain, with no real action so far. Meanwhile the agency has gone on approving new opioid painkillers to the frustration of its critics, some of them within the FDA.
Dr Raeford Brown, chair of the FDA’s committee advising the agency on whether to approve new prescription opioids believes the agency is failing to apply the lessons of its role in the epidemic.
“We’re going to revisit an opioid problem in five years and 10 years and 15 years and 25 years. We can’t just make believe that things are going to go away,” Brown told me.
Gottlieb resigned earlier this month, so it is not even clear that the commitments he made will be acted on.
One of the few institutions to come out of this crisis with credit is the Centers for Disease Control and Prevention (CDC)
The drug companies and their surrogates have, as ever, been quicker off the mark and up to their old tricks.
One of the few institutions to come out of this crisis with credit is the Centers for Disease Control and Prevention (CDC). It called the epidemic by its name in 2011. Five years later, the agency issued guidelines recommending doctors significantly scale back prescribing on the grounds that opioids are not only addictive but do not work well other than in the treatment of short-term acute pain after an injury or operation. The CDC recommended limits on both the dose and duration of prescriptions.
Now the industry and its allies are working to water down those guidelines and keep the doors of mass prescribing open. They engineered the creation of the Pain Management Inter-Agency Task Force by Congress with the power to overturn the CDC guidelines. The taskforce was packed with specialists who take consulting fees from Purdue and other drug companies, and hold positions in professional and pain management organisations funded by pharma.
So it was little surprise when the taskforce said there is no scientific basis for the CDC’s recommendations and recommended they be scrapped. This from an industry that has spent two decades pushing drugs while avoiding clinical trials and studies about whether they are effective and safe.
Why does this still matter? Without bringing down prescribing levels, and the quantity of pills dispensed with each prescription, Americans will continue to become addicted to opioid painkillers and then move on to drugs such as heroin and fentanyl to feed the torture of their habit.
And, as Dr Raeford Brown said, the epidemic will roll on.
• Chris McGreal is the author of American Overdose, The Opioid Tragedy in Three Acts