image by: Psychonaught
Over the last few years opioids have gotten a lot of bad press. But is profit motive more to blame than the drug itself?
First, let's clarify our terms. Traditionally the word epidemic has meant "a widespread occurrence of an infectious disease in a community at a particular time." In that sense, there is no more an opioid epidemic than there was a Pokémon GO epidemic last summer. You cannot become addicted to opioids simply by breathing the air in a roomful of opioid addicts.
Nevertheless, opioid addition has been a major problem in the United States for over a decade, one created by the federal government's taking its eye off the ball as Big Pharma prioritized profit over responsibility.
The term opioid refers to a class of drugs either derived from what is commonly known as the opium poppy—known as opiates—or are synthetically created to mimic opiates. But what differentiates opioids from opiates matters far less than what they have in common: they are extremely effective painkillers, and they are highly addictive.
Both of these properties of opium were well known long before medical science had the ability to deliver the substance and its derivatives in non-organic form. Extant written accounts of opium's medicinal properties date back to c. 1,500 BCE, while discussion of opium's addictive potential was well underway by the 16th century CE.
Opium played a fairly prominent role in early American history. During the Civil War opium (along with morphine, an active ingredient of the opium poppy and perhaps the first medicinal substance isolated from a plant) was liberally used as a painkiller, making addicts of perhaps hundreds of thousands of soldiers.
But opium use and addiction in America both predated the Civil War and did not cease as the war became a distant memory. In 1909 the U.S. took a step in the direction of regulating opium use with the passage of Smoking Opium Exclusion Act. While the new law aimed to stop the recreational use of opium, it did not regulate the use of opium-based products for medicinal use.
You know where this is going without being walked through the entire history. Human physiology does not change appreciably over the course of a mere century or even a millennium, and so opiates are as effective as ever for pain management. What has changed—drastically—during the last hundred years is humankind's ability to synthesize, package, deliver, market, and profit from what nature provides via the opium poppy. By the mid 20th century, opioids such as oxycodone were big business. Increases in availability led to increased use and abuse. By the 1990s opioids was a billion-dollar industry, with pharmaceutical companies working fast and furiously to come up with new opioids and new marketing schemes to get doctors to prescribe the pills.
A classic example is the story of OxyContin, a time-released version of oxycodone that was pushed as a safe and effective painkiller for 12-hour dosing. As the Los Angeles Times documented last May, even before OxyContin hit the market in 1996 Purdue Pharma knew its claims about the drug were inaccurate, and over the next 15 years would push doctors to overprescribe dosages, even though "[r]esearch shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death"—including one study that found 3% of patients on high doses of OxyContin went on to fatally overdose.
The Atlantic Monthly reports that "[t]he abuse and misuse of opioid products containing oxycodone and hydrocodone […] doubl[ed] between 1998 and 2008," resulting in 165,000 deaths since 2000. According to an investigation by the Associated Press and the Center for Public Integrity, part of the reason the problem is so rampant is because of how effectively Big Pharma has lobbied government officials. For example, over the last decade "[d]rug companies and allied advocates spent more than $880 million on lobbying and political contributions at the state and federal level," including contributing to approximately 7,100 state-level politicians. For comparison, that is eight times more than the gun lobby has spent over the same time period.
But Big Pharma's influence goes beyond the financial. "For over a decade," the AP and CPI report, "a group called the Pain Care Forum has met with some of the highest-ranking health officials in the federal government, while quietly working to influence proposed regulations on opioids and promote legislation and reports on the problem of untreated pain. The group is coordinated by the chief lobbyist for Purdue Pharma, the maker of OxyContin."
And it's been working. According to the Associated Press, opioid sales quadrupled from 1999 to 2010, with 227 million opioid prescriptions written last year alone. "The opioid lobby has been doing everything it can to preserve the status quo of aggressive prescribing," says Dr. Andrew Kolodny, an advocate for opioid reform. "They are reaping enormous profits from aggressive prescribing."
In recent years the federal government has at least made some noise on the subject. In September the White House declared Prescription Opioid and Heroin Epidemic Awareness Week. "Each year, more Americans die from drug overdoses than in traffic accidents, and more than three out of five of these deaths involve an opioid," wrote President Barack Obama. "[…] My Administration is steadfast in its commitment to reduce overdose deaths and get more Americans the help they need. That is why I continue to call on the Congress to provide $1.1 billion to expand access to treatment services for opioid use disorder.
Whether Congress will approve Obama's proposed expenditure—or whether that is an effective way to combat the opioid problem—remains to be seen. But as the country with the world's highest rate of opioid use, it's a problem we're far from solving. Some are proposing thinking outside the box. One possible strategy may be cannabis, which is an effective pain-management alternative for many and which some studies have suggested may be useful in combating opioid addiction. Senator Elizabeth Warren, for example, has asked the Centers for Disease Control to investigate the “effectiveness of medical marijuana as an alternative to opioids for pain treatment in states where it is legal.”
But despite the relatively safety of cannabis—which has been responsible for 165,000 fewer deaths than opioids since 2000 (in other words: zero)—on the federal level cannabis remains a Schedule I, illegal for all uses and unable to be prescribed by a physician. Perhaps that is because cannabis does not have an industry like Big Pharma behind it. Whatever the case, one thing seems certain: as long as money is allowed to influence U.S. medical laws and practices, the health of Americans will suffer.
About the Author:
Except for a four-month sojourn in Comoros (a small island nation near the northwest of Madagascar), Greggory Moore has lived his entire life in Southern California. Currently he resides in Long Beach, CA, where he engages in a variety of activities, including playing in the band MOVE, performing as a member of RIOTstage, and, of course, writing.
His work has appeared in the Los Angeles Times, OC Weekly, Daily Kos, the Long Beach Post, Random Lengths News, The District Weekly, GreaterLongBeach.com, and a variety of academic and literary journals. HIs first novel, The Use of Regret, was published in 2011, and he is currently at work on his follow-up. For more information: greggorymoore.com
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