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Opioids in the US – a crisis prescribed by profit

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The US is in the grip of a huge health epidemic so big that it is killing more than 130 people a day. But don’t look to the big drugs companies to help out, says Gabby Thorpe, they are the ones that started the crisis in the first place
Issue 2686
People take opoids to drown out the physical and emotional pain created by the system
People take opoids to drown out the physical and emotional pain created by the system

Tens of thousands of people die of opioid misuse every year in the US. They’re the victims of a crisis caused by big pharma companies and private healthcare firms that exploit their pain, poverty and addiction for profit.

Some ten million people misused prescription opioids—including two ­million first time misusers—in the US in 2018. More than 130 of them die every day.

In fact there have been so many opioid-related deaths that US life expectancy has entered a sustained decline for the first time since the final years of the First World War.

Overdoses in one county of Ohio got so bad in 2017 that a mobile morgue was brought in to cope with the number of bodies.

That year more people died of opioid overdose in the US than from Aids related illnesses at the height of the epidemic. Opioids can be helpful when used appropriately. They can help people in severe pain.

But the US crisis shows them being used to dull the effects of social devastation—and the victims are ­overwhelmingly working class.

For some addiction is driven by the pain caused by backbreaking physical labour. They take opioids to help them keep working, then become addicted.

A recent report in the state of Massachusetts found that construction workers there are six times more likely to suffer an opioid-related death than workers in all other occupations.

In other places it’s driven not by too much work, but by too little. The opioid crisis is at its worst in states where industry has been smashed. Here, opioid addiction is linked to what in the US have been called “deaths of despair”—suicide, alcohol and drug-related deaths.

It’s not just physical pain that leads people to take opioids, but all the emotional pain and stress that comes with being poor in the richest country in the world.

This is the despair that big US drug firms have cashed in on. Companies such as Purdue Pharmaceuticals—the producers of Oxycontin. In the 1990s they pushed claims that drugs such as Oxycontin were both effective and ­non?addictive.

None of these claims were true.

The reality is that Oxycontin is not suitable for treatment of chronic pain. And it’s so addictive that the US’s Drug Enforcement Agency refers to it as “heroin in a pill.” Long term use causes patients to build up a tolerance. Dosage has to be dangerously high in order for patients to feel any benefits.

Purdue Pharmaceuticals knew its drug was highly addictive—as it admitted in a 2007 court case.

Nevertheless it ploughed large amounts of money into “pain ­management training” for medical professionals that promoted opioid prescription. It managed this through the American Pain Society (APS)—an organisation it funded.

Opioids have made many peoples lives a misery

Opioids have made many people’s lives a misery (Pic: K-State Research and Extension/Flickr)

Doctors were advised to question patients about levels of pain. Many adopted a smiley face system to describe pain levels—where a neutral looking face means pain was “very distressing”.


Those deemed to be in pain through patient self-evaluation would be referred to a pain consultation. Often they would walk out with an opioid prescription.

The APS used customer ­satisfaction surveys to monitor the amount of drugs being prescribed. Hospital managers who signed up to APS recommendations disciplined doctors if prescriptions weren’t offered quickly.

By the mid-2000s Oxycontin was being prescribed en masse. The owners of Purdue Pharmaceuticals, the Sackler family, have made £9 billion from the sale of Oxycontin since its development.

It’s not just big pharma companies that have cashed in—insurance firms and major retail chains did too.

Insurance companies wanted doctors to cut down on the time they spent with their patients—leading to a significant increase in the prescription of painkillers as a first-stop solution to chronic pain.

Counties all over the US took major pharmacy chain Walgreens and Walmart to court in July of this year. Chains were ordering suspiciously large amounts of oxycodone. In one case in Port Richey, Florida, a Walgreens store was ordering 3,271 bottles of ­oxycodone a month in 2011. The population there is 2,831.

And lawyers for the plaintiffs claimed that Ireland-based drugs manufacturer Mallinckrodt sold some 53 million orders to drugstore chains.

The first trial started in October and is set to see the chains pay out billions in compensation.

Meanwhile, for those who fall into addiction, there are very few free or affordable treatments to help them get out.

There are free and “low-income” rehab centres across the US. But they are few and far between. Many medical insurance companies don’t cover addiction, and others will only pay for 10-30 day programmes.

For a lot of people affected by the opioid crisis, recovery is something they just can’t afford.

Simply restricting prescriptions and distribution has in the past led people to turn to the black market. And people are entitled to expect treatment for pain caused by a lifetime of work.

The beginning of a solution would be to introduce universal healthcare that treats addiction as a medical condition.

But a real solution also means tackling the causes of pain—physical and emotional—that lead people to rely on opioids in the first place.

Those are solutions that the powerful alliance of big pharma business, for-profit healthcare—and the US governments that support them—will do anything to block.

Kentucky given enough pills for everyone to down 63 a year

Between 2006 and 2012 drug companies poured 76 billion oxycodone and hydrocodone pain pills into US neighborhoods.

Just six companies distributed 75 percent of the pills during this period—including retail giant Walmart.

Three companies manufactured 88 percent of the opioids.

The figures come from US Drug Enforcement Administration, analysed in The Washington Post newspaper.

Together the companies distributed enough pills to supply every adult and child in the country with 36 pills each per year.

However, the distribution of the pills was not uniform from state to state or from city to city.

The state of Kentucky, for example, was flooded with enough pills to give every person 63 pills each per year, South Carolina 58, and Tennessee 58.

West Virginia, the state with the highest opioid death rate during this period, received enough pills to give every person 67 pills each year.

A child in West Virginia has a greater chance of dying from opioids than of becoming a doctor. Many children enter school gates as “drug babies”—either having become addicted in the womb or as victims of parental overdoses.

One small town, Williamson, with a population of just 3,000, shipped in more than 20 million opioid pills, mostly oxycodone and hydrocodone, in a seven-year period.

These are areas of shattering poverty for many people—and where the desperation led some to vote for Trump.

Since 2012 overall opioid deaths in the US have skyrocketed. The flooding of markets with prescription drugs, especially in economically depressed areas, then spawned increased heroin use as people looked for stronger drugs.

It ultimately, along with a number of other factors, led to the current fentanyl crisis that added more than 67,000 to the death toll from 2013 to 2017.

Pharma aggravating India

For a vision of society where big pharma gets its way, look at India.

Previously the country had rigorous laws restricting the use of painkillers.

That was until decades of lobbying by medical professionals led to the relaxation of legislature on opioid painkillers.

The new laws meant that people in pain could finally find relief. But it also left a healthcare system vulnerable to exploitation.

Like Oxycontin in the US, Tramadol has led to the beginnings of an addiction epidemic.

It was easily available, and a lack of serious checks meant that anyone could file a prescription for it.

After reports of misuse soared in 2018, the Indian government cracked down on Tramadol misuse.

Shortly following the new restrictions, a paper was published claiming that a crackdown would lower the standard of healthcare in India.

The paper was funded by a number of international drug companies—including US companies Pfizer, Johnson and Johnson, and Mundipharma.

Mundipharma is owned by the Sackler family—which fuelled and profited from the opioid crisis in the US.

US drug companies didn’t create the flourishing Tramadol crisis in India.

But they are more than happy to aggravate it in the name of profit.

Oxycontin firm now bankrupt

Drug company Purdue Pharmaceuticals, the producer of Oxycontin, filed for “Chapter 11” bankruptcy protection in September last year.

It is a process that firms use to fend off creditors trying to enforce debts.

It was part of an effort to settle court cases with dozens of US states and other authorities who say the company deliberately fueled the opioid crisis while making massive profits.

Under terms of the settlement, Purdue would admit to no guilt for the epidemic and its owners would protect their personal wealth.

Negotiations continue about the process.

Most recently it has tried to insist that massive bonuses must still be paid to its top executives.

Purdue paid chief executive Craig Landau about £7 million in the 12 months before it filed for bankruptcy.

Now—despite all the revelations—it wanted to give him another £1 million.

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