America is Addicted: States Take Action Against Opioid Epidemic
“I didn’t even know I was addicted,” he said. He took a pause before choosing his next words carefully.“I just thought it was like anything else.”
That’s what a source, who chose to remain unidentified, said in a brief interview with The Politic. He’d been struggling with addiction for the past several years—and unlike more common addictions, such as those to alcohol or nicotine, this patient is addicted to something much more sinister: opioids.
Opioids have pervaded the United States over the past several decades, with an estimated 2 million people in the United States having a substance abuse disorder related to prescription opioid pain medication, and an uncountable number battling an addiction to non-prescription illegal opioids, according to the American Psychiatric Association. This number has skyrocketed since the 1990s: since one of the most potent opioids, oxycodone, was legalized by the Food and Drug Administration for clinical use, nearly 20 million people are estimated to have suffered from some form of opioid addiction since the year 2000, according to a report by the Center for Disease Control (CDC). As a result, popular media coverage of this crisis of addiction, as well as healthcare providers and health nonprofits, have dubbed this “The Opioid Epidemic.”
And indeed, America is sick. Opioid addictions are on the rise, according to the CDC, as well as overdoses and associated mental and physical repercussions of a dangerous addiction. And as the Hospitals & Health Networks Association phrased it in a report published a few years ago, “America is Addicted, [and] we’re the Generation at Risk.”
But, as the Opioid Epidemic rises, so are new strategies to combat it.
California, Hawaii, Maine, and the District of Columbia recently filed lawsuits against the mega-pharmaceutical giant Purdue Pharma—raising the number of states taking action against the OxyContin manufacturer to 48, and the total number of lawsuits filed against the company to nearly 1,200. These new lawsuits allege that the pharmaceutical company was not only explicitly aware of OxyContin’s highly addictive properties, but at the time of the drug’s release into the market, was knowledgeable of OxyContin’s ability to create drug dependency in the majority of subjects it was tested on in preliminary clinical trials. The states allege that information on these properties of OxyContin was deliberately withheld from the general public, not only in order to market the drug as safe, but to deceptively create a dependent base of patients who would repeatedly have to purchase the drug throughout their lives. However, as public health nonprofits like the Addiction Center allege—what Purdue Pharma didn’t anticipate was the resulting opioid crisis, the proliferation of illegal opioids and narcotics, and the trail leading back to Purdue. “They just couldn’t cover their tracks” said Massachusetts Attorney General Maura Healey in a press release in January 2019 about the lawsuit her state filed against the company.
Pennsylvania, in its press release following a lawsuit filed last May, alleged that the company was deliberately marketing OxyContin to the elderly and veterans, people who are more likely to be taken advantage of with a highly addictive drug. The report cites instances where representatives of Purdue Pharma would visit Veterans Hospitals upwards of a dozen times in one week, badgering doctors into adding OxyContin to their list of treatments to use on veterans with debilitating chronic pain or disabilities. Similar circumstances were seen at nursing homes, where OxyContin was alternatively marketed to geriatric caretakers as a palliative drug for elderly patients with a chronic illness. “Purdue owes the thousands of Pennsylvanians who had their lives taken from them by drug overdoses,” said Pennsylvania Attorney General Josh Shapiro at a press conference on May 14 in Harrisburg, further adding that the Pharma giant “needs to stop making excuses, and finally take responsibility for their actions.”
But the Purdue Pharma seems to be sticking to the excuses; a quick Google search of “Purdue Pharma Opioid Crisis” returns some 510,000 results, but the entirety of the first page is populated with promoted advertisements redirecting to various pages of Purdue Pharma’s website. The top result is a short document titled “Get the Facts: Purdue Pharma and OxyContin.” This infographic pushes Purdue’s main defense to the allegations brought by the lawsuits filed against them: that OxyContin is safe, that OxyContin is not Oxycodone (the addictive pain-killing agent active in OxyContin), and that OxyContin is not responsible for the onset of the Opioid Epidemic. In fact, Purdue Pharma presents OxyContin as a “safe, medically controlled alternative” to some of the opioids and narcotics that someone would find on the street. They claim that these “non-prescription drugs,” as they tactfully call them, are what created the Opioid Epidemic in the first place: that these drugs arose in the 90s on the street and merely proliferated due to their highly addictive nature. OxyContin, as these reports published by Purdue Pharma allege, was merely swept up in a pre-existing epidemic that they are committed to combating as much as anyone else is.
However, that’s not what the Attorney Generals are saying in their new wave of lawsuits, at least not according to Maine’s Attorney General Aaron Frey. Frey, in a press release granted to The Politic in the immediate aftermath of his public filing of a lawsuit against Purdue Pharma, makes the bold claim that the pharmaceutical company was aware of the potential of the Opioid Epidemic arising from the release of a controlled yet highly addictive dependence-forming substance into the market, and that they had an invested interest in withholding the information pertaining to its addictive nature in order to get their company in the black. The lawsuit cites numerous psychological and medical studies done on patients addicted to both prescription and illegal opioids—which should be noted have no difference in their effect on the chemistry of the brain.
In these studies, researchers found that the majority of patients addicted to opioid painkillers first encountered the drug through legal means—by having it prescribed to them by a physician for a serious injury or pain condition, such as a car accident or major surgery. Patients were then taken off of the substance gradually as they recovered, just as a doctor would do with any other drug. However, OxyContin isn’t like any other drug: patients would form a chemical dependency in their brains for Oxycodone, the active agent in OxyContin. The Mayo Clinic, which charters a program focused on the rehabilitation of patients addicted to substances, explains that as a patient’s body “develops a tolerance to the drug, they need a higher dose to maintain the same relief or high. The transition from use to abuse to addiction can be a quick and dangerous road.” This is how hundreds of thousands of Americans have become addicted to opioids since OxyContin was first released in the 90s, and why even more of them are turning to street drugs like heroin, and more recently, illegally manufactured fentanyl. These drugs result in thousands of deaths every year—the CDC, in a report from 2017, reported that an estimated 494,000 people age twelve and over in the United States have used heroin in the past year, and in the same year, 81,326 of those people had to be admitted to intensive emergency care at a hospital due to a heroin overdose. And just this past Thursday, 25 people died from a fentanyl overdose in one hospital in Ohio.
Tackling an epidemic that’s as prolific as this will take a deliberate effort conducted on a massive scale: rehab centers will have to receive better allocative funding from state and local governments, hospitals in America’s urban centers will have to develop better capabilities to handle rising inflows of overdose cases, and alternative methods of addressing chronic and serious pain will have to be developed to avoid getting more patients addicted to opioid painkillers through prescriptions. A report from When Seconds Count, an organization of anesthesiologists, claims that the painkilling properties of regularly prescribing an opioid to a patient can be achieved with a special alternating regimen of ibuprofen and Tylenol, two over-the-counter painkillers that are virtually harmless compared to OxyContin. Steps towards overcoming the opioid epidemic are going to be hard, just as it’s challenging to overcome any type of addiction. But this can be accomplished, and it can be done through raising awareness and by passing new legislation to control not only the distribution of opioid painkillers, but the production and marketing of them to healthcare providers and the general public. This is why Attorney Generals across the country are persistently filing lawsuits against Purdue Pharma—they hope to send a message to both the pharmaceutical industry, as well as to the medical field, that America is at serious risk, and that it’s time, as Attorney General Shapiro said, “to take responsibility.”