Simanaitis Says

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ON OPIOIDS PART 2

OPIOID ADDICTION IS plaguing the country. Tidbits on this epidemic are gleaned at SimanaitisSays yesterday and today from “A Blizzard of Prescriptions,” by Emily Witt in the London Review of Books, April 4, 2019.

OxyContin Arrives. In 1996, Purdue Pharma introduced OxyContin, an oxycodone-based semi-synthetic opiate. The “Contin” part of its name implies the drug’s extended-release technology.

Richard Sackler is a scion of the family owning Purdue Pharmaceuticals. At an introductory party for the new drug, he said, “The launch of OxyContin tablets will be followed by a blizzard of prescriptions that will bury the competition.”

The Epidemic. It buries more than the competition: LRB reviewer Emily Witt observes, “Since OxyContin’s arrival in 1996, a widespread increase in opiate use in America has killed more than 400,000 people. Drug overdoses have been the leading cause of accidental death in the United States since 2008 when they surpassed deaths from road accidents. In 2017, more than 49,000 Americans died of opiate-related overdoses.”

Why an Epidemic? The three books reviewed by Emily Witt in LRB offer reasons for an opiate epidemic: A dysfunctional privatized health care system in the U.S. makes it possible for addicts to accumulate prescribing doctors. Poverty, joblessness, and despair encourage such abuse. The U.S. legal system criminalizes users in lieu of offering them medication-assisted rehabilitation. Insurance companies perceive pills as less expensive than physical therapy and other treatment.

And there’s greed: A corrupt regulatory structure is beholden to the industry it is tasked with regulating. Politicians take marching orders from industry lobbyists. And doctors are susceptible to inducements from industry sales reps.

Last, Witt notes, there’s a “general epistemological failure when it comes to ideas about what ‘drugs’ are, which psychoactive chemicals are safe and which are dangerous, and what a drug dealer is supposed to look like.”

Witt says, “It is common in the U.S. for people who would never dabble in cocaine or LSD to take psychoactive pills without shame or suspicion.”

The Patent Game. New pharmaceuticals cost a lot in research and development. For this reason, pharma patents last for 20 years, after which prices of generics can drop as much as 90 percent.

A patent game has evolved. “Through minor tweaks and reformulations,” Witt observes, “Purdue has re-patented OxyContin 13 times. Under its original patent, the company would have lost exclusive rights to the drug in 2013. Now it maintains them until 2030.”

The Lawsuits. “Over the past several years,” Witt writes, “Purdue has become mired in lawsuits from states for its promotion of OxyContin…. The most prominent of these is a lawsuit filed in June 2018 by the state of Massachusetts.”

The suit directly implicates eight members of the Sackler family, claiming that from 2007 to 2016 they were among those at Purdue who ‘‘engaged in a deadly and illegal scheme to deceive doctors and patients,’’ by encouraging sales reps to pitch OxyContin at higher doses even when its dangers were well known.

Witt writes, “During these years the family paid itself more than four billion dollars in profits.”

Witt cites an email exchange between Robert Kaiko, the inventor of OxyContin, and Richard Sackler: Kaiko wrote with apparent concern: “If OxyContin is uncontrolled, it is highly likely it will be abused.” Sackler responded, “How substantially would it improve our sales?” ds

© Dennis Simanaitis, SimanaitisSays.com, 2019

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