The Opioid Crisis: Unmasking Big Pharma's Role in Fueling the Epidemic
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- Jun 14
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The Opioid Crisis: Unmasking Big Pharma's Role in Fueling the Epidemic
What Was The Opioid Crisis?
The opioid crisis represents (arguably) the most devastating public health challenge in recent American history, with widespread implications across the nation. Originating in the late 1990s, the crisis was precipitated by an exponential increase in the prescription of opioid pain relievers, driven by misleading marketing tactics and aggressive promotion by major pharmaceutical companies. These corporations used deceptive and at times fabricated data to support their fraudulent claims in the pursuit of profits and at the expense of the american public’s health and well being; there is substantial evidence that company executives at Purdue Pharma, Johnson & Johnson, Teva Pharma and Endo Pharma exaggerated the drug’s benefits and outright lied about the addictive nature of these prescribed opioids (Van Zee, 2009). These companies, amongst others, catalyzed the omnipresent addiction and overdose fatalities that characterized the epidemic by pressuring doctors to overprescribe these highly powerful and addictive opioids for symptoms as miniscule as a headache, subsequently wrecking the lives of millions of Americans (Macy, 2022). This corporate deception, combined with lack of oversight and proper guidelines for opioid prescribing, fueled misuse and addiction like never before in the United States of America; since 1999, over 500,000 people have died from opioid overdoses, with an estimated 80,000 more deaths annually, but even more notably, the immoral marketing tactics of these rapacious companies gave way to second and third waves of the epidemic as individuals transitioned their addiction to even more destructive drugs like heroin and fentanyl (CDC, 2021).
It’s also clear that these pharmaceutical companies could not act alone in causing an epidemic to this extent; there's long been a concept of revolving doors (employees that have worked for both companies + a general alliance) between these major pharmaceutical companies and the Federal Drug Administration (FDA). My paper will aim to capture not only how Big Pharma acted as the main player in causing this crisis but also how they leveraged their power in order to collude with the FDA and form Iron Triangles with governmental organizations that allowed for these unchecked regulations. Because of their consistent displays of malpractice and billions of dollars in lawsuits, pharmaceutical companies have been equated to legalized drug cartels and the industry characterized as ‘criminal’ by the outspoken Harvard physician and pharmaceutical researcher John Abramson (Abramson, 2022). After describing the extent of the problem and explaining its importance, I lay out a multitude of potential policy solutions to alleviate the crisis: some of which I deem to be flawed and others assessed as viable. By delving into the deceptive practices of Big Pharma, my policy paper aims to unveil the root causes of the opioid crisis, elucidate its impacts on American society, and explore policy solutions to mitigate its effects and prevent future public health catastrophes.
Big Pharma’s Nefarious Tactics
As more research and data continues to come out regarding the root causes of the Opioid Crisis, it is becoming increasingly clear that a nexus of pharmaceutical industry leaders drove the proliferation of dangerous opioids that sparked this public health tragedy. Purdue Pharma owners like the Sackler family, former Johnson & Johnson CEO Alex Gorsky, and other leaders of generic drug giants Teva and Endo like Eli Hurvitz and Roger Kimmel catalyzed the crisis by grossly exaggerating the benefits of opioids while blatantly lying about their addictive nature (Vaida, 2021). Through a web of deliberate misinformation and regulatory manipulation, these individuals fostered the over-prescription laying the groundwork for misuse, diversion and ultimately mass addiction + overdose.
The deception propagated by these entities could not solely engender the crisis without the FDA's negligence as the lack of oversight and deep-rooted connections between Big Pharma and regulatory bodies like the FDA turned the crisis into a full-scale epidemic. A culture of corporate cronyism - exemplified by a revolving door between agency leadership and the pharmaceutical industry - enabled improper industry influence on oversight, as Abramson critiques in his analysis of medical corruption (Abramson, 2022). The docuseries Dopesick depicts a disturbing example of this collusion: Curtis Wright, an FDA official responsible for the misleading label about opioids' addictiveness, later joined Purdue Pharma as one of their prominent spokesmen, “They’re forcing pharmacies to carry it with threats of lawsuits if they don’t. The FDA is an unwitting co-conspirator as they issued Purdue a warning label to say the drug is less addictive than other opioids when it’s clearly not. The individual who produced this warning label now works for Purdue – Curtis Wright'' (Strong, 2021). This represents a stark illustration of the 'Iron Triangles' and 'Revolving Doors' phenomenon, where individuals move between roles in pharmaceutical companies and regulatory agencies, allowing for the unchecked and manipulative practices that characterized the epidemic. Additionally, the FDA approved these opioids for prescriptive use despite the fact that there is absolutely zero research that supports the idea that they are safe for long-term use; Ed Thompson, the owner of a successful Pennsylvania pharmaceutical company that manufactures drugs for Big Pharma, is now putting his livelihood at risk by doing what no other drug maker has ever done: he's suing the FDA in federal court to force it to follow the science and limit the opioid label to short term use because "There are no studies on the safety or efficacy of opioids for long-term use" (CBS, 2022). Another profound malpractice that fueled the crisis was the fabrication of a five-sentence letter published in the New England Journal of Medicine in 1980, claiming that less than one percent of patients exposed to opioids become addicted. These pharmaceutical companies used this clearly non-credible, non-scientific, five sentence claim as their ‘golden page’ to deceive the public into believing that opioids are non-addictive. This singular paragraph with zero scientific backing was cited as a major study (and proof that opioids are safe) by pharmaceutical companies and subsequently medical schools across the country, creating an entire school of thought espousing opioids as non addictive (Kaplan, 2017). If I were to pinpoint the most influential specific example of corporate deception in fueling the opioid crisis, it would be this gross manipulation of an unreliable couple of sentences that allowed these pharmaceutical executives to build their empire on a lie. Another nefarious tactic employed by Big Pharma was their use of Shadow Companies to help fund an entire network of pain groups that represented themselves as independent but all heavily promoted the use of opioids. Purdue and other companies created different brand names for pain groups, like The American Pain Society, posing as independently sanctioned despite being 100% owned by these same pharmaceutical companies (Haffajee & Mello 2017). The deceitful use of these shadow companies strengthened the norm that opioids were not harmful and epitomizes Big Pharma’s strategy of De Facto Propaganda – using their extreme power to slyly market their drug by any means necessary. Lastly, these companies also facilitated the existence of ‘pill mills’, illegal facilities that resemble a regular pain clinic, but regularly prescribe opioids without sufficient medical history, physical examination, diagnosis, medical monitoring, or documentation. In addition to pressuring doctors and hospitals to over-prescribe opioids with threats of lawsuits if they didn’t oblige, Big Pharma allowed pill mills to run amuck through their financial incentives (kickbacks and rebates) for doctors + pharmacies to mass sell Oxycontin and their extensive lobbying efforts which made for favorable policies that ensured easy availability of opioids, weakened regulations and increased difficulty to control the spread of pill mills (Vaida, 2021).
Throughout the past month of researching Big Pharma’s role in catalyzing the crisis, it has become increasingly clear to me that these companies did not only engage in misleading marketing tactics and the aggressive promotion of their drug, but also the manipulation of fabricated data, characterized by straight-up illegal and immoral lies. Big Pharma’s coercion with the FDA, exploitation of the New England Journal’s ‘golden page’, disingenuous use of shadow companies to support their fraudulent claims and facilitation of pill mills offer the unambiguous perspective that that these companies are essentially massive drug cartels hiding in plain sight, as they were willing to exploit the wellbeing of the american public in the pursuit of ‘blood money’.
The Extent of the Epidemic + Lasting Effects
As I dissect certain statistics presented by the CDC and CQ Researcher in this paragraph, it’s important to note that understanding the true extent of the opioid epidemic is virtually impossible as the death toll, amongst other metrics, does not justly tell the whole story of the uncountable number of families and communities that were torn apart by their loved ones’ addictions. The direct opioid overdose death toll of half a million human beings from 1999 to 2019 is just the tip of the iceberg as the epidemic mutated into two other distinct but interconnected waves; what started with prescription opioid misuse was followed by a surge in heroin use, and most recently, a spike in synthetic opioid fatalities, predominantly driven by illicitly manufactured fentanyl (CDC, 2021). The initial overzealous sales of opioid prescriptions paved the way for the second wave, characterized by a dramatic rise in heroin use as individuals struggling with opioid dependence turned to cheaper and readily available alternatives. And now, the epidemic has only recently entered its most lethal phase, with the emergence of synthetic opioids like fentanyl driving a significant spike in overdose deaths. If you consider the ripple effects of the Opioid Crisis, then the death toll becomes a multi-million number (even greater than the million Americans that have died from COVID 19), which thus characterizes the Opioid Epidemic as the most deadly public health challenge that modern America has ever faced (Vaida, 2021). This intertwined progression created a vortex of soaring addiction, families destroyed, infants born dependent, and communities across America left hollowed. Another jarring statistic that only partially illustrates Big Pharma’s role in fueling the crisis is the 40 billion dollars paid in settlements by the four aforementioned pharmaceutical companies in relation to the opioid epidemic (CDC, 2022). When taking into account the notion that these companies were forced to pay this substantial sum despite having the highest-paid lobbyists + lawyers, equipped with a vast arsenal of coercive/bullying/extortion tactics, one can only imagine the actual number of billions of dollars that could account for their mass murder campaign. The opioid epidemic's crushing impacts continue reverberating through society via economic devastation, psychological trauma, hollowed communities, and millions of years of human potential extinguished precipitated by regulatory negligence enabling corporate greed over patient welfare; settlement figures cannot encapsulate the generational public health betrayal from this interconnected contagion, so the true cost reflects both the lives diminished and dignity robbed by this crisis from families and communities still struggling in its relentless wake. Over 500,000 people lost their lives, but many more saw loved ones endure merciless cycles of addiction detonating families and communities while births of dependent infants soared, necessitating comprehensive prevention approaches before sufficient treatment access emerges for an epidemic persisting at intense levels. The sheer magnitude fails quantification by statistics alone considering the multitudes shattered by personal losses and communities rendered wastelands by callous profiteering, inflicting a legacy of harm that screams for compassionate solutions to counterbalance regulation that amplifies business over life itself.
Flawed Solutions: Moral Hazards + Settlements
A moral hazard is the idea that if someone is given insurance against some problem, that they will abuse the insurance by engaging in risky or problematic behavior. While well-intentioned harm reduction measures like Narcan (Naloxone) + fentanyl test strips access, Good Samaritan Laws, and open-use clinics aim to mitigate the immediate threat of overdose deaths, they inadvertently perpetuate the core issue of addiction. By focusing solely on harm reduction, these moral hazard solutions fail to address the underlying causes of addiction and instead normalize drug use, potentially leading to increased dependence, and in turn creating a dangerous cycle where individuals become reliant on these interventions rather than seeking true recovery. The study ‘Does evidence support supervised injection sites?’ reiterates the notion that these hazards do successfully reduce the number of overdose deaths, hospitalization calls and needle-transmitted diseases like HIV, but it also notes that individuals who attended these sites were significantly more likely to be chronically addicted to the drugs in use, namely opioids (Sutherland, 2017). Such flawed solace facilitates the very behaviors fueling record mortality while leaving systemic drivers unchanged; though important for preventing deaths, in isolation these moral hazards offer incomplete solutions at best.
Furthermore, the current system of settlements, plea deals, and fines levied against Big Pharma does little to deter future malpractices. These financial penalties are often viewed as mere business expenses, easily absorbed by the pharmaceutical giants. Without real consequences, there's no incentive for companies to change their deceptive marketing tactics or prioritize public health over profits as this lack of accountability allows Big Pharma to continue fueling the crisis with impunity. The last 20 seconds of the above clip epitomizes this concept as Jonathan Sackler urges his troops on after the plea deal, stressing the continued aggression of selling Oxycontin, while claiming that the executives didn’t have anything to do with what they are charged with, and that the crisis was the result of ‘a few bad apples who were fired years ago’. The large sample size of the pharmaceutical industry’s malpractice over the years, magnified by the results of the opioid crisis, demonstrates that deals exchanging fines for impunity enable executors evading accountability to regenerate elsewhere, consequences disproportionate to devastation wrought. It’s sufficiently unambiguous that justice rings hollow when suited villains refuse remorse while victims’ sorrow persists.
Viable Solutions: Accountability is the Answer
Amidst an epidemic fueled by corporate avarice and regulatory negligence, sincere solutions demand accountability to align incentives with ethical imperatives of social welfare over profits. Instead of settlements spared by complicit boards, prosecutorial zeal must pursue individual liability of decision-makers directly responsible for fueling this profiteered plague.‘The Deterrent Effect of Federal Corporate Prosecution Agreements: An Exploratory Analysis’ reveals the data that supports the commonsensical solution that incarceration, not settlements, causes less subsequent malpractice. The study asserts that companies with ex-board members incarcerated were significantly less likely to have subsequent violations compared to companies that were only punished via plea deals and fines (Homer et al., 2022).
In addition to the obvious solution of letting the punishment fit the crime, there is a clear problem of a lack of transparent medical data in the drug creation process, which John Abramson refers to as the peer review paradox. Abramson sums up the paradox succinctly, “The peer reviewers don’t have the data, they have the manuscript produced by the drug manufacturers. So peer reviewers are unable to perform the job that doctors think they’re performing — vet the data to ensure it’s accurate and reasonable” (Fridman, 2022). Because the drug companies are able to form their own manuscripts with no third-party fact checking of the actual data, they’re able to act as judge, jury and executioner, easily manipulating the data to support whatever findings will ultimately generate the most revenue. My proposed solution to this problem is simple: legally mandate transparent data in the peer review process – the scientific world MUST be able to access the actual data regarding these drugs in order to determine the truth of their efficacy, side effects and addictive nature, or else these monstrous pharmaceutical companies will continue to march to the beat of their own drum and alter their findings to maximize shareholder value. Simultaneously, fortified protections must shelter industry whistleblowers refused sanctuary by non-disclosure agreements weaponized to conceal injustice. True change requires revelations from principled insiders lifting corruption’s veil; their courage the clarion call awakening cultural forces needed to fuel movements precipitating reform. This clip from Dopesick depicts how someone from inside the company is usually needed to expose these companies' malpractice, but rarely anyone ever steps up because they are assuming all of the liability without any personal incentive to speak up; an under-resourced lawyer tries to urge former Purdue employee to blow the whistle, “to end this cycle of rampant abuse, we need someone from inside the company to testify” but she tells him “when I was fired I had a choice; I could walk away with nothing or receive a severance package and sign a strict NDA. I signed it. There’s no way I can cross Purdue. If I did, it would cost me everything” (Strong, 2021). This exchange explains why there is a steady lack of willing ‘whistleblowers’ as those who are fired when they realize the vast misalignment between their personal values and the company’s, are unable to contribute to the prosecution because of their unforgiving non-disclosure agreements. With severance packages essentially acting as hush money, former employees have no choice but to keep their mouth shut despite the large-scale atrocities being committed behind closed doors. This dynamic causes a cycle of fruitless efforts in which prosecutors are unable to successfully charge companies with what they are guilty of because of the lack of internal testimony. It’s evident to me that a federally mandated Whistleblower Protection Program could easily solve this major problem. The program would articulate that any employee at a pharmaceutical company is unable to be harmed by the contents in their non-disclosure agreement AND ideally a policy that pays the individual who gives the testimony an equivalent amount of the severance package they would have received.
Only through a multifaceted approach that prioritizes public health and accountability can we break the cycle of addiction and prevent future tragedies. We must reject the plea bargains and settlements that allow Big Pharma to escape true consequences for their actions as true justice demands holding executives personally accountable and dismantling the system that enables their malpractices. Until personal prison sentences match callous offenses, opioid wrongdoers are incentivized towards recurrent ethical bypass of patient welfare for profits. Only once suits face mandatory minimums in cells rather than boardrooms will change permeate an industry nursed on deception and greed at the expense of so many; executives must be indicted as dealers of death if we ever hope to see this profiteered plague of addiction subside for good. Through holding corporate executives accountable in the form of jail time, implementing policies that decree transparent data in the peer review process and formalizing a Whistleblower Protection Program, a public health catastrophe like the opioid crisis will never again be possible.
What It All Means: Money Runs The World
The opioid crisis paints a grim portrait of a capitalist society consumed by money and power, where greed trumps ethical considerations and human lives become casualties in the pursuit of profits. The epidemic was undoubtedly caused and exacerbated by Big Pharma’s toxic cultural milieu of narcissism and unchecked ambition, which unleashed a wave of devastation through its deceit and manipulation. This tragedy exposes the vulnerabilities of a system that allows corporations to prioritize profits over the well-being of society, creating a breeding ground for corruption that impacts everyone, from doctors and scientists to judges and government officials. Our current justice system, designed to deliver "fair" outcomes, fails to provide adequate punishment for those who knowingly inflict harm on millions; the legal system, heavily influenced by Big Pharma's seemingly infinite financial resources, becomes complicit in the epidemic, offering mere slaps on the wrist instead of the true justice these individuals deserve. This crisis is a stark reminder that the pursuit of wealth can eclipse basic human decency. It calls for a fundamental shift in our values, one that prioritizes human life and well-being over financial gain. We need leaders who are not only driven by profit but also possess moral integrity and a commitment to ethical conduct; only then can we dismantle the system that enabled this tragedy and build a future where compassion and responsibility replace greed and manipulation.
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References
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