The Purdue Pharma settlement gave family members of people who were harmed by opioid prescribing the opportunity to confront Purdue family members, a dramatic spectacle that represents some measure of justice but casts blame for the disaster of the opioid epidemic on one family. That is not the whole story, or really a true story.
Prior to the 1980s, opioids were generally prescribed in the U.S. only for short-term use, after surgery or severe injury, or for people who were terminally ill.
In the 1980s, for reasons which are not entirely clear, attitudes in the medical profession began to shift and physicians began to treat chronic pain with opioids. States even passed laws to shield physicians from prosecution for prescribing them. In 1985 the American Pain Society, a physicians’ association, launched what they called “Fifth Vital Sign” campaign to encourage the profession to monitor patients for pain as routinely as they monitored blood pressure and heart rate, and to prescribe opioids.
It seems an inadequate explanation, but some people trace this shift to a letter to the editor in The New England Journal of Medicine published in 1980, which asserted that of 11,882 people who were prescribed opioids in a Boston teaching hospital, only 4 became addicted. The letter gave no credible evidence for this claim, and in any case it is irrelevant to the issue of long-term prescribing for chronic pain. A study published in 1986, based on only 38 people, claimed that prescribing for chronic pain was safe and effective. On this very flimsy evidence, it became conventional wisdom that opioids were not addictive only when to treat pain.
Not surprisingly, pharmaceutical manufacturers jumped on this development to create new products and aggressive marketing campaigns for them. The most notorious is Purdue Pharma, which developed a timed release version of an old drug, Oxycodone, called Oxycontin, which they claimed was particularly safe and not subject to misuse. In order to keep their licenses, physicians have to take what are called Continuing Medical Education courses, which are not really courses but two or three hour workshops. Purdue developed and funded these, as well as sending salespeople to visit doctors and tout the product.
Over time it became evident that some people who are prescribed opioids do become dependent on them, producing a catastrophe. In 1999, the death rate from opioid overdoses in the U.S. was 2.9 per 100,000. In 2019, it was 15.5, nearly 50,000 individuals. Initially, the increase was largely attributable to drugs available by prescription, which were associated with 1 death per 100,000 in 2019, but steadily increased until 2017, to 4.4.
But as you can see, that doesn’t account for the bulk of the increase in the later years. People who became dependent on prescribed opioids often found that they could not satisfy their addiction with prescribed drugs and began to buy illicit drugs on the street. They would buy prescription drugs diverted to the illegal market, and also heroin. To increase their profits, criminal syndicates began to mix heroin with much more powerful synthetic opioids, notably fentanyl. People thinking they were using heroin but who are actually consuming fentanyl can receive a fatal overdose. Deaths per 100,000 from overdoses of fentanyl and similar chemicals increased from just 0.3 per 100,000 in 1999 to 11.4 in 2019, or more than 36,000.[1] In 2020 and 2021, there was a further discontinuity. During the Covid 19 epidemic, deaths from opioid overdose jumped to more than 68,000.[2]
Of course, not everyone who uses illegal opioids and not
everyone who dies from overdose began by taking prescription medications. As
there was a growing market for illicit opioids and more people using them, the
epidemic spread to some extent by social contagion, amplifying the iatrogenic
epidemic. So this is a complicated story, that tells us as much about the medical profession and organized crime as it does about corporate greed.
[1] National Center for Health Statistics data brief 394, December 2020.
[2] NIDA Trends and Statistics Overdose Death Rates https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates
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3 comments:
I know this is completely off topic, but I just don’t understand how anyone can be as complete a traitor and just-plain-fucking asshole as Joe Manchin.
If I were a mathematician in 2022, my work would center on the conundrum of ameliorating the effects of the one jerk in the concert hall who decides to cough in a pianissimo section, the one idiot driving recklessly on a highway who has a crack-up and inconveniences 100,000 people, the one senator in a Democratic Party who is committed to torpedoing not just every progressive plank in his party’s platform, but the best interests of the people in his own state and elsewhere.
With Pyooteen’s megalomaniacal invasion of Ukraine, we once again see the horrific effects of one asshole on the rest of the world. We need to find a way to deal with the biggest assholes in the world. Most people just want to get along, but we need to have a way to put assholes in their place.
While I share your frustration about Manchin, don't forget that there are 50 Republican senators. If there were only 48, Manchinema wouldn't matter.
Well then, we need to get rid of two Republican senators. And then, of course, right-wing conservative lobbyists will put pressure on another Democratic senator, trying to line their pockets so they also will be a traitor to their party and country.
I suppose the real problem is interest politics and the lobbyist system.
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