Opioid crisis: Aberration, or logical outgrowth of for-profit US healthcare system?

Four major drug companies have reached a partial settlement over their role in the opioid epidemic, dodging a federal trial. The drug plague is less of an accident than an inevitable consequence of a for-profit healthcare system.

US drug distributors AmerisourceBergen Corp., Cardinal Health Inc., and McKesson Corp. – as well as Israel-based drug manufacturer Teva Pharmaceuticals – have tentatively settled suits with two Ohio counties for $260 million, over charges they misled the public about the addictive potential of their drugs. The deal narrowly avoids a federal trial that was set to start on Monday, but does not address some 2,600 other suits nationwide against those companies and others – including Purdue Pharma, the company that kicked off the epidemic with its blockbuster opioid OxyContin.

More than 20 years and 400,000 deaths after the debut of the devastatingly popular drug, it’s a relief that authorities are finally getting around to holding some of the perpetrators responsible. Opioids kill more Americans every year than car crashes, and have singlehandedly decreased the average US lifespan. However, the crisis is less due to especially evil schemes by those particular companies, and more of the inevitable outcome of a healthcare system where curing the patient pays less than keeping them coming back, again and again.

Opioid manufacturers and distributers merely took advantage of a corrupt and broken business model, where pharmaceutical companies were able to collude with medical authorities to elevate “pain” to the level of a vital sign alongside blood pressure, temperature, respiratory rate and pulse, presenting their product as the only truly effective solution to the problem. When Purdue unleashed OxyContin on the market in 1996, they simply lied and claimed their product had an addiction rate in the single digits. The other companies followed their lead: by the time OxyContin was reformulated to make it less appealing to addicts, there were Vicodin, Lortab, and fentanyl, waiting in the wings.

Hand in hand with the American Academy of Pain Medicine, the American Pain Society, and other authoritative-sounding groups, Purdue seduced doctors with an irresistible one-two punch. First they were told they were remiss in not checking all their patients for pain, the fifth vital sign. Then they were told that OxyContin is the only opioid painkiller that has managed to overcome the addictive factor, so they should overcome “opiophobia” and start writing prescriptions.

Doctors saw dollar signs in every patient who walked in with a sore back – unlike pulse or temperature, “pain” is a subjective sensation – and if the drug wasn’t addictive, who gets hurt in the case of excessive prescription? Drug reps were showering them with gifts, from hats to branded plush toys. Who could have guessed the stuffed gorilla would turn into a monkey on their back?

By the time doctors figured out they had patients for life – some of whom became hopelessly addicted, after coming in with nothing more than temporary discomfort caused by an accident or injury at work – they had become complicit in addicting huge numbers of Americans to a drug that was actually even more habit-forming than its opioid peers. Purdue paid a measly $635 million in 2007 for misleading doctors with its marketing – a small price to pay for over $35 billion in Oxy profits.

Drug-maker obviously did not think it is wrong to create a hugely addictive drug for the purposes of dramatically expanding one’s customer base, ensuring a lifetime flow of profits. If one takes morality out of the equation, their actions look merely like a series of intelligent business decisions.

Opioid addiction is big business, even beyond the opioids themselves. Following up on the Oxy debacle, the Sackler family that owns Purdue Pharma patented a novel form of delivery for buprenorphine – a long-acting synthetic opioid used to treat opioid addiction – last year. Buprenorphine itself is addictive, and detoxing from it can take months (while OxyContin detox takes a few weeks). Teva Pharmaceuticals’ donation of $20 million worth of suboxone – another formulation of buprenorphine – as part of Monday’s settlement looks much less charitable in this light.

Naloxone is the overdose reversal drug that is now ubiquitous across American cities, with pictographs in store windows allowing the panicked companions of dying addicts to recognize a potential lifesaver from afar. It has more than sextupled in price from 2014 to 2016, going from $690 to $4500. Some $274.1 million worth of naloxone was sold in 2016, according to IQVIA.

The US healthcare system rewards doctors the more they see their patients, disincentivizing quick and easy cures in favor of lifetime treatments. Opioids are just the tip of a pharmaceutical iceberg that includes psychiatric drugs, statins, blood pressure drugs, insulin and other medications – many with serious side effects – meant to be taken for life. Chronic diseases are on the rise even as the cost of treating them skyrockets. As a result, two thirds of Americans who file for bankruptcy do so because of medical issues. Healthcare is a $3.5 trillion industry in the US, and the quality of that care is dead last in the developed world.

Hauling the drug companies into court is a good place to start, but without looking at the system that profits handsomely from sickness – but not from cures – it’s virtually guaranteed that tragedies like the opioid epidemic will keep happening.

By Helen Buyniski, RT

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