There’s only one way to end the opioid epidemic, and the White House isn’t talking about it
Linette Lopez March 29, 2017
There’s only one way to end the opioid epidemic, and so far – despite all the noise around Wednesday’s meeting of a White House commission on the issue – it doesn’t look as if the White House wants to touch it.
You see, what was discussed by the commission isn’t just a plan in its early stages; it’s a clear step in the wrong direction.
In a Wednesday press briefing following a meeting of this White House commission, the White House press secretary, Sean Spicer, blamed the crisis on “cheap heroin” flooding the market, and he credited President Donald Trump with already taking action against drug cartels. He framed the battle against the epidemic as one for the Drug Enforcement Administration and law enforcement.
If that’s what the White House is focused on, it has the situation all wrong.
The problem here isn’t with drug cartels; the problem is big pharma and its multidecade campaign to normalize the prescription and sale of highly addictive opiate pain medication. It’s usually only after prescriptions for this medication run out, or become too expensive, when addicts turn to cheap heroin.
If Trump isn’t going after big business, he’s not going after this problem. Period.
Since the 1990s, big pharma has paid off doctors to encourage them to write prescriptions for opioid painkillers, it has generated studies that made the effects of these drugs seem way less destructive than they are, and it has greased the wheels of the US healthcare system to make insurance payments easier to collect.
Here’s an example of this behavior. Last month two Alabama doctors were found guilty of making millions by running an opioid “pill mill.” They were getting patients addicted, overcharging them and their healthcare providers for treatment, and accepting payments from Insys Therapeutics, a maker of fentanyl.
Centers for Disease Control and Prevention
Another one: In 2009, the American Geriatrics Society created guidelines recommending that doctors use opioids to treat all kinds of pain. Of the 10 experts on the panel, however, at least five had ties to big opiate producers.
You may recognize some of the names in this game, and you might not: Purdue, Janssen/Johnson & Johnson, Insys, Mylan, and Depomed, to name a few.
More companies are involved in the rise of the opiate crisis, but those five are a start. At least, they’re a starting point for Sen. Claire McCaskill, the Missouri Democrat who on Tuesday announced an investigation into the marketing practices of companies that manufacture opioids and the drugs that are meant to treat opioid overdoses. According to the press release announcing the investigation, McCaskill requested from those five companies:
- Documents showing any internal estimates of the risk of misuse, abuse, addiction, overdose, diversion, or death arising from the use of any opioid product or any estimates of these risks produced by third-party contractors or vendors.
- Any reports generated within the last five years summarizing or concerning compliance audits of sales and marketing policies.
- Marketing and business plans, including plans for direct-to-consumer and physician marketing, developed during the last five years.
- Quotas for sales representatives dedicated to opioid products concerning the recruitment of physicians for speakers programs during the last five years.
- Contributions to a variety of third-party advocacy organizations.
- Any reports issued to government agencies during the last five years in accordance with corporate integrity agreements or other settlement agreements.
AP Photo/J. Scott ApplewhiteSen. Claire McCaskill.
“All of this didn’t happen overnight – it happened one prescription and marketing program at a time,” McCaskill said in the statement. “The vast majority of the employees, executives, sales representatives, scientists, and doctors involved with this industry are good people and responsible actors, but some are not. This investigation is about finding out whether the same practices that led to this epidemic still continue today, and if decisions are being made that harm the public health.”
Of course, the ways a White House policy could deflect blame for the opioid crisis away from the pharma companies have been out in the ether for a while, and no one has articulated them better than Sen. Joe Manchin of West Virginia.
Manchin, a Democrat, would have the government focus on the Food and Drug Administration’s classification of opioids, maybe have the agency slow down approval for new opiates, and have a “one-penny fee on every milligram of opiates that are produced and sold in America” to be collected for treatment.
As a side note, Manchin’s daughter Heather Bresch is the CEO of the drug company Mylan, one of the five companies McCaskill is going after.
Manchin also called marijuana the gateway drug to opioids.
This is a joke, and it’s an insult to the people whose “gateway” to addiction was a doctor who said these medications would be safe.
Please stop joking.
The Senator from ground zero of the opioid crisis has no idea what he’s talking about
Linette Lopez March 28, 2017
In fighting the opioid crisis that is taking lives across the country, it would be helpful if the Senator from ground zero of the crisis, West Virginia, knew what he was talking about when it comes to solving it.
But sadly, Senator Joe Manchin (D-WV) has demonstrated that he has little to no grasp of what’s causing and exacerbating the problem.
In an interview with STAT News, Manchin offered nothing but pithy solutions and ideological dog whistles to the White House. He talked about educating people about the dangers of the drug, decried marijuana as a gateway drug, and called for a “one-penny fee on every milligram of opiates that are produced and sold in America” to be collected for treatment.
That’s all very nice. But that’s all it is — nice.
Manchin said nothing of the true driver of the opioid crisis — the pharmaceutical industry’s greed and the lack of transparency in our healthcare system. What this requires is regulation, and there was none of that talk in Manchin’s interview.
And that’s sad, because West Virginia is the poster child for how big pharma used its power and influence to shove drugs down people’s throats. Addiction to opioids doesn’t start with marijuana. It starts with a doctor’s prescription, and in West Virginia, that has been all-too readily available.
Back in October, David Armstrong of STAT News wrote a mind-blowing report detailing how West Virginia health and insurance officials tried to slow the pace of prescriptions in their state, but were thwarted at every turn thanks to collusion between Purdue Pharma, the maker of OxyContin, and pharmacy benefits manager, Merck Medco (which is owned today by PBM giant, Express Scripts).
Here’s the short version of events: In early 2001 West Virginia coroners noted a big uptick in deaths related to Oxy. Since 1996 state spending on the drug had jumped from $11,000 to $2 million in 2002 as Purdue and its partners used office meetings, lunches and dinners to convince doctors of the wonders of the drug. Court records show that one surgeon was won over by a bunch of donuts and snacks arranged to spell OxyContin.
By 2004 officials had had their fill. So they asked their pharmacy benefit manager to limit prescriptions or slap a prior authorization on the drug. They were refused.
Merck would ultimately claim that it was trying to help officials, but internal memos from the company and from Purdue told a different story. The two companies were in league together.
From STAT: “Contrary to the picture of helpfulness and cooperation Purdue attempts to paint, Purdue’s employees were actively and secretly trying to prevent West Virginia from imposing any control on the sale of OxyContin,” the state claimed. The case with Purdue was settled in 2004 when the company paid $10 million to West Virginia. Portions of the case file, including documents about marketing of the drug and Purdue’s attempts to ward off limits on prescribing, remained sealed until STAT filed a motion in May to open the records.
Senator Manchin, this isn’t about marijuana, and it’s not about how opioids are classified by the federal government, but it is about pennies — a lot of them. It’s about greed.
He should be more familiar with the business. Manchin’s daughter, Heather Bresch, is the CEO of Mylan. Her company is best known for jacking up the price of life-saving EpiPen anti-allergy medication, but it also manufactures naloxone, a drug meant to treat opioid over-doses. In June, the Senate Committee on Aging demanded that Mylan explain eye-popping price moves for that drug.
So maybe Senator Manchin does know more than we’re giving him credit for. If he does, though, he’s holding it really close to the vest.