Why Outrage At 'Big Pharma' For Opiate Crisis is Misguided

There was a time, namely circa-1996-97 according to the Wall Street Journal, when severe pain was being undertreated in by medical professionals in the United States. Approximately 20 years ago, several credible, mainstream authorities were calling for the development of more effective pain-killing drugs. And thus, in 1996, OxyContin was released on the market and heavily promoted by Purdue Pharma. Similarly high-powered painkillers with a variety of names would follow. It did not take long for the negative consequences of increased availability of these painkillers to emerge. By 2004, OxyContin had become the leading drug of abuse in the United States.

Many would roll their eyes at the idea that pharmaceutical companies may have had well-intended reasons for the development of opioids, the synthetically-altered versions of opiates such as heroin and morphine, which are derived from the opium poppy. But many credible sources back up the view that many were calling for stronger pain relievers for loved ones and patients enduring chronic pain and fatal illness. Unintended consequences aside, these synthetic, controlled pain pills were something that the marketplace was demanding.

‘the epidemic didn’t begin with greedy drug companies or reckless prescribers. It began with compassionate doctors trying to end the suffering of millions of people in pain.’ (Drug Rehab)

It was not impossible to foresee scenarios of abuse should these drugs fell into the wrong hands or became overprescribed to those without a proven need. But the scale to which OxyContin, Oxycodone, Hydrocodone, Vicodin, Percocet, and other prescription drugs have given way to a nation-wide epidemic of heroin and fentanyl abuse is undoubtedly due to a convergence of factors. The drugs are powerful, to be sure, but there is something within the younger generation that has made them more susceptible to opioid and opiate addiction than their parents. According to SAMHSA, ‘In 2014, youths aged 12 to 17, or young adults aged 18 to 25, were more likely to misuse prescription drugs in the past year than adults aged 26 or older.’

The statistical data meshes with our perception of the heroin epidemic’s victims; people in their twenties and even teens completely bereft of hope, eventually killing themselves via overdose after varying intervals of addiction. It’s true that prescription painkillers have been the real gateway drug to heroin and now fentanyl abuse. But the blame for this epidemic is too often laid solely at the feet of pharmaceutical companies. The truth is, with severe patient pain still a real problem in need of a solution, statistics show that prescriptions for painkillers have been written at a decreasing rate since 2010. The problem in 2017 is not Big Pharma or a prescription drug marketplace yet to be regulated. It is street drugs, fentanyl and heroin, that are primarily hooking and eventually killing people.

There are still prescription drugs abundant on the black market, but the decreasing supply has meant higher prices and more people turning to heroin and fentanyl for their fix. We won’t pretend to pose a solution for rooting out heroin and fentanyl from the underbelly of society. But what we should do is stop misdirecting the issue of opiate addiction to the feet of pharmaceutical companies, as the Washington Post did in an expose earlier this month.

The basis of the Post’s claim is that the U.S. Drug Enforcement Agency, the agency most responsible for getting heroin and fentanyl off of the streets, has had its hands tied by a 2016 measure that changed the legal standard for “immediate suspension orders”, which are issued by the DEA to stop doctors, pharmacists, and wholesalers from prescribing prescription painkillers.

The reason that these immediate suspension orders required some measure of reform is that, according to the NCBI, once one’s ability to prescribe prescription painkillers is suspended, they have very little room for reinstatement. These orders often mean doctors going out of business, in many cases unjustly.

‘a suspension of the registration may be certain death to doctors and pharmacists without the financial means to operate the business in the absence of the registration. Because the DEA registration is a constitutionally-protected interest, there is a better way to challenge the suspension. The Supreme Court has held that once a license is issued, the continued possession of it is essential to the registrant's livelihood.’ (NCBI)

That is part of the reason why these suspension orders had continued to drop in use over the years. As doctors, pharmacies, and wholesalers who were intentionally over-prescribing opioids were put out of business, the orders tended to punish unjustly more than do good. Another fact exposing the disingenuousness of the WaPo editorial is the totality of institutions, including the DOJ and the DEA, that supported the 2016 measure now being vilified.

‘The measure in question, which rewrote the legal standard for suspension orders, was approved by the Obama White House, DEA and Justice Department. It was unanimously supported by Congress. It reflected, as the New York Times noted, a Congress under pressure from drug lobbyists to show an interest in “ensuring access to narcotic painkillers” for patients even while “addressing the addiction epidemic linked to those drugs.”’ (WSJ) As the AP reports, immediate suspension orders were only one of ‘a mountain of bills addressing the nation's opioid abuse crisis,’ and one of the least effective at that.

The DEA approved the measure, but the Post now accuses lobbyists and drug companies of curtailing the DEA’s efforts to tamp down the flow of prescription painkillers on the black market. As the Journal points out, the primary source for the WaPo smear piece is a trial lawyer and former DEA agent named Joseph Rannazzisi, who now makes a living primarily by suing drug companies.

The opioid epidemic is now, truly, more of an opiate epidemic. Prescription drugs still get young and old people hooked, but it is heroin and fentanyl that are causing the vast majority of overdoses. Pharmaceutical companies were inevitably the root of prescription pill abuse, as nobody else could produce such a synthetic painkilling substance, but they have long scaled back operations and cooperated with efforts to keep opioids out of the hands of those on the black market.

In order to work toward fixing the heroin and fentanyl epidemic, we must call it what it is: a heroin and fentanyl epidemic. They are street drugs that must be stopped at the street level. A wall on our southern border limiting cartel infiltration will be a large part of the fight against these deadly drugs. But please, stop with the red herrings and distractions. Big Pharma is no longer the one to point to for genuine answers to why America’s youth continue to drop like flies from shooting up.

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