The Irony of Opioids

In early September, Purdue Pharma tentatively settled lawsuits with thousands of municipal governments and almost two dozen states. Purdue, the plaintiffs argued, had deceptively marketed Oxycontin, an addictive opioid, fueling a nationwide epidemic of dependency and overdose. The agreement stipulated that the company would file for bankruptcy, then create a public trust and pay plaintiffs with its profits. They would also donate addiction-treatment and overdose-reversal drugs to afflicted counties. Finally, the Sackler family, owners of Purdue, would pay out $3 billion of their personal fortune over seven years.

Jurisdictions around the country, from cities to Native American tribes like the Cherokee Nation, are attempting to hold pharmaceutical companies, drug distributors, and pharmacies like CVS and Walgreens accountable for their role in America’s “opioid crisis.” Of the 70,000 overdose deaths in 2017, close to 70 percent involved opioid drugs. And though most of these deaths were caused by illegal opioids, the connection to the medicine cabinet is apparent: nearly 80 percent of heroin users used prescription drugs (nonmedically) first.

In August, Johnson & Johnson was ordered to pay $572 million to the state of Oklahoma; Purdue paid out $270 million to the state earlier in 2019. In October, four companies tentatively settled with Ohio, which, in 2017, had the second-highest number of opioid-overdose deaths in the United States.

Across all these cases, the allegations are consistent. Drug manufacturers aggressively sold their drugs, now-household names like Percocet and Vicodin, and encouraged doctors to overprescribe them: to patients with chronic back pain, to kids after wisdom-teeth surgeries who could have just taken ibuprofen.

One report estimates the economic impact of the opioid crisis—taking into account lost human “productivity,” plus health care, substance-abuse treatment, and criminal-justice costs—at $2.5 trillion between 2015 and 2018. In light of that expense, are pharmaceutical companies paying enough? Twenty-five state attorneys general refused to sign the Purdue settlement, demanding that the Sacklers pay out an additional $1.5 billion, sell Purdue’s sister company Mundipharma immediately, and stop producing drugs for international markets. In December, an audit revealed that the Sacklers had stashed nearly $10 billion in trusts and overseas holding companies over the past dozen years. Johnson & Johnson’s $572 million payment will fund Oklahoma’s recovery plan for only one year, while state officials say the recovery will take twenty.

Meanwhile, the problem these drugs were deployed to address hasn’t been solved. Americans are complaining of more chronic pain; we’re sicker than other developed nations. We’re more obese, thanks in part to the sugar lobby. We’re more anxious about work (studies show opioid use increases during economic downturns). Our insurance often doesn’t cover alternative, long-term treatments, like physical therapy, for conditions like back pain.

Of course, some patients need opioids. Last year, the CDC had to clarify its 2016 guidelines over concern that they were being used to deny needed drugs to patients  with cancer or sickle-cell disease (ten times less likely to die from opioids than the rest of the population). Non-addicted patients who rely on high doses of opioids are suffering dangerous withdrawal symptoms, as panicked doctors put them on “forced tapering ” plans.

Meanwhile, Mundipharma—Purdue’s international affiliate, also owned by the Sacklers—is selling the nasal spray overdose treatment naloxone abroad. The family is profiting by treating addictions to their own drugs—a darkly ironic indication of the extent of corporate greed, and the powerlessness of individuals in the face of it.