With such focus on Covid19, the US opioid pandemic has largely been ignored in the UK yet continues to destroy lives, devastate families and fracture communities and it worsened rather than lessened as Covid19 ravaged the US. The US Centre for Disease Control published provisional data recently showing that 2020 was a record year for drug overdose deaths with 93,331, up 29% from a year earlier.
500,000 deaths between 1999 and 2019 need to be explained so cities, states, counties and finally Federal authorities are taking legal action against those they view as the perpetrators and it’s not the Mexican Drug Cartels it’s the white-collar players of Corporate America, the very essence of the capitalist model. In the dock are; Big Pharma who manufactured and marketed the drugs, their advisers who provided the strategy, the wholesalers who distributed and the national pharmacy networks who supplied.
The general response from each of these groups on learning that legal action is being taken follows a similar pattern. Firstly they claim the opioid crisis is nothing to do with them. Their defence then moves to a “bad apple” manager who acted independently and has since been dealt with. Then there is a settlement with no acceptance of guilt and finally, reluctantly, an apology. There is a mess to clean up and each of the groups is at a different stage of contrition but they are all paying. Moral hazard has not protected them from the risks they took in seeking greater profits.
Big Pharma has been chastened with massive fines. A key player is Purdue Pharma who in the UK owns Napp. They set the fire burning by bringing to market OxyContin in the 1990s claiming, since it was a slow-release formulation, it could not cause addiction. There was no evidence for this claim yet they got a licence to market the medicine. Their marketing strategy focused on addressing a huge “unmet clinical need for pain treatment” since doctors traditionally avoided opioids due to addiction risk. It was an ominously successful strategy. Other manufacturers got into the game including Johnson and Johnson and Teva. Manufacturers are accepting a role in the opioid pandemic but once they controlled their product supply by shutting down the “pill-mills” the backfill came from the Mexican Cartels who supplied illegal heroin and fentanyl into affected communities with devastating effect. It is a tragic example of how, when you turn on a tap that has a faulty washer, turning it off does not stop the flow.
The biggest fall from grace happened to the Sackler Family owners of Purdue Pharma. Their $8.3 billion settlement bankrupted the business and, ironically, they lost control of the family Trust fund used for their generous philanthropic work and other good deeds. Initially, the Sacklers used a defence straight out of the National Rifle Association’s handbook something like; there’s no such thing as a bad drug (gun) just bad people who misuse drugs (guns).
Finally, and after considerable prompting and public humiliation, the Sackler family conceded that their over-zealous marketing, largely based on a lie, was the main source of the epidemic. In a carefully worded statement that accompanied their settlement they said sorry; sort of. They finally seem to be accepting that, despite denials for over 20 years, they really did do something wrong.
Johnson & Johnson are less contrite. They agreed to pay a total of over $5 billion to settle claims that the company fuelled an opioid addiction crisis in New York State and in other jurisdictions. The company, in settling, however does not admit liability or wrongdoing.
The main consultant implicated is McKinsey & Company who has agreed to pay nearly $600 million to settle claims it “turbocharged” opioid sales. They still claim they are innocent but the settlements came after lawyers unearthed a trove of documents showing things differently.
One email revealed that after the Federal government reached a settlement with Walgreens Boots Alliance (WBA) in 2013 (WBA do not admit any liability) to crack down on illegal opioid prescriptions sales to WBA began to fall. At this point, McKinsey recommended that Purdue “lobby Walgreens’ leaders to “loosen up.”
Wholesalers McKesson, Cardinal Health and AmerisouceBergen agreed to pay a combined $21 billion. McKesson said that this $21 billion, the three distributors will pay over 18 years, will largely be used to remediate the opioid crisis. The Wholesalers seem to be accepting that they had a role in identifying and reporting unusually large deliveries of opioids to certain locations, something they failed to do.
Pharmacy Multiples; Walmart, Walgreens (WBA) and CVA are also in the dock. Walgreen’s (WBAs) legal defence is simple; it did nothing wrong. What would be wrong, it argues, would be for its pharmacists, dispensing legally prescribed medicines, to interfere with the doctor-patient relationship by querying what was prescribed and even refusing to dispense. For me, this displays a stunning ignorance of the fundamental professional and ethical responsibilities of a pharmacist. WBA’s senior management and Board seem to be confusing the pharmacist’s role with that of a dispensing robot. The fact that that WBA had in place incentive payments for pharmacists based on opioid prescription numbers and didn’t see this as a problem, says a lot. They also ran businesses of such efficiency dispensing workloads hampered proper clinical assessment and scrutiny of prescriptions. Could a similar opioid crisis happen here?
For further reading on this topic I recommend the book: Empire of Pain: The Secret History of the Sackler Dynasty.
I am a pharmacist in Belfast.