Pharmaceutical culpability for the opioid epidemic
An important question for the nation as it struggles with its opioid epidemic is whether, or to what degree, Big Pharma is behind the disaster. Were doctors too often swayed by drugmakers in prescribing painkillers needlessly? Were the drugmakers aware of the dangers of addiction but unwilling to change practices in marketing the drugs? Could more have been done to make the drugs harder to abuse?
Such questions gain even more importance now that the coastto-coast epidemic is overwhelming hospitals. According to recently released public data from the Agency for Healthcare Research and Quality, hospitals saw 1.27 million opioid-related emergency room visits or inpatient stays in 2014, the latest year for which data are available. The total is a 64 percent increase for in-room care and nearly 100 percent increase in the ER from 2005.
So count us as pleased that Colorado Attorney General Cynthia Coffman has been working with dozens of state attorneys general in a months-long investigation that intends to answer these questions. Coffman tells us that findings from the recently acknowledged investigation are soon to be released.
What to expect? “We have reason to believe that there are some opioid manufacturers who chose not to see the dangers of over-prescribing,” Coffman tells us.
A little history helps in considering the investigation by the attorneys general. Starting in the mid-1970s, as Percocet and Vicodin started showing up in the medicine cabinet, doctors were being told the drugs could work wonders in managing pain. In 1980, a New England Journal of Medicine report stated that addiction shouldn’t be of concern. In the ’80s, pain-management specialists like Russell Portenoy were telling doctors and patients that opioid painkillers were safe and a more humane alternative to surgery.
In the ’90s, Purdue Pharma’s OxyContin debuted. Doctors started talking about doing a better job of treating pain. Purdue created a video promotion sent to doctors’ offices that showcased patients who had reclaimed their lives from chronic pain, and an expert in the videos claimed the drugs came without serious side effects.
Sales of the painkillers mushroomed, and during the first years of this century, pain management through opioid prescriptions became the expectation.
In 2011, Portenoy and others began reversing their recommendations as addictions to opioids, either prescription drugs or illegals like heroin, began to rise.
“Clearly,” Portenoy said, “if I had an inkling of what I know now then, I wouldn’t have spoken in the way that I spoke. It was clearly the wrong thing to do.”
But it wasn’t until last year that the Centers for Disease Control and Prevention issued guidelines for prescribing the drugs to alert doctors. The U.S. Food and Drug Administration ordered oxycodone and fentanyl carry warnings about addiction.
Yes, there should be the expectation of personal accountability. Abusing prescription medications or turning to the illegal drug trade to feed an addiction are irresponsible acts. But given that we’re talking about highly addictive substances in the first place, the AGs are easily within their right to question whether prescription drugmakers were cynical in promoting their medicines.
We’ll have to wait to review the findings to know exactly how to respond. But, as with investigations that revealed corrupt practices in cigarette sales, it’s certainly reasonable to think that drugmakers should be on the hook to help cover the societal damage this epidemic has created.