The opioid crisis in America is more than a national crisis. It is a national disgrace. Much of what I have to say here is taken from a story in the October 30, 2017 New Yorker magazine entitled “Empire of Pain” by Patrick Radden Keefe. I suggest you check it out on line, and see if it makes you as angry as it did me. But I want you to do more than just get mad. I want you to help me stop this insanity by supporting my bid for Congress to replace our pharmaceutical bought and paid for congressman.
Did you know there is a Medical Advertising Hall of Fame? In 1997 Arthur Sackler, was inducted into this “Hall of Shame”. The citation read: “for bringing the full power of advertising and promotion to pharmaceutical marketing”. And who may you ask is Dr. Sackler? What did he invent and market that warranted this acclamation? Dr. Sackler was one of three brothers who in 1952 bought a small patent medicine company named Purdue Frederick, known for laxatives and ear wax removal. Dr. Sackler had other businesses as well. He was a medical journal publisher. He had a medical newspaper prescribed to by 600,000 doctors. And he ran a medical advertising company. Purdue initially developed a time released morphine based drug which achieved considerable success. But as its patent was about to expire, Purdue started looking for a drug to replace it. They began looking at Oxycodone, a synthetic opioid developed in 1916. Oxycodone was inexpensive to produce and was already used in other drugs such as Percodan and Percocet. Purdue developed a pill of pure oxycodone with a time release formula. The drug was described in terms of firepower, as a nuclear weapon. Although early focus groups of doctors were highly concerned about the abuse potential of opioids, Dr. Sackler was able to use his publishing businesses to counter the arguments and promote the product. Dr. Russel Portenoy, a pain specialist at the Memorial Sloan Kettering Cancer Center spoke out about the wisdom of using opioids to treat chronic pain, describing opioids as a “gift of nature”. Not surprisingly Portenoy who received funding from Purdue, claimed the concerns about addiction and abuse amounted to “medical myth”. In 1997, the American Academy of Pain Society published a statement regarding the use of opioids to treat chronic pain. The statement was written by Dr. David Haddox, also a paid speaker for Purdue. The FDA approved OxyContin in 1995 for use in treating moderate to severe pain. Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be prior to approval. The FDA, in an unusual step, approved a package insert for OxyContin announcing that the drug was “safer” than its rival painkillers due to its time release mechanism. The FDA examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterwards, and two years later went to work for Purdue.
With a thousand sales reps, Purdue went all out to sell OxyContin with the major thrust being the drug is not just for severe pain but, instead for all sorts of pain including backaches, arthritis, sports injuries, etc.. Purdue targeted general practitioners who were not pain specialists. David Kessler, former head of the FDA said from a public health standpoint, the drug should have been marketed to the least amount of patients with the most severe pain. But that approach was at odds with Purdue objectives, which were to do the exact opposite. Sales reps were told to tell doctors the drug is virtually non-addicting. As with most drugs subject to abuse, people could learn how to make them more potent. With OxyContin you did not have to figure out how to make it more potent, Purdue told you how to do it. The warning label that came with the drug told you that taking broken or crushed tablets, or chewing them would lead to rapid release and absorption which could kill you. Abusers ground them up, dissolved them in liquid and injected them, and snorted them. Patients began selling them on the street. Pill mill doctors and clinics over prescribed them. As the epidemic grew, Purdue insisted the only problem was people were not properly following the directions. DUH…
Purdue has been sued thousands of times since the release of OxyContin and defended by such people as Rudolph Giuliani who had tried on Purdue’s behalf to get the lead prosecutor to scuttle one case where three top executives were charged with and plead guilty in Virginia to criminal charges of misbranding with intent to defraud or mislead. The three received probation and were ordered to personally pay $35 million dollars in fines. Purdue agreed to pay an additional $600 million dollars. But remember, they have sold $35 Billion dollars of this drug. They are still way ahead.
Estimates for treating currently addicted people in the US is $50 Billion dollars. On top of that, funds will be needed for education and prevention. The federal government has been slow to react to this crisis. The 2018 Trump budget does little to nothing about the crisis. In reality, it will make it worse. In 2016 Congress passed the 21st Century Cures Act adding $1 Billion dollars over two years. A far cry from the $50 Billion dollars required. As Trump campaigned to “end the opioid epidemic in America” and “spend the money” on drug treatment, there was hope the government would do better. But as we have all come to understand, what Trump says and does, are two different things. The Trump budget proposed a 2% increase of $200 million to $10.6 Billion dollars already spent. However, the 21st Century Cures Act had previously authorized an additional $500 million for 2018. So Trump’s $200 million proposal actually decreases the authorization by $300 million. Let me know if you are surprised. Trump actually REDUCED the budget after campaigning he would increase it.
When you combine the Cures Act reduction with Trump’s proposed cuts to Medicaid, his continued attacks and defunding of the ACA with the ultimate goal of killing it, this national problem will eventually become a national disgrace. Medicaid paid for a quarter, or $7.9 Billion of the projected $31.3 Billion public and private spending for drug treatment in 2014. The 2018 budget is asking for nearly $400 million in cuts to Substance Abuse and Mental Health Services Administration, hundreds of millions in cuts to mental health block grants, and billions in cuts altogether to the National Institutes of Health (NIH), Centers for Disease Control (CDC), and Food and Drug Administration (FDA). The hope is Trump’s budget proposals are dead on arrival and Congress will put forth its own spending measures. But the bottom line is, don’t expect Trump (with his lead supporter Greg Walden) to do ANYTHING about the opioid crisis in this country.
Ten states have thus far filed suit against Purdue and dozens of counties and cities are going to bring additional suits. In the meantime, pharmaceutical companies are doing what they do best, making a killing out of the crisis. Naloxone is one of the primary drugs to treat opioid addiction. The price for treatment dosage from Amphastar Pharmaceuticals has risen from $690 in 2014 to $4,500 in 2017, a 500% increase.
Ironically, Dr. Sackler wrote a regular column for the Medical Tribune back around 1980 and one of his targets for misleading and false advertising was the tobacco industry. Tobacco eventually paid $246 Billion dollars to settle the government’s law suit. Let’s hope Purdue eventually earns its just punishment the same way. Forbes estimates the Sackler family receives $700 million dollars a year from the family business and as such, the Sacklers are not going quietly into the night. Between 2006 and 2015, Purdue and other painkiller producers spent nearly $900 million dollars on lobbyist and political contributions, eight times what the gun lobby spent. Did Greg Walden get any of this money? I do not know. What I do know, however, is that health care is Walden’s top contributor, so your guess is as good as mine.
To date Purdue has made $35 Billion dollars from OxyContin. Since 1999, 200,000 people have died from overdoses related to OxyContin and other prescription opioid drugs. The total opioid epidemic is killing an estimated 64,000 Americans a year. That is nearly the same amount who die from the combined deaths in car accidents and guns. Opioid overdose is the leading cause of death in the US for people under 50. And how are the Sackler family members doing? With a combined estimated net wealth of $13 Billion dollars, they are wealthier than the Rockefellors or the Mellons. They lead the lavish lifestyle you would expect from billionaires, donating to art museums and funding university buildings with their names firmly planted over the doors. Meanwhile 175 people die every day in the US to support their lifestyle.