Cracking down on opioid suppliers

Though opioid deaths have subsided slightly from their record high levels in 2017, addiction and overdose are still sweeping the nation.  Thankfully, our city, state, and federal governments are fighting back.  Policy proposals have tightened regulations and increased the availability of medication-assisted treatment (MAT).  Our criminal justice system has begun to pursue alternative treatment programs where possible to help those struggling with substance use overcome their addictions. 

States have also chosen to fight back through their Attorneys General, filing lawsuits against firms who make, distribute, and market opioids to hospitals and pharmacies around the country.  Charges range from deceptive marketing to working with pharmacies to thwart inspectors and regulators.  And the courts are siding with the plaintiffs: distributors including McKesson and Cardinal have paid out millions in settlements, as have drug manufacturers such as Perdue Pharma and the Reckitt Benckiser Group (RB Group).

Does America have a prescription problem?

The problem doesn’t end with the companies at the top of the ladder.  Pharmacies are also coming under scrutiny for excessive orders of opioids, and many doctors have been arrested for overprescribing the drugs.

How was it that things got this out of control?

Before the opioid crisis came into the public eye, there was little attention to restrictions and regulations.  The Drug Enforcement Administration has insufficient resources to track all opioid sales, as do state-level agencies.  Distributors themselves either lacked internal mechanisms to flag suspicious activity or knowingly ignored and overrode such warnings.  As a result, pharmacies stocked opiates at levels that far exceeded reasonable demand. 

Today, the United States accounts for over 80% of opioid pill use worldwide.  Prescriptions for opioids have increased fourfold since 1999.  And opioids, including heroin, began causing a larger percentage of overdoses in the US during that time.

The problems set in when these drugs reached their final targets: patients in need of pain relief.  After being reassured by drug manufacturers that medications such as oxycodone were not addictive, doctors began to prescribe opioids whenever they could to reduce patient pain.  And, despite the manufacturers’ guarantees, prescription opioids are misused by around 25% of patients, and more than 10% go on to develop an opioid addiction.  Studies have also shown that family members of these patients are more likely to overdose on opioids than those whose loved ones do not have a prescription.  These statistics have led some lawmakers to suggest increased security measures on the pill bottles themselves.

It’s clear that the flood of opioids into patient hands has been a factor in the rising rates of addiction and overdose.  The question of whether this problem can be solved through our court system remains unanswered for now.

Court cases won’t stop Big Pharma

Though the settlements ordered by courts have yielded nearly a billion dollars, that money is a drop in the bucket compared to the profits of many pharmaceutical giants.  Even for companies like Insys, which filed for bankruptcy after having to pay out a large settlement, the fight isn’t over.

Insys is trying to use bankruptcy protections to protect themselves from having to defend themselves against thousands of lawsuits filed against them.  Perdue Pharma has considered doing the same, hoping that internal changes will be enough to protect them from having to shut down completely.  Meanwhile, the larger firms continue to pump out opioids as fast as they can, unwilling to let their cash cow go.

Will decreasing prescription rates decrease overdose?

The scientific community is split on whether decreasing access to opioids will help or hinder the fight against this crisis.  On the one hand, there is clear evidence linking the prevalence of prescription opioids with the rise in opiate addiction and overdose rates.  On the other, current users have developed a dependence on prescription opioids may turn to more dangerous options like heroin or fentanyl.

However, with prescription rates vastly outpacing those in the rest of the world, America can protect patients by finding other solutions.  Opioids have limited effectiveness for pain relief, as patients’ tolerances rise quickly.  Plus, the longer patients take opioids (or the higher dosages prescribed), the more likely they are to develop an opioid use disorder.  This combination is putting patients, especially those who need long-term pain relief, in a place where opioid misuse and addiction becomes more likely.  For these individuals especially, a better solution is needed.

Opioids are only one tool when it comes to treating pain

With doctors facing limits when they prescribe opioids, other pain management techniques are having a renaissance.  Non-drug-based options such as physical therapy, acupuncture, and the like may help some patients go prescription-free.  In other situations, where prescription painkillers are needed, doctors have literally hundreds of options to choose from.

This pivot to a highly-individualized response rather than a one-size-fits-all prescription may tax doctors’ already busy schedules, especially given their lack of training on pain management.  It is also much easier to prescribe a painkiller than it is to identify the root cause of any pain—which may be psychological rather than physical.  The higher time investment is likely one of the reasons behind medical professionals’ choice to prescribe opioids so frequently. 

Doctors may have also found that prescribing opioids helped increase their finances.  Insurance pays much more on average for primary care than for behavioral care, meaning services can be billed at higher rates.  It also pays for doctors to fit in as many patients as possible each day, which disincentives the longer consults necessary to craft a personalized plan for patients.  The overprescription of opioids may have been as much a systemic problem as anything else, and further changes will be needed to encourage responsible and appropriate prescriptions.