April 7, 2020

The Problem in the Mirror

By Stephen Tuttle | May 26, 2018

Thank goodness our politicians have found the villain in the opioid crisis and overdose epidemic: It's the drug companies or the drug distributors. Honestly, we didn't much care about this when the fatality was some homeless person under the Cass Street bridge. Now that it's visiting every neighborhood, we've decided to take it seriously.

According to the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC), there were more than 64,000 drug overdose deaths in 2016. It's nearly twice as many as die in traffic accidents or by gunfire. More than 6,000 of those deaths were children 18 or younger. 

Two-thirds of those were the result of heroin, fentanyl, or a combination of both. 

Fentanyl is the newest and deadliest addition to the heroin trade. Developed in 1959 as a surgical anesthetic, it is 50 times more powerful than heroin. When the two are mixed together, the combination simply shuts off your brain. It can happen so fast many overdose victims are found with the needle still in their arm.

Several states have now sued various opioid manufacturers and distributors, claiming  false advertising led to over-prescribing of drugs, or that distributors either knew or should have known something suspicious was in the air when they were shipping millions of pills to counties with a few hundred people. 

The false advertising claim being raised in some of what are now hundreds of lawsuits against the manufacturers is pretty straightforward. Manufacturers claimed their drugs were an effective treatment for long-term chronic pain and spent millions encouraging doctors to prescribe them and patients to use them. But there isn't any published, peer-reviewed research indicating that's true. Long-term users of opioids typically develop a tolerance requiring ever-higher doses and more refills. The most likely result is dependency and addiction. 

Additionally, manufacturers significantly understated the likelihood of dependency and addiction, not to mention the significant overdose danger. At least that's what the lawsuits claim. 

The manufacturers respond that their drugs are safe and effective, with very few adverse  effects, when used as prescribed in the recommended dosage. 

Some settlements have already been made — most without the defendants acknowledging wrongdoing. Even a few executives have been convicted on criminal charges. But the states aren't looking for justice, they're hoping for a financial windfall similar to what they received from the tobacco settlement.

If drug companies make multi-billion dollar settlements it will sting their cash reserves and their insurance companies. It will also be a pretty good excuse for increasing the prices of their products. It will certainly change their marketing strategies. It won't do much else. 

The lawsuits will do absolutely nothing to halt the proliferating black market manufacture and distribution of opioids. In fact, if legitimate pharmaceutical houses produce less the black market will produce more. If legitimate prescriptions cost more it makes black market alternatives more attractive.

The lawsuits appear to hold harmless unscrupulous doctors consistently over-prescribing so it will not stop that. Some of the over-prescribers have been hit with civil suits, some have lost or surrendered their license and a handful have been criminally prosecuted. But some of the small percentage who value dollar signs over patient well-being are still out there.

It won't do a thing to stop a heroin epidemic that represents a third of all overdose deaths.

It won't stop Americans, who consume more than 80 percent of the world's opioid pain medications and nearly all the oxycodone, from begging their doctors for “a little something for the pain.” We are awash in prescription drugs here unlike in any other country. Fully 60 percent of American adults take prescription medications, and even 11 percent of children under 12 are on prescription meds. 

It won't stop Mom and Dad from leaving their extra pain meds in the medicine chest, mostly forgotten, where junior has access to them. 

The unpleasant truth is we bear at least much responsibility as the drug makers and everyone else in their supply chain. Prescription drugs are part of our culture; we accept them and in many cases demand them.

We did the same thing with antibiotics until we discovered their overuse had created bacterial nightmares that kept evolving to the point there are now those we can't stop at all. 

Some doctors and pharmacies have now started restricting opioid prescriptions. That will help more than the lawsuits. The awareness campaigns now in motion will also help. When Americans start to realize every ache and pain does not require a prescription pain medication, that will help even more. 

Making the drug companies write big checks won't solve much. Our need for a pill to fix everything in our lives is the real cause of this problem. The solution is in our mirrors, looking back at us. 




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