The opioid crisis in the U.S. is one of the most deadly and pressing public health issues of the 21st century. Statistics from the United Nations, the largest intergovernmental organization in the world, have shown that opioids are the most lethal drug and are the leading cause of fatal overdose deaths. The United Nations Office on Drugs and Crime’s 2023 World Drug Report stated that “Opioids accounted for nearly 70 percent of the 128,000 deaths attributed to drug use disorders in 2019” (UNODC). This highlights the magnitude of the problem and how opioids are the main contributor to drug overdose. Over ⅔ of drug-related deaths were directly caused by the overuse of opioids. Opioids will continue to be the group of substances with the highest contribution to severe drug-related harm. Opioids are intended to relieve pain by creating a false sense of well-being in the brain, but their euphoric effects contribute to their highly addictive nature. Furthermore, overusing them severely damages the central nervous system which threatens the life of its consumer. Opioids have devastated many lives, families, and communities alike. This crisis can be traced back to greed and negligence within corporations, administrations, and individuals. Thus, the opioid epidemic in the U.S. is a result of fraudulent advertising used by pharmaceutical companies, combined with neglectful regulation by government agencies, which is trickling down to corruption among physicians.
Pharmaceutical Companies
Many pharmaceutical companies have a history of lying to the public and containing internal corruption. One such company was Purdue Pharma, the creator of OxyContin, which fraudulently advertised its opioid. Purdue claimed that one dose of OxyContin could eliminate pain for 12 hours by slowly releasing small doses over long periods, a duration significantly longer than its competitors, which typically provided relief for only 4-6 hours. However, these claims were false, as Purdue’s trials showed that OxyContin did not last nearly as long as they claimed. In a peer-reviewed journal published by the Harvard Public Health Review, Ronald Chow stated that this claim popularized OxyContin as it, “captivated the attention of patients and doctors by presenting a new world of pain management” (Chow). Additionally, Purdue blatantly lied about the safety of the drug. They claimed that the risk of addiction to OxyContin was as low as 1% when in reality it could be as high as 50% (Chow). This meant that OxyContin’s highly addictive properties were unknown to the physicians who prescribed it and the consumers who ingested it. This meant that the public was unaware of the dangers of OxyContin as it became popularized. To carry out these lies, Purdue Pharma invested millions of dollars into its physical marketing workforce. Art Van Zee, MD states that from 1996 to 2000, Purdue doubled its sales force from, “318 sales representatives to 671” (Zee). They strategically leveraged the size of their workforce to target individual physicians and falsely market the usage of OxyContin by lying about the long-lastingness and risk of addiction. Ultimately, Purdue’s fraudulent marketing strategies caused the popularity and prescription of OxyContin to skyrocket which added to the deaths of the opioid crisis.
Government Agencies
Although the corruption and deceptive nature of pharmaceutical companies like Purdue Pharma is inexcusable, a portion of the blame must also be placed on the government for allowing fraud to occur. The Food and Drug Administration (FDA) is the largest drug regulatory agency in the world, however, they neglected their policy when approving OxyContin. The government’s Federal Food, Drug, and Cosmetic Act requires well-done and well-controlled studies to demonstrate the safety and effectiveness of a drug before it can be approved. The FDA enforces this by obligating drug manufacturers to present them with at least two of these studies. Regardless, the FDA approved OxyContin in 1995 based on only one trial, therefore, the FDA did not have enough evidence to demonstrate the effectiveness of OxyContin. Paul Dolan from the American Medical Association explains that the same federal policy also says that “The benefits of a drug must outweigh potential risks for specific indications listed on an FDA-approved label” (Dolan). Considering this, the FDA should have forced OxyContin drug labels to have narrow indications stating the conditions where its benefits outweighed its harms. However, the FDA failed to firmly regulate this policy, so Purdue was free to dangerously promote OxyContin for treating everyday pain conditions. Aside from failures to enforce policy, there was also corruption within the FDA. Soon after the approval of OxyContin, the FDA gathered a committee of 10 field experts and discussed whether the labels of OxyContin should be narrowed (Dolan). The committee ended up refuting this idea because eight of the committee members had financial ties with pharmaceutical companies like Purdue. This corruption within officials prevented the entire administration from being able to intervene and restrict OxyContin’s promotion. Considering together that the FDA violated its regulatory policy and allowed corruption to prevent intervention, they must be held responsible for their role in the opioid crisis.
Physicians
Purdue Pharma’s deception led to the popularity of OxyContin, and the FDA’s neglect allowed it to be approved but in the end, this corruption trickled down to the physicians that allowed themselves to be swayed by pharmaceutical companies. Purdue Pharma incentivized thousands of physicians. Art Van Zee, MD explained that “From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California” (Zee). These positive experiences had a disastrous impact on physicians, as they were exposed to Purdue’s misleading claims and ideology, compromising their judgment. Although they strongly believed that they were not influenced by these conferences, these events often led physicians to prescribe and promote Purdue’s painkillers. Additionally, many physicians allowed themselves to be influenced by bribes and funding. In his article for the National Library of Medicine, the largest biomedical library, Arthur H. Gale, MD recounted the story of Russell Portenoy, MD. Portenoy, a neurologist and pain specialist, ran a pain center that received significant funding from various pharmaceutical companies, including Purdue (Gale). Although this indicates signs of corruption, Portenoy was convinced that he could receive money directly from opioid manufacturers to fund his research without allowing them to sway his actions. However, this appeared to be false as he continued to primarily promote OxyContin. Lastly, physicians like Portenoy also did not properly assess the validity of claims made by pharmaceutical companies. It is their job to determine whether or not they believe opioids like OxyContin are safe and effective before prescribing or promoting it. However, many physicians blindly believed the claims of low addictiveness and long-lasting relief. Portenoy did not research these claims and continued to spread misinformation through numerous lectures, where he falsely defended opioids. In the end, the negligence of physicians and their susceptibility to influence led to the drastic overprescription of opioids.
Conclusion
The opioid epidemic in the U.S. is a result of fraudulent advertising used by pharmaceutical companies, combined with neglectful regulation by government agencies, which is trickling down to corruption among physicians. Purdue Pharma made several false claims about OxyContin involving its risk of addiction, effectiveness, and its uses. Additionally, the FDA violated its laws by not demanding enough research and trials on the safety of OxyContin and by allowing broad labels, which allowed for misuse. The FDA also housed corrupt officials which prevented intervention. Lastly, physicians allowed themselves to be incentivized through symposiums and direct funding. They also did not assess the validity of Purdue’s claims. The lethal combination of unethical practices and corruption resulted in one of the deadliest public health disasters in U.S. history. The government must understand the neglect that occurred and work tirelessly to tighten restrictions on pharmaceutical companies, physicians, and its very own regulatory agencies. If reform is not made, then the health of U.S. citizens will be forever at stake.
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