The Opioid Epidemic: Should We Be Surprised?

The current opioid epidemic in the United States has been officially recognized by the government as a health crisis. President Trump has declared over a week ago that it is a “health emergency.” Opioids act through receptors present in the spinal cord and brain. This allows them to act as painkillers. In those who don’t suffer from pain opioids will instead make them feel relaxed and elated. Some people can have a hard time distinguishing between opiates and opioids. Opiates are mostly natural extracts such as morphine and heroin while opioids are drugs made synthetically in labs of pharmaceutical companies. There’s no way to acquire them if pharmaceutical companies stopped making them basically. The U.S is now looking to combat this epidemic that has cost over 60,000 Americans their lives over the past year alone. The committee president Trump formed will require congress to increase the money in the public health emergency fund which currently only has 57,000$ and hasn’t received additional funds in years. The important question is: what can be done to stop this epidemic? Who is to blame? Some think doctors are prescribing painkillers too much and unnecessarily while others believe that pharmaceutical companies are the ones to blame.

If you still don’t see how serious this epidemic is just take a look at some of the numbers. Over 2 million Americans are addicted to opioids while over 60,000 have died due to overdose over the past year which is twice the number of those dead from motor vehicle accidents. Since the year 2,000 over half a million Americans have died from overdose. These are scary numbers to think that so many people are addicted and dying from painkillers. Just think that someone you love might be at risk. It’s certainly not to be taken lightly and needs to be dealt with as soon as possible.

If we were looking for someone or something to blame then our fingers would probably point to pharmaceutical companies first. In the 1990s doctors only used strong painkillers such as opioids as a last resort if all else failed. This was because they knew how addictive these drugs were and their dangers. Now as a pharmaceutical company you’re looking to sell your product and you’re going to use everything you can to make that happen. Unfortunately some relied on illegitimate ways such as lying to physicians and the public. One of these companies started advertising its drug by saying that it’s nonaddictive and suitable for any kind of pain. In the absence of studies that proved otherwise doctors started to prescribe this drug more often. It also makes sense that patients started asking for it too. Why wouldn’t they want a drug that can take away their pain especially if that drug is safe and won’t make them addicted? That company made about 3 billion dollars selling their drug by 2010, later on it was discovered that they mislead the public and physicians and that the drug is actually addictive. They ended up paying over half a billion dollars in penalties. That still seems like a small price to pay considering their net profit still ended up being about 2.5 billion dollars.

Drug companies producing opioids used respected medical journals to advertise their drugs. They also sponsored CMEs in order to teach doctors about the benefits of prescribing and using opioids and how they’re mostly safe. CME stands for continuous medical education they are basically courses in different forms that doctors take in order to enhance and update their medical knowledge. Another strategy pharmaceutical companies used was funding nonprofit organizations such as the American Academy of Pain Management and the American Pain Society. If you’re influencing NGOs that deal with pain along with teaching doctors that these drugs are completely safe and are great solutions for all sorts of pain then how are you not influencing their choices? Advertising through well known and respected medical journals also has a lot of influence.

Groups with a lot of medical influence were also taken advantage of through funding in order to promote the use of opioids. The Pain & Policy Studies Group which is based in Wisconsin received over 2 million in funding from pharma companies. The Pain & Policy Studies Group is widely respected and has influence over both medical schools in the U.S and over the medical field and practitioners in general. A group such as this one promoting the use of opioids and lobbying against regulating and limiting their use of course had a lot of influence over the matter as well. It’s surprising how much can be achieved through funding the right groups.

Another strategy was giving high incentives to their pharmaceutical reps on the basis of selling the drug. It’s said that the average bonus for selling these painkillers was higher than a reps original annual salary. This of course motivates pharmaceutical representatives to push harder and work harder to convince physicians to prescribe these drugs and that they’re completely safe and can be used for all kinds of pain.

It can be argued that the pharmaceutical companies took advantage from current regulations as well. Currently the FDA (Food and Drug Administration) needs to approve promotional activities and the marketing of controlled substance, but prior approval is not necessary in order to start selling that product on the market. So the drug could be released while the FDA was still looking into its promotion. It can be said that the FDA being understaffed and taking its time was another advantage for the companies as they could sell their product for years while the FDA reviewed it.

Ohio’s attorney general has taken action by filing a lawsuit against 3 major drug companies. The lawsuit is based on them spending millions on campaigns that made the risks of opioid pain killers seem negligent and practically safe while that’s not the truth. The suit also focuses on how these companies lobbied and convinced physicians that their drugs were safe. This isn’t the first lawsuit to be filed against these major companies as lawsuits have also emerged from Illinois, Mississippi, New York, and California. One of the arguments used in the lawsuits is that one of the drugs was marketed to relieve pain for 12 hours. The truth is that it doesn’t and its effects start to wear off earlier which makes patients go through withdrawal and eventually addiction. One of the problems that may result in the failure of these lawsuits is that most of those who are addicted or have died from addiction acquired additional doses of the drug through the black market and didn’t stick to their prescriptions.  

Pennsylvania is also taking the issue to courts. They’re suing the major distributors of these drugs as well as doctors who testified that they’re not addictive. They’re basically suing up to 14 companies that manufacture and sell these drugs claiming they’re safe and not addictive.

It’s important for doctors to be more careful when prescribing opioid painkillers. Perhaps it’s best to go back to relying on leaving them as a last option. There are lots of other ways to relieve pain from simple nonsteroidal anti-inflammatory drugs to physiotherapy. Physiotherapy is actually much better because it teaches a person to live and control the pain and not just hide it temporarily. One of the things that have been done as well was rescheduling opioids from Class III to Class II drugs by the Drug Enforcement Agency. This makes it harder for physicians and pharmacists to automatically refill prescriptions and limits their spread and ease of access.

The opioid epidemic is now reaching a critical stage. More people are dying from addiction than they are from gun violence or car accidents. Serious steps need to be taken and there has to be awareness in order to act quickly.