Who's to blame for the opioid crisis: Pharma companies or doctors? | The Tylt
Who's to blame for the opioid crisis: Pharma companies or doctors?
In 2012 in Ohio, the state leading the nation in overdose deaths, doctors prescribed 793 million doses of opioids. According to The Atlantic's Alana Semuels, that's "enough to supply every man, woman, and child, with 68 pills each," statewide. Although it's easy to place blame for this over-prescribing phenomenon on physicians, some key players are pointing the finger at the pharmaceutical companies responsible for producing the drugs in the first place, namely Purdue Pharma with OxyContin.
Semuels reports a number of attorneys general are questioning whether or not these pharma companies knowingly downplayed the addictive nature of their drugs, and if they should be held legally responsible for the fallout as a result. This tactic is not unlike what happened in 1998 with the tobacco industry:
Ohio’s Attorney General Mike DeWine filed a lawsuit Wednesday against a handful of pharmaceutical companies, including Purdue Pharma, Teva Pharmaceuticals, and Johnson & Johnson…[accusing ]the companies of spending millions on marketing campaigns that “trivialize the risks of opioids while overstating the benefits of using them for chronic pain.” The companies, the lawsuit alleges, lobbied doctors to influence their opinions about the safety of opioids, “borrowing a page from Big Tobacco.”
Purdue is facing so many lawsuits that the company might be forced into bankruptcy. According to the Wall Street Journal'sSara Randazzo and Jared S. Hopkins, as of March 2019, Purdue faces lawsuits from "1,600 cities, counties and states seeking to recoup costs incurred by widespread opioid abuse." Randazzo and Hopkins explain that these lawsuits claim:
...Purdue and other drugmakers’ aggressive marketing of prescription painkillers helped hook the nation on opioids, leading to a proliferation of overdoses from both legal and illegal opioids.
The lawsuits are going after pharma companies because plaintiffs believe these organizations to be responsible for America's current crisis. Although OxyContin specifically has been on the market for over 20 years, Purdue has been in hot water with the drug before:
OxyContin was approved by U.S. regulators in 1995. The company faced a federal investigation in 2007 that led it and three of its executives to plead guilty to criminal charges of misleading the public about the addiction risk related to the drug.
Purdue also said it would no longer promote Oxycontin to doctors in 2018, demonstrating at least some awareness of fault.
It should also be noted that if Purdue were to file for chapter 11 bankruptcy, it would be doing so in order to halt these lawsuits and settle claims via bankruptcy court. In other words, for Purdue, bankruptcy is a quicker and potentially more orderly solution to the ordeal, and could possibly minimize the time it spends among negative headlines in the press.
Some might be placing the blame entirely with pharma companies or with patients themselves, but others are looking to the doctors writing the prescriptions. According to the New York Times, prescriptions for oxycodone–the active ingredient in Perdue Pharma's OxyContin–increased by 82 percent between 2007 and 2010 in the state of New York alone.
According to Steven A. King, MD, MS of the Psychiatric Times, there's no excuse for any highly-educated doctor to place trust in pharmaceutical company representatives, who are salespeople at heart.
If we accept the argument that these doctors were misled, then it must be asked how someone who spent 4 years in medical school and at least an additional 3 years in postgraduate training could be so ignorant about opioids.
King adds that an increase in opioid prescriptions was not followed by a corresponding decrease in the number of people suffering pain, which should have tipped off doctors that the drug was not having the intended effect.
Furthermore, when doctors say no one could have foreseen that patients prescribed opioids for legitimate pain complaints might end up abusing them, they fail to note that research published more than 25 years ago was already reporting problems with opioid analgesics.
So to fulfill my duty as an American and a physician who practiced internal medicine for over 20 years and was faced with many patients with real pain and many drug-seeking patients, allow me to place blame for our current opioid crisis and provide a roadmap for further investigation.
We overprescribe opioids, just as we overprescribe antibiotics. But it is generally well meaning; we don’t want our patients to experience pain. But then we prescribe 30 or 60 pills when 5 or 20 would have been adequate.
Despite what Hirsch describes as a "well-meaning" effort, current estimates state that 4-20 percent of all prescribed opioid pills in the U.S. are taken for non-medical reasons. Well-intentioned or not, doctors are actively participating in furthering the opioid crisis by failing to do their due diligence when it comes to research and accurate dosages.