The opioid epidemic has devastated communities and lives across the country, causing more than 250,000 deadly overdoses between 1999 and 2016. It’s easy to point fingers, and there are plenty of places to point. But the epidemic didn’t begin with greedy drug companies or reckless prescribers. It began with compassionate doctors trying to end the suffering of millions of people in pain.Since the new millennium, prescription painkillers, such as OxyContin, Vicodin and Percocet, have caused hundreds of thousands of drug overdoses. Illicit use of heroin and fentanyl has surged and devastated communities across the country. Doctors began prescribing drugs containing opiates at enormous rates in the late 1990s. After government crackdowns made the drugs harder to get, people addicted to the pills turned to a cheaper and more accessible alternative on the street. As a result, the number of people addicted to and overdosing from heroin increased significantly.
“They had the impression people were still scared of opioids. They thought they were still fighting the tide. What happened was they took over and became a tidal wave.”
“They were trying to stop kids from getting into grandma’s medicine cabinet. Nobody was asking ‘why does every grandma now have opioids in her medicine cabinet?’”
In the United States, we grow up using painkillers. Have a headache? Take an aspirin. Running a fever? Try some Tylenol. Sprain an ankle? Ice and ibuprofen. We get laughing gas when we have teeth pulled and powerful painkillers after surgery.It wasn’t always like this. People suffered from pain for centuries without reliable sources of relief. Severe pain was once treated with alcohol, chloroform or a number of herbal remedies. For most of the 1900s, physicians treated severe pain with high doses of less effective pain relievers, such as aspirin, ibuprofen and acetaminophen. The drugs rarely worked.
“If you read [the letter] carefully, it does not speak to the level of addiction in outpatients who take these drugs for chronic pain.”
By 1990, the pain management movement was gaining momentum. Opioid therapy for the treatment of cancer pain became more common, but some researchers believed opioids could be used for other forms of pain.They believed that the principles of the WHO’s cancer pain guidelines could be used to treat chronic, nonterminal pain such as arthritis, Meldrum said. In a 1993 interview with The New York Times, Portenoy said, “There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem.” In a 1996 interview, Foley talked about how the pharmaceutical industry was helping spread the word about a revolutionary approach to pain management, according to Quinones.
“There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem.”
Pharmaceutical companies have revolutionized the health care industry. They’ve developed medications that improve well-being and save lives. But the industry is not altruistic.“In some ways, they were actually rather slow to move into the field because the pharmaceutical company’s interest is in selling drugs at profit,” Meldrum said. “In order to do that they have to have a patent. Most of the opioids are not patentable. They’ve been on the market forever.” Before opinions on opioids changed, numerous opiate-based pain relievers were on the market.
“There is no doubt that the upper echelons of the marketing department were probably aware very early on that their formulation was subject to abuse.”
“He was ready to write anything. He didn’t even really care.”
“A lot of these people say, ‘Well, I was taking the medicine like my doctor told me to,’ and then they start taking more and more and more. I don’t see where that’s my problem.”
“I was with my first boyfriend, the one who introduced me to heroin, when he overdosed in my arms. It was a traumatic experience for me.”
Purdue launched an innovative product into the pain relief market at an opportune time for the company. It took advantage of the growing belief among many pain management experts that opioids could be effectively used to treat chronic, nonterminal pain.“Doctors had been prescribing cautiously because they worried about patients becoming addicted,” Kolodny said. “They were told that addiction was very rare and they were told the fear of addiction was irrational. The term opioidphobia was even used. That was very important for convincing the medical community to prescribe aggressively.”
“The term opioidphobia was even used. That was very important for convincing the medical community to prescribe aggressively.”
“The DEA was chasing down doctors who they thought were overprescribing opioids just as they had done for ages, and they were frequently chastised for doing so.”
We formed PROP because within our own organizations we all felt that the prescribing needed to change quickly and we understood that overprescribing of opioids was fueling a public health crisis.”
“We lost the house. We lost the business. We lost the car. We eventually lost [custody of] our child.”
In June of 2001, the state of West Virginia sued Purdue for inappropriately marketing OxyContin. It accused the company of hiding the drug’s addictive potential from doctors and using aggressive marketing tactics, which led to numerous West Virginians to become addicted.The state of Virginia began investigating Purdue the same year. The state’s attorney general realized that increasing numbers of Appalachian workers who were prescribed OxyContin after being injured on the job were dying from overdoses. West Virginia and Purdue settled the charges of the 2001 case out of court. Purdue agreed to pay a $10 million fine and to support law enforcement efforts and doctor education programs. But the company didn’t admit any wrongdoing in the settlement. Virginia gathered evidence for five years before filing its lawsuit against Purdue in 2006. That case eventually became a federal lawsuit that involved 25 states and the District of Columbia. Kentucky joined the lawsuit in 2007 after 484 people died from OxyContin overdoses in the state the year before. In May 2007, Purdue settled the federal case and three company executives plead guilty to misbranding and fraudulently marketing OxyContin between 1995 and 2001. The company admitted to falsely claiming OxyContin was less addictive, had lower potential for abuse and caused fewer side effects than other pain medications. It paid a $600 million fine, and the three executives agreed to pay $34.5 million in fines.
“The distributors could have stopped what was going on, but they didn’t. They were doing the bare minimum. Why would you want to cut off a customer that’s paying you $2 million a year?”
“Some of these same companies and nonprofit groups have continued to promote aggressive opioid use and continue to block federal and state interventions that could reduce overprescribing.”
More than 20 years have passed since Purdue began marketing OxyContin. We’ve known that increases in opioid prescriptions are associated with increases in opioid addiction and overdoses for more than a decade. For years, we’ve known that prescription drug addiction leads to heroin addiction in a significant number of people.But the problem is getting worse.
From 2013 to 2014, heroin overdose deaths increased by 26 percent across the country.
“We tend to have more overdoses than we do fires, so it’s a piece of equipment that we can’t go without now. Just like we have the hose.”
“There is no proof that these are effective at ending the opioid epidemic, and they’re just as addictive as the regular formulations.”
“I would cite six, seven, maybe 10 different avenues of thought or avenues of evidence, none of which represented real evidence.”
“Once I was free, I wasn’t getting sick and I was able to get into a shelter, I knew I didn’t want to go back [to heroin].”
During his final year in office, President Barack Obama made fighting the opioid epidemic a top priority for his administration. He requested $1.1 billion from Congress to fight addiction, and Congress passed the Comprehensive Addiction and Recovery Act of 2016 in July. The law authorized $181 million in new funding for prevention, treatment and recovery efforts.In December 2016, Congress passed the 21st Century Cures Act which included $1 billion to fight opioid addiction in 2017 and 2018. Obama signed it into law less than a week after it was passed. Earlier in 2016, the president appointed Agricultural Secretary Tom Vilsack to fight heroin and prescription drug abuse in rural America. The goal of Vilsack’s Rural Impact initiative was to bring jobs and educational programs to rural America to boost protective factors in those communities. Obama spoke with Grammy Award-winning artist Macklemore about the opioid epidemic in a 2016 MTV documentary. The goal of the documentary was to help raise awareness about opioid addiction and to inspire people to seek help.
“We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”
“They’re still quick to still prescribe them, even knowing the consequences and what’s happened to so many people.”
“If you get clean, everything can really get put back together. But it’s not going to be overnight.”
Published on: January 3, 2017
Last updated on: November 8, 2019
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