The Pharmaceutical Industry and Drug Addiction: A Crisis and an Opportunity (#2 or 40 series)

Drug addiction is a serious and complex problem that affects millions of people around the world. According to the World Health Organization (WHO), about 269 million people used drugs in 2018, and 35.6 million suffered from drug use disorders. (1) Drug addiction can cause physical, mental, social, and economic harm to individuals, families, and communities. It can also increase the risk of infectious diseases, violence, crime, and overdose deaths.

Honestly, I thought there would be more people than that. Take away the radically religious places (cough Dubai)....I just thought there would be more than 269 million. For a size reference, the entire US population is 330 million.

While there are many factors that contribute to drug addiction, such as genetic, psychological, environmental, and cultural influences, one of the major drivers of the current drug crisis is the pharmaceutical industry. The pharmaceutical industry is responsible for developing, producing, and marketing drugs for medical purposes. However, some of these drugs, especially opioids, have been misused, abused, and diverted for nonmedical purposes, leading to widespread addiction and overdose.

How did the pharmaceutical industry contribute to drug addiction?

Here are some of the ways:

The pharmaceutical industry aggressively marketed opioids as safe and effective for chronic pain, despite the lack of evidence and the high risk of addiction and dependence. For example, Purdue Pharma, the maker of OxyContin, launched a massive campaign in the late 1990s to persuade doctors and patients that OxyContin was a breakthrough painkiller that was less addictive than other opioids. They used misleading claims, such as "less than 1% of patients become addicted" or "delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of a drug." (2) They also paid doctors, patient groups, and professional organizations to endorse their products and influence prescribing guidelines. As a result, opioid prescriptions skyrocketed from 76 million in 1991 to 254 million in 2010, enough to medicate every adult in the U.S. for a month on a round-the-clock basis. (3) In that same year, pharmaceutical companies generated revenues of $11 billion from opioid sales alone.

The pharmaceutical industry failed to monitor and report suspicious orders and shipments of opioids, allowing massive amounts of pills to flood into communities with high rates of addiction and overdose. For example, between 2006 and 2012, drug distributors shipped more than 76 billion opioid pills across the country, with some rural areas receiving enough pills to supply every man, woman, and child with hundreds of doses each year. (5) Many of these pills ended up in the hands of illicit dealers or users who obtained them from friends, relatives, or street sources. According to the Drug Enforcement Administration (DEA), prescription opioids are a factor in 32% of opioid overdose deaths.

The pharmaceutical industry resisted efforts to regulate and reform their practices, using their political and financial power to lobby against laws and policies that could curb their profits or hold them accountable for their role in the drug crisis. For example, between 2006 and 2015, the pharmaceutical industry spent more than $880 million on lobbying and campaign contributions at the state and federal level, more than eight times what the gun lobby spent in the same period. (7) They also hired former DEA officials to influence or undermine the agency's enforcement actions against opioid manufacturers and distributors. (8) As a result, many attempts to pass legislation or impose sanctions on the pharmaceutical industry were delayed, diluted, or defeated.

What are the consequences of the pharmaceutical industry's role in drug addiction?

The pharmaceutical industry's role in fueling drug addiction has not gone unnoticed or unpunished. In recent years, thousands of lawsuits have been filed against opioid manufacturers and distributors by states, counties, cities, tribes, hospitals, and individuals who have suffered from the opioid crisis. Some of these lawsuits have resulted in settlements or judgments that require the defendants to pay billions of dollars in damages and penalties, as well as implement changes in their policies and practices. For example:

In 2007, Purdue Pharma pleaded guilty to federal charges of misbranding OxyContin and agreed to pay $634 million in fines and forfeitures. Three of its executives also pleaded guilty to misdemeanor charges and were sentenced to probation and community service. (9)

In 2019, Purdue Pharma filed for bankruptcy as part of a tentative settlement deal that would require it to pay up to $12 billion over time and dissolve itself into a new entity that would continue to sell opioids but direct the profits to plaintiffs. The deal also requires the Sackler family, who owns Purdue Pharma, to pay $3 billion from their personal fortune and relinquish control of the company. However, the deal has been opposed by some states and creditors who want more money and accountability from Purdue Pharma and the Sacklers. The bankruptcy case is still ongoing. (10)

In 2019, Johnson & Johnson was ordered by an Oklahoma judge to pay $465 million for its role in creating a public nuisance by deceptively marketing opioids and downplaying their risks. The judge found that Johnson & Johnson had created a "cunning, cynical and deceitful scheme" to supply, sell, and profit from opioids. Johnson & Johnson appealed the ruling, but later agreed to settle the case for $5 billion as part of a larger deal with other states. (11)

In 2020, Mallinckrodt, one of the largest generic opioid manufacturers, agreed to pay $1.6 billion and place its generics business into bankruptcy as part of a settlement with thousands of plaintiffs. The company admitted that it had violated the Controlled Substances Act by failing to report suspicious orders and prevent diversion of opioids. (12)

In 2020, McKinsey & Company, a consulting firm that advised Purdue Pharma and other opioid makers on how to boost their sales, agreed to pay $573 million to settle claims by 47 states that it had contributed to the opioid crisis by promoting aggressive marketing strategies and downplaying the dangers of opioids. The firm also agreed to stop advising companies on potentially addictive narcotics and to disclose its documents related to its work on opioids. (13)

In 2021, three major drug distributors (McKesson, AmerisourceBergen, and Cardinal Health) and Johnson & Johnson agreed to pay $26 billion to settle thousands of lawsuits by states and local governments over their role in the opioid crisis. The distributors agreed to pay $21 billion over 18 years and implement a new system to track and report opioid shipments. Johnson & Johnson agreed to pay $5 billion over nine years and stop selling opioids in the U.S. The deal also requires the defendants to provide funding for opioid treatment, prevention, and recovery programs. However, the deal is contingent on the approval of enough states and localities to participate in it. (14)

These settlements and judgments are significant steps towards holding the pharmaceutical industry accountable for its role in the drug crisis and providing some relief and compensation for the victims and communities affected by it. However, they are not enough to end the drug crisis or prevent future ones from happening.

What are the solutions for the pharmaceutical industry's role in drug addiction?

There is still a need for more regulation, oversight, education, and research on the safety and effectiveness of drugs, especially opioids, and their alternatives. There is also a need for more access, availability, and affordability of evidence-based treatment and recovery services for people with drug addiction and co-occurring mental health disorders.

The pharmaceutical industry has a dual responsibility:

to develop and market drugs that can improve health and save lives, but also
to ensure that these drugs are used appropriately and safely, without causing harm or addiction.

The pharmaceutical industry should not only comply with the laws and regulations that govern its activities, but also adhere to the ethical principles and standards that guide its profession.

The pharmaceutical industry should not only pay for the damages and costs that its actions have caused, but also invest in the solutions and innovations that can prevent or reduce drug addiction and overdose.

By doing so, the pharmaceutical industry can redeem itself from its role in the drug crisis and restore its reputation as a trusted partner in health care. It can also contribute to the well-being of millions of people who suffer from pain, illness, or addiction, and help them achieve recovery and wellness.

The pharmaceutical industry has a unique opportunity to turn a crisis into an (a word synonymous with opportunity for 500, please):

an opportunity to learn from its mistakes,
an opportunity to improve its practices,
an opportunity to collaborate with other stakeholders,
an opportunity to innovate new treatments,
an opportunity to save lives.

The pharmaceutical industry should seize this opportunity before it is too late.

Holding my breath. Reclaiming my time.

References

World Health Organization. World drug report 2020. https://www.unodc.org/unodc/en/data-and-analysis/wdr-2020.html. Published June 25, 2020. Accessed January 28, 2023
United States of America v. The Purdue Frederick Company, Inc., et al. Plea agreement. https://www.justice.gov/archive/usao/vaw/press_releases/purdue_docs/plea_agreement.pdf. Published May 10, 2007. Accessed January 28, 2023.
Centers for Disease Control and Prevention. Opioid overdose: understanding the epidemic. https://www.cdc.gov/drugoverdose/epidemic/index.html. Updated December 16, 2020. Accessed January 28, 2023.
Meier B. In guilty plea, OxyContin maker to pay $600 million. The New York Times. May 10, 2007. https://www.nytimes.com/2007/05/10/business/11drug-web.html. Accessed January 28, 2023.
Higham S, Horwitz S, Rich S, et al. Pain pills flooded the nation for years before opioid crisis was declared a public health emergency in 2017, DEA data shows. The Washington Post. July 16, 2019. https://www.washingtonpost.com/investigations/pain-pills-flooded-the-nation-for-years-before-opioid-crisis-was-declared-a-public-health-emergency-in-2017-dea-data-shows/2019/07/16/fcdfb2b2-a73e-11e9-86dd-d7f0e60391e9_story.html. Accessed January 28, 2023.
National Institute on Drug Abuse. Overdose death rates. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates#:~:text=Prescription%20Opioids&text=Prescription%20opioids%20were%20involved%20in,involving%20prescription%20opioids%20in%202018.. Updated September 2020. Accessed January 28, 2023.
Higham S, Bernstein L, Crites A. Investigation: The opioid industry’s political power in Congress and the states [video]. The Washington Post. October 15, 2017. https://www.washingtonpost.com/investigations/the-opioid-industrys-political-power-in-congress-and-the-states/2017/10/15/

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