An increasing number of the people in the United States are falling into the hole of opioid addiction. Although most people blame addiction on the individuals who become addicted, it is important to focus on the companies that are making millions off the crisis. These companies are arguably responsible for the opioid epidemic and the increasing number of addicts and overdoses on drugs such as OxyContin. Drug companies such as Purdue Pharma, Depomed, and INSYS Therapeutics that produce opioid medicines have immense power over this issue, and their aggressive marketing of the drug is a big part of the reason it became so widespread. The companies behind the manufacturing, marketing and distribution of opioids in America are to blame for a large part of the opioid epidemic as they falsely advertised the drug and played down the addictive side effects of the drugs as well as controlling the perception of the drug through financial motivation.
Up through the early 1990’s, there was little issue with opioids. They were prescribed sparsely and only when absolutely needed. In the early 1990’s there was a shift to the importance of treating patients pain. Doctors and nurses first focus became treating pain by having patients rate pain and prescribing drugs in response then the issue. Then they treat the initial issue for the pain. This shift in pain was lead by neurologist and pain specialist Russell Portenoy also known as the “King of Pain” (Gale). He “proclaimed that the risks of addiction to opioids were minimal and that not treating pain was cruel and even amounted to medical negligence” (Gale). This mindset, supported by a study done by Porter and Jick “that stated that only 1% of patients treated with narcotics became addicted,” was the tipping point and the start of the rise of the epidemic(Gale). In recent years, the study has been disproved as it only looked at addiction within a hospital, not outside of the hospital. Portenoy has aldo come out stating that many of the speeches and claims he made regarding the addictive properties of opioids were false, yet the opioid epidemic still continues to spread, killing over “200,000 Americans over the past two decades”(Hoffman). This spread continues to be influenced in large part by the companies in charge of the drugs.
To fully understand how drug companies gained so much power on the medical field, it is important to look at a supreme court case that took place in 1972. The supreme court case known as Goldfarb “ruled that Medicine (and Law) were no longer to be considered learned professions but were to be considered ordinary purveyors of commerce” (Gale). Based on this decision, the Federal Trade Commision was able to win a lawsuit against the American Medical Association and remove the restatement of the Hippocratic Oath. The Hippocratic Oath is one of the major indicators of Ethics in medicine, and without it, the door opens for medicine that is driven not by the desire to help patients, but the desire to make money.
People are attracted to money and doctors are no exception so when major companies offer them money, “more than 68,000 physicians” accept resulting in “about $46 million in non-research payments” (Zezza). A large part of these payments come from opioid companies. Opioid companies offer money to doctors to prescribe their drugs which leads to an increase in prescriptions written. Some of these prescriptions are needed, but with the benefits doctors receive from excessive prescribing, not all of them are. A study in New York found that by simply offering ten dollars worth of benefits, the opioid companies made one hundred dollars extra from prescriptions. (Zezza) On top of the basis of doctors making money off prescriptions, the longer amount of time a doctor works with an opioid company, the more money they make. “Physicians who received opioid-related payments in 2014 and 2015, but not in 2013, received…payments…amounting to about a mean of $251. Physicians who received payments in 2015, but not in 2013 or 2014, received…payments totaling a mean of $40” (Zezza). With this increase in money within payments, the doctors were shown to write more prescriptions, write prescriptions for more expensive drugs, increase the amount a patient should take, or decrease the time interval between each dose and therefore increasing the amount a patient would take (Zezza). This is an issue within the medical field, but it is also an issue within the business of drugs and is likely to blame for a part of the epidemic. Opioid companies control more than just the drugs manufactured, they control the way in which doctors prescribe them and the more a doctor prescribes, the more money the companies make while more people get addicted.
On top of directly providing financial incentives for doctors to increase prescriptions, drug companies also assist greatly in the financing of research related to pain management. This research is often published in highly accredited Medical Journals and thought of as fact. Although this knowledge is known in the medical field, the only response to it is to make publishers provide information of possible conflicts of interest in the article. Unfortunately, this has changed little as doctors do not have the time to do background research into every drug and every study. This has been seen to have a large impact on the research that comes out and the way in which drugs are prescribed. For example, Purdue Pharmaceuticals falsely advertised the addictive properties of OxyContin and was able to get away with it, leading to thousands of prescriptions. Drug companies have also covered up research that would lead to a decrease in sales such as the research that “shows that opioids are not effective in most non-cancer chronic conditions causing pain” as well as the research showing “that patients receiving opioids long term can develop both tolerance and hyperalgesia or increased sensitivity to pain” (Gale). Unfortunately, the money that these drug companies are providing is a big enough deterrence for any change in the medical field.
It was not until 2017 that investigation began to arise regarding the drug epidemic. One of the first major investigations was lead by Missouri Senator Claire McCaskill. The investigation she opened, looked into whether the companies Mylan, Depomed, INSYS Therapeutics, Purdue Pharma, and Johnson & Johnson’s Janssen division “marketed their opioid painkillers in a manner that may have contributed to the nation’s opioid epidemic” (Lyon). She looked at a variety of factors such as the studies done, the marketing of the drug and financials of these companies. In a conference call, McCaskill stated: “We want to get to the bottom of why all of a sudden opioids have been handed out like candy in this country”. She brings up multiple examples of times when these drug companies were able to brush the negative effects of their drugs under the rug such as INSYS Therapeutics, who manufactures a fentanyl spray (Subsys), failing to mention the knowledge that “if you can keep [patients] on [Subsys] for 4 months, they’re hooked” (Lyon). As well as INSYS, she brings up the criminal charges that three member of Purdue’s executive board plead guilty to regarding the misbranding of OxyContin. All of these were hushed and doctors keep prescribing these drugs.
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