| September 14, 2019 12:00 AM
Purdue Pharma, the maker of OxyContin, may have been the prime mover in the Big Bang of opioids in the 1990s, when doctors were aggressively treating pain and OxyContin was pushed as a non-addictive medication. But Purdue didn’t act alone.
In August, Johnson & Johnson was fined $572 million for its role in Oklahoma’s opioid crisis; Purdue settled with Oklahoma in March for $270 million. Beyond the cases in Oklahoma, there are now 2,000 lawsuits against opioid manufacturers and distributors. But rather than bringing a few bad players to justice for criminal behavior, these lawsuits are exposing a massive conspiracy 20 years in the making, along with a government database to prove it.
The opioid crisis is a manufactured (and profitable!) public health emergency that has killed more than 400,000 Americans since 2000. It’s the perfect storm of gross negligence of regulators, lawmakers, and law enforcement, coupled with predatory tactics of lobbyists, drug manufacturers, distributors, doctors, and management consulting firms. Drug companies pushed opioids as a non-addictive pain medication while simultaneously releasing a deluge of 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012. This is demonstrated by the data in the Drug Enforcement Agency’s Automation of Reports and Consolidated Order System, known as ARCOS.
In small towns like Kermit, West Virginia, (population 392), one pharmacy received 5.7 million hydrocodone and oxycodone pills between 2005 and 2011 from McKesson, which shipped over 100 million pills into the state during that time. McKesson settled in May for $37 million, a fraction of the estimated $8.8 billion annual cost of the opioid crisis in West Virginia.
Mallinckrodt flooded Florida (population 20 million) with 500 million oxycodone pills between 2008 and 2012. That’s enough pills to create an entire state of addicts. One Florida doctor, Barry Schultz prescribed a patient 23,000 pills over eight months — that’s 100 pills a day.
Drug companies and distributors point the finger at law enforcement and regulators, questioning why they didn’t do more given their access to ARCOS data, which was only made public in June after a protracted legal battle. For years, drug companies, the DEA, and the Department of Justice fought against release of the data, which reveals what each company knew about the number of pills it was shipping year by year, town by town.
In 2006, a confidential Department of Justice “prosecution memo” detailed how government lawyers believed that Purdue Pharma knew in the mid-1990s that OxyContin was fueling a rise in abuse and addiction. This memo might have changed the course of the opioid crisis if it were made public.
The secrecy surrounding the government memo and data is emblematic of a legal process that favors the suppression of corporate information, even when it could benefit the public’s health and safety.
Corporate malfeasance wasn’t limited to the drug industry. McKinsey, a top-tier consulting firm, advised Purdue Pharma and Johnson and Johnson on marketing strategies for opioids. The state of Massachusetts released documents from 2013 detailing McKinsey’s recommendations on how Purdue could “turbocharge” sales of OxyContin. McKinsey advised Purdue to consider mail orders as a way to bypass pharmacies that had been tightening oversight of opioid prescriptions. In a 2002 presentation for Johnson & Johnson, McKinsey pushed for more aggressive marketing for its fentanyl patch, recommending targeting doctors who specifically treat back pain in the elderly and those in long-term care.
The conspiracy doesn’t end with getting patients hooked on opioids. It continues throughout the addiction life cycle, with emergency response and treatment. As the opioid crisis grew, companies increased prices of lifesaving drugs like naloxone, which reverses an opioid overdose within minutes. A decade ago, a dose of naloxone cost $1, but in 2018 that same dose cost $150. Kaleo increased the price of its auto-injectable overdose-reversal drug Evzio from $575 to $4,100 between 2014 and 2017 which cost the federal government more than $142 million. (Kaleo paid $10.2 million to a consultant who recommended the new pricing.) Only after investigations in 2018 by a Senate subcommittee and 60 Minutes, did the company authorize an identical version of its automated naloxone injector for a $178.
The burgeoning industry of addiction treatment is haphazardly regulated and rapidly expanding. Online and television marketers prey on a vulnerable population, making promises without any data that accurately reflects results. Others engage in practices such as patient-brokering, in which large sums are paid for referrals. Some charge insurers exorbitant fees — for example, $4,000 per urine test taken two to three times per week until the patient dies.
This malignant ecosystem has thrived for 20 years.
Today, 46% of American adults have a family member or close friend who struggles with addiction. Millennials are dying at such high rates that it has driven life expectancy in the U.S. to decline for two years in a row, for the first time since the early 1960s, in large part due to the emergence of the synthetic opioid fentanyl, which is 50 times more potent than heroin. An estimated 20% of deaths among U.S. adults ages 25 to 34 are related to opioid use.
While 2018 saw a 5% decline in drug overdose deaths, it was still the second-worst year of all time for drug overdose deaths. And deaths linked to synthetic opioids like fentanyl increased. The opioid crisis continues to metastasize across the country with no end in sight, but you wouldn’t know that listening to our elected officials.
Democratic presidential candidates generally ignored the issue in the 2019 debates. President Trump seems solely focused on law enforcement solutions and has dismissed the crisis saying, “We could solve the entire problem — I say 45 minutes…if the Democrats would agree to do certain basic, commonsense things with respect to our laws.”
But the president’s Council of Economic Advisers estimated that opioid crisis cost taxpayers $504 billion in 2015 alone. Researchers estimate the federal government lost $37.8 billion in tax revenue between 2000 and 2016 because of adverse effects on the labor market due to opioid misuse. The president’s commission on opioids recognized the urgent need for action in its 2017 report, recommending a multi-faceted solution with more funding for states, increased prevention, evidence based treatment, drug courts and criminal justice reforms, and better data sharing. The Comprehensive Addiction Resources Emergency (CARE) Act of 2019 does all of this, and more.
The CARE Act is a comprehensive plan to fix the opioid crisis over the next decade and provides states with funds needed to prevent and treat substance use disorder: $100 billion would be invested to build an addiction treatment infrastructure modeled on the approach to combat the HIV/AIDS epidemic. By comparison, the federal government spent $34 billion in FY2019 to combat AIDS. The plan addresses treatment, training for health professionals, monitoring and surveillance, prevention, and expanded access to naloxone.
We know how to fix this. We just need the political will to do it.
My family, like too many other American families, has been devastated by the opioid crisis. My sister Jenny died from prescription opioids in 2017. She was a 44-year-old college graduate and middle-class suburban mom in Buffalo, NY. Her gruesome death in a hospital bed with my parents on either side of her haunts me every day.
We are heartbroken. We are angry. We deserve — no, demand — that Congress and our president ensure adequate funding, accountability, and patient-centered solutions that fix this public health crisis.
Kelly O’Connor lives in Washington, D.C. Watch her TEDx Talk, My Introduction to Narcan.