How Corporate Greed Helped Create The Current Opioid Addiction Crisis

The opioid epidemic is probably one of the United State's biggest public health issues since the turn of the century. It has destroyed lives and ripped families and communities apart. The causes for the crisis are varied with some of the responsibility lying in the despair of once vibrant communities that have lost the economic vibrancy they once, or in some cases, never had. But one thing is clear and that is the epidemic was and is fueled every step of the way by corporations in a deadly drive for profits above all else.

Back in the late 1980s, a company called Purdue Pharma was scheduled to have the patent on its main source of revenue, a pain pill called MS Contin, expire. Facing a massive revenue loss due to the coming competition from generics after the patent expired, the company needed to find a new cash cow. The success of MS Contin was based on stretching the release of the drug's main ingredient, morphine, over a period of eight to twelve hours. The company decided to replicate that process using oxycodone, which was currently sold under names like Percocet, instead of morphine. Thus was born the painkiller OxyContin.

Traditional oxycodone like Percocet lost efficacy after about 6 hours. With their time-release technique, Purdue believed they could stretch OxyContin's effectiveness out to 12 hours. And when the drug was finally ready to be introduced in the mid-1990s, that is how the company planned to market it. The problem was that clinical trials actually showed that the drug wore off well before the 12 hour period. In one study on cancer patients, 95% needed additional pain medication before the twelve hours ended. But the crucial selling point of OxyContin for Purdue was that it lasted for 12 hours, twice as long as its competition and meaning that patients would not be disturbed at night because of the need to take another pain pill. The company did complete one study in Puerto Rico where only one-third of participants needed additional medication and that study was used to get OxyContin approved for use by the FDA.

It soon became apparent to doctors that OxyContin was not providing the full 12 hour relief to many patients. Of course, Purdue was well aware of this fact as their studies had shown that to be the case. Doctors started prescribing Oxy for patients to take at 8 hour intervals. But that was just marginally longer than traditional oxycodone and would therefore reduce OxyContin's marketability. In addition, insurance companies started to refuse to fill OxyContin prescriptions for less than the 12 hour period. Purdue's sales teams forcefully instructed doctors not to prescribe for eight hour intervals but instead to increase the dosage of Oxy for those patients not getting full relief instead.

Raising the dosage also increased returns for Purdue. The highest dosage pills cost over six times as much as the lowest dose. And part of that increase went into the pocket of the sales team and executives at Purdue. But increased dosages along with the withdrawal that comes when the painkiller wears off in just eight hours also massively increased the chances for addiction and overdose. In 2007, Purdue and three of its executives were sentenced for downplaying the risks of addiction and forced to pay $635 million as a result of a Justice Department lawsuit. A study in Canada of 32,000 OxyContin patients showed that 1 in every 32 had died of an OxyContin overdose. As one researcher noted, these patients were "more likely to die as a result of their medication than almost anything else." But none of that mattered to Purdue because, as part of their defense in another case in Connecticut stated, "The 12 hour dosing schedule represents a significant competitive advantage of OxyContin over other products."

Purdue was well aware of the difficulties with OxyContin from the very beginning. They knew that for many people it would not work for the full twelve hours, creating withdrawal symptoms and risking addiction. In response, the company recommended upping the dosage which increased the chances for overdosing. All in the name of profits.

But Purdue was not the only company interested in getting on the gravy train of OxyContin and other oxycodone drugs. The oligopoly of prescription drug wholesalers, McKesson Corporation, Cardinal Health, and AmerisourceBergen Drug Company have done nothing to stop the clearly abusive flow of prescriptions for these addictive drugs into communities across the country. These companies are obviously abetted by doctors and local pharmacies in every instance. And often they are assisted by lax oversight, if not willful blindness, by state regulators.

In West Virginia, pharmaceutical companies flooded the state with over 780 million hydrocodone and oxycodone pills over the span of six years. That comes to 130 million pills per year. The town of Kermit, West Virginia, has a population of 932 but a single pharmacy in that town received over 4.5 million pills per year over a two year period. In the town of Oceana, a pharmacy received 600 times more oxycodone pills as another pharmacy literally just down the street. The population of the entire state of West Virginia is about 1.83 million and the number of pills delivered to the state amount to over 430 for every single individual in the state. And, as we saw with what Purdue did with OxyContin, the dosages for these prescriptions increased as time went on. The state Board of Pharmacy was made aware of the potential problems with local pharmacies for years but refused to investigate and kept on giving those pharmacies positive inspection reviews.

A similar pattern is now a subject of a lawsuit in Oklahoma where the Cherokee Nation has sued the prescription drug wholesaler oligopoly of McKesson, Cardinal, and AmerisourceBergen as well as the three members of the prescription drug provider oligopoly, Walgreen's, CVS, and WalMart for having turned "a blind eye to the problem of opioid diversion and profited from the sale of prescription opioids to the citizens of the Cherokee Nation in quantities that far exceeded the number of prescriptions that could reasonably have been used for legitimate medical purposes."  As in West Virginia, the suit alleges that these firms flooded the 14 counties that comprise the Cherokee Nation with enough hydrocodone and oxycodone pills to supply every man, woman and child in the Nation with at least one pill each in 2015 alone.

The prescription drug wholesalers and the prescription drug providers are both required by law in many states to report potentially abusive or suspicious prescription orders to authorities. For the most part, these companies simply ignore that requirement. There is simply too much many too be made from these companies' sales forces up to the top executives from preying on people's addiction and oversight from the states is either lax or captured. In addition, doctors are equally complicit in feeding these addictions as virtually every one of the prescriptions for these millions of opioid pills was written by a medical professional.

In the last two decades, over 7 million Americans have abused OxyContin and more that 190,000 have died from opioid overdoses related to oxycodone abuse. In 2015, it is estimated that 2 million Americans had a substance abuse problem related to painkilling medication. In addition, there is no doubt that prescription drug abuse has also led to an increase in heroin addiction, with another half million Americans currently abusing that drug. These are just numbers and they don't tell the heart-wrenching stories of the individuals involved. But so many of these numbers and the tragic stories behind them are driven by a collection of oligopolies that elevated the primacy of corporate profits and greed over the actual health of the people these companies are actually intended to serve. Such is the state of unrestrained American capitalism.

I suggest you read the incredible reporting that provided the information for this post, the LA Times' incredible expose on OxyContin and the Charleston (West Virginia) Gazette two part series on the opioid crisis in West Virginia. The level of greed and corruption that both articles uncover will shock you, especially when you consider the incredible damage that has been done.