The Definition: Opioids
"Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia." -- Hugh C. Hemmings, BS, MD, PhD, Talmage D. Egan, MD.
A little background on the opioid crisis...
America is in the throes of the worst drug epidemic in its history. Since 1996 opioid-related deaths have driven the overall statistics and have ravaged the lives of millions of people across the nation. In 2017 alone, an estimated 1.7 million individuals in the U.S. suffered from substance abuse disorders related to opioid consumption, while 47,600 died of an opioid overdose. That’s around 130 deaths per day and represents a fivefold increase from 1999 when the number of opioid deaths stood at 8,048.
For decades, drug overdoses in the U.S. had roughly been in line with those of other wealthy nations. But, by 2015 the U.S. had the highest drug-related death-rate in the world.
Those numbers are pretty high. How did it all start?
This question is hotly contested. But many people look to Purdue Pharma and the launch of OxyContin in 1996. Like morphine, OxyContin is used for pain relief in patients. However, the pill is twice as strong but was aggressively marketed to doctors as a miracle drug that could relieve patients of pain for 12 hours (more than twice as long as generic medications), with a virtually negligible risk of addiction. Other companies quickly followed suit and began producing similar prescription pain medication.
We have seen three big waves in terms of the deadly impact wielded by opioids. This first initial surge in overdose deaths occurred in the late 90s and was followed a few years later, in 2000, by a second wave of deaths caused by an influx of heroin that suddenly flooded the illicit drug market. Why? Because now you had a growing slice of the American population who were addicted to opioids, and drug dealers were quick to exploit that. Heroin had a similar effect to OxyContin, and other prescription opioids, but could be sold as a cheaper or more readily available alternative for people who had been taken off of their prescription.
Then fentanyl hit the black market and with it a third wave of drug overdoses occurred just a few years later. The fully synthetic opioid initially developed as a potent anesthetic used to treat people in extreme pain, such as patients with terminal cancer, is 100 times more powerful than morphine. And thus, much deadlier when misused. According to government stats, Fentanyl caused more than 28,400 deaths in 2017, precipitating the sharpest increase in overdose-related deaths.
Has the federal government stepped in to help?
Well, sort of. In his first State of the Union Address, President Trump said his administration was “committed to fighting the drug epidemic and helping get treatment for those in need”. Then, in 2017, he declared the opioid crisis a public health emergency and has since gone on to sign abipartisan bill to tackle the epidemic (SUPPORT for Patients and Communities Act - October, 2018) and introduce an omnibus bill that added $3.3 billion to combat opioid and mental health issues.
What about local government? Is anything happening there?
Yes. That’s where the action is really happening. There are now lawsuits taking place across the nation, in which 2000 local, state and tribal governments are suing the drugmakers responsible for creating different types of opioids, and attempting to recoup the billions of dollars that has been spent on trying to address the human cost of opioid addiction. At the center of these lawsuits isfederal data showing how the crisis has unfolded year on year. Until recently, this data was kept private, but last month U.S. District Judge Dan Polster agreed for it to be released following a campaign headed by the Washington Post and HD Media demanding that it be made public.
So what does this data show?
A lot. In legal cases across the country, certain pharmaceutical companies have deniedresponsibility for America’s burgeoning opioid crisis, arguing that they have simply provided what are, they’ve continually reminded us, government-approved drugs. It has been the responsibility of doctors to prescribe appropriately. But a wealth of data from numerous of these lawsuits has recently been released, contradicting the pharmaceutical companies’ claim that they have been mere bystanders to this unfolding crisis. Instead, the data shows how very significant a role manufacturers, distributors, and pharmacies played in saturating the market, and specifically rural, working-class communities, with prescription painkillers.
The data reveals, amongst other things, that between 2006 - 2012, 76 billion opioids were distributed to pharmacies and practitioners across the U.S., the number of pills distributed in 2012 was 50% greater than that of 2006 (increasing from about 8.4 billion in 2006 to 12.6 billion in 2012), and that some communities (including West Virginia) received enough pills for every single person living in that community to have more than 100 pills per year.
The data also shows that the places that received the most prescription opioids had the highest rate of opioid overdoses and, even as the number of these deaths rose, so too did the amount of drugs that were sent to pharmacies. During that period, prescription drugs were linked to around half of opioid-related deaths.
The data further identifies the three main producers of opioids as SpecGX, Par Pharmaceutical and Activis Pharma, who together made around 9 in 10 opioid pills delivered to pharmacies. Purdue Pharma, whose name is often at the center of reporting around the opioid crisis, produced only 3% of the pills in this period.
Right, so what about the lawsuits?
The first federal trial is scheduled for October. Plaintiffs in the lawsuits argue that Purdue, followed by other big pharma companies, were responsible for persuading doctors to overprescribe opioids and want the company held to account. We wait and see.
What the Candidates Say On the Opioid Crisis:
Elizabeth Warren has pledged $100 billion to tackle the crisis over the next ten years. Labeled the CARE Act, her plan is designed to cover every aspect of care: from preventing addiction, to harm reduction, to giving additional support to people to stay clean.
Amy Klobuchar has also put forward a $100 billion plan, which focuses more broadly on addiction and mental health issues. She proposes paying for the plan by placing a 2% tax on opioid ingredients, which the drug manufacturers would pay for.
It Started With Good Intentions
In 2012, doctors in the U.S. wrote 259 million prescriptions for opioid painkillers… that's enough to provide every single U.S. adult with 30 days of the drugs.
So how is it that an epidemic can go on for 20 years; cause hundreds of thousands of fatalities; and begin under Clinton, but remain unaddressed by a U.S. President until Obama’s final year in office?
These were the questions that led Guardian reporter, Chris McGreal, to delve into the heart of the biggest drug epidemic in modern history: America’s opioid crisis.
In this episode, McGreal discusses how, as with so many tragedies, it started with good intentions…
And Then The Market Was Flooded…
Between 2007 and 2012, 9 million hydrocodone pills were supplied to a town in West Virginia… of 392 people. Was every man, woman and child really consuming 12 pills a day for those five years? Of course they weren’t.
In this episode we learn about the pharmaceutical distributors who flooded the U.S. market with prescription pills, and what happened when one man tried to stop them: ex-DEA officer, Joe Rannazzisi.
The Wrong Response
When Michael Jackson died in 2009, leading healthcare attorney, Harry Nelson, received an anxious call from a doctor who had been prescribing the singer drugs. After learning that another of Jackson’s physicians was facing criminal charges for providing the singer with the cocktail of drugs eventually linked to his death, the doctor worried the law would be coming for him next. A few days later he took his own life.
In this episode, Nelson discusses the unintended consequences caused by the DEA’s attempt to tackle America’s opioid epidemic, and the ‘climate of fear’ he thinks has now been instilled in the minds of physicians across the country as a result.