How Pharmaceutical Companies Have Exacerbated the Opioid Epidemic
Drug use, specifically the opioid epidemic, has been an ever-present public health crisis exacerbated by pharmaceutical companies in the United States since the late 1900s.
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- Since the late 1900s, the opioid epidemic has drastically affected public health, and unfortunately, pharmaceutical companies have played a significant role in exacerbating this crisis. As physicians and public health organizations work to combat the outbreak, understanding the history and mechanisms of opioids and opioid use disorder (OUD) is essential.
What Are Opioids?
According to the American Society of Anesthesiologists, “opioids, sometimes called narcotics, are medications prescribed by doctors to treat persistent or severe pain.” On a basic level, opioids manage pain by binding to receptors on nerve cells, preventing pain signals from being sent to the brain.
The National Institute on Drug Abuse (NIDA) identifies the primary use of opioids as a pain management treatment; however, they have implications for treating diarrhea and cough.
Often opioids are prescribed following surgical procedures, for end-of-life pain management for cancer patients, and for chronic pain management. Common prescription opioids include hydrocodone, oxycodone, oxymorphone, morphine, codeine, and fentanyl.
Opioid Use Disorder
Despite the benefits that many believe opioids have, they are highly addictive medications due to the feelings of euphoria that they elicit. Many people taking opioids suffer from an addiction called opioid use disorder.
What Is OUD, and How Does It Work?
Johns Hopkins Medicine characterizes OUD as a condition in which a person is addicted to opioids and revolves their life and behaviors around opioid use.
While addiction science is not a fully understood field, it is thought that opioid addiction occurs because the medication activates a reward pathway in the brain, called the mesolimbic pathway.
According to the Addiction Science and Clinical Practice journal, “the mesolimbic reward system appears to be central to the development of the direct clinical consequences of chronic opioid abuse, including tolerance, dependence, and addiction.
An editorial statement in JAMA outlines the two different kinds of prescription opioid abuse as (1) not following prescription guidelines for medication, thus overdosing, and (2) taking a prescription medication intended for someone else.
According to a StatPearls textbook, meeting two or more of the following criteria is indicative of opioid use disorder:
- increased tolerance or dosage
- need to reduce medication use
- excessive time spent focused on the medication
- medication cravings
- continued use despite interference with obligations
- withdrawal symptoms when not using
- continued use despite side effects or potentially hazardous situations
OUD Statistics
The CDC states that 75% of drug overdoses in 2022 involved an opioid. Based on data from the NIDA, between 21% and 29% of people who have been prescribed an opioid for pain management will abuse them.
Furthermore, in 2019, there were almost 50,000 opioid-related deaths in the United States alone.
The StatPearls textbook states that globally, 16 million people have or have had opioid use disorder. Of that number, over 18% are in the US. The publication also states that, of all new heroin users in the US, 80% attribute prescription opioids and OUD to their use.
A publication in Nature attributes decreased life expectancy to opioids, stating that they have increased the number of drug overdoses and suicides. The article says, “the death rate from drug overdoses more than tripled between 1999 and 2017, and that from opioid overdoses increased almost sixfold during the same period.”
OUD Treatment
Like most addiction care, OUD treatment is continuous and varies based on the patient’s condition and lifestyle.
Additionally, “the chronic, relapsing nature of opioid addiction means most patients are never ‘cured,’ and the best outcome is long-term recovery. The lifelong implications of this disease far outweigh the limited benefits of opioids in the treatment of chronic pain, and in many cases, the risks inherent in the treatment of acute pain with opioids,” concluded clinicians in the JAMA publication.
Johns Hopkins Medicine highlights additional medications that can be used alongside traditional treatments, such as talk therapy to help treat OUD. These medications include methadone, buprenorphine, naltrexone, and naloxone.
Methadone and buprenorphine work mainly by relieving opioid cravings and withdrawal symptoms. Meanwhile, naltrexone prevents the euphoric effects of opioids. However, naloxone is only used in emergency cases to reverse an overdose.
Despite options for treatment, OUD care is costly.
The NIDA states that “the total ‘economic burden’ of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.” Of that number, $2.8 billion alone is just for treatment.
The NIDA calculates that annually methadone treatment costs $6,552, buprenorphine costs $5,980, and naltrexone costs $14,112, making OUD treatment more expensive than diabetes and kidney disease costs.
How Did OUD Become So Prevalent?
The Nature publication outlines the history of opioid use and how we got to where we are now. In the 1980s, several intractable pain treatment acts passed in the US, allowing physicians to treat pain symptoms aggressively.
The focus on pain management was furthered when, in 1995, the American Pain Society marketed pain as the ‘fifth vital sign,’ stating that its management should be treated similar to other vitals such as blood pressure.
In the mid-1990s, Purdue Pharma in Stamford, Connecticut, created OxyContin, an opioid-based product that was essentially an extended-release formulation of oxycodone. Alongside other pharmaceutical companies, Purdue pharma marketed this product, and others like it as safe, effective, and non-addictive forms of pain management.
Despite their insistent efforts to market the product, we know now that their claims are false.
“Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a $635 million fine for the company. But doctors and patients were unaware of that at the time,” as stated in a Nature publication.
In addition to pharmaceutical deceit, physicians have historically overprescribed opioids. According to the Journal of Neuroscience, in 2012, over 259 million prescriptions for opioids were written.
“There is little evidence for long-term benefit from opioid therapy for most types of chronic pain. It remains unclear why this practice of opioid prescribing continues despite recommendations to the contrary. New opioid medications, many of them with tamper-resistant formulations, continue to be marketed despite the lack of evidence that these preparations reduce the risk of addiction,” stated the author in the JAMA article.
Looking Ahead
Regardless of the crisis’s contributors, this epidemic affects all Americans and the healthcare industry.
While improving access to care will benefit those suffering from OUD, physicians must remain vigilant about how often they prescribe opioids. Alternative forms of pain management may be considered before the use of medication.
Furthermore, healthcare professionals, government agencies, and the general public must hold pharmaceutical companies accountable and look for non-biased support for their claims.
Despite the severity of the issue, making data on opioids more widely available has allowed people to think critically about the issue and consider OUD treatment.
“It is inspiring to celebrate the estimated 25 million people who are in recovery. People in recovery are heroes for me. So many have been able to rebuild relationships with people they care for, contribute again to society, and regain a sense of purpose and meaning in their lives. It may seem to be a hopeless situation, but it’s not. In the midst of this terrible crisis, that’s what gives me the greatest hope for the future,” Harvey V. Fineberg, Professor of the Practice of Public Health Leadership, told the Harvard School of Public Health.
