About That Opioid Epidemic

Credit where credit is due: Medical science and pharmacology have been nothing short of miraculous over the past century. People live longer and healthier lives as a result of breakthroughs in our understanding of how the body works, and how it responds to medications.

But we are also beginning to see some troubling consequences of our reliance on “miracle” drugs. Scientists warn of an emerging resistance to penicillin and other antibiotics, and blame their overuse. And then there is the opioid epidemic, which is yet another example of the problems that emerge when drug use and policy are dictated by the profit motive rather than by medical science and the Hippocratic Oath’s dictum “First, Do No Harm.”

AP and the Center for Public Integrity recently released a study detailing the effects of Big Pharma lobbying on opioid use and abuse. It should give us pause.

Key findings from the reporting:

 Drug companies and allied advocates spent more than $880 million on lobbying and political contributions at the state and federal level over the past decade; by comparison, a handful of groups advocating for opioid limits spent $4 million. The money covered a range of political activities important to the drug industry, including legislation and regulations related to opioids.

The opioid industry and its allies contributed to roughly 7,100 candidates for state-level offices, with the largest amounts going to governors and the lawmakers who control legislative agendas, such as house speakers, senate presidents and health committee chairs.

The drug companies and allied groups have an army of lobbyists averaging 1,350 per year, covering all 50 state capitals.

The opioid lobby’s political spending adds up to more than eight times what the formidable gun lobby recorded for political activities during the same period.

There’s much more.

I know I’m beating a dead horse (what, no medical interventions for the horse?), but there are economic arenas where markets work beautifully, and there are arenas where they don’t. Health care falls in the latter category. “Buying” health care is not equivalent to buying a car or a stove or other consumer good. The parties to the transaction do not possess equivalent information, and the “buyer” needing immediate care is rarely in any shape to go comparison shopping in any event.

The opioid epidemic is just one more example (in a very long list) of what happens when we insist on maintaining markets and encouraging the profit motive in a sector where informational and power asymmetries make genuine competition impossible.

Perhaps–if this election gives us a sane President and legislature–we can begin to correct the situation, by revisiting both the prohibition on government’s ability to negotiate drug prices, and the inclusion of a public option in the Affordable Care Act.

And someday–no doubt after I’m long dead–we might stop letting lobbyists make health policy, get Medicare for All or its equivalent, and join the majority of countries that have recognized that access to health care and lifesaving drugs should not be treated as  profit-generating consumer commodities.

18 thoughts on “About That Opioid Epidemic

  1. Few in the U.S. know that a universal healthcare system is a Colorado ballot referendum (Amendment 69) in Nov. 2016. Big Pharma is lobbying vigorously against it; it is getting little national news coverage.
    Coloradocare.org

  2. You know that the healthcare industry has lost its way when hospitals refer to patients as “customers”. When “customer satisfaction” is more important than patient improvement. When more is spent on the aesthetics of waiting and hospital rooms than on the pay of “assistants and technicians”. And you really know the healthcare industry has lost its way when profits are the ONLY reason for helping the sick and injured. An Epipen anyone?

  3. I have said for years that progress does NOT always mean improvement. That includes the medical industry – and they are now an industry at all levels with highly paid lobbyists. Coats left his Senate seat in Indiana, moved to a southern state to work as a lobbyist and returned with enough money to buy back his senate seat which he is currently vacating. The wife of SCOTUS member Clarence Thomas owns a health care provider which he supports via his high level position – good for life, but only HIS life. People are always looking for an immediate cure for all ills, real or imagined; like drug abusers looking for instant gratification to escape their problems – real or imagined.

    We are bombarded via the media, count and time ads during your favorite TV programs, with magical cures for everything and attorney assistance when those “cures” backfire and cause more serious problems, disabilities or death. We are also dealing with prescribed medications such as Terbutaline and treatments such as bladder and vaginal mesh surgeries and countless others which have been prescribed for uses they have not been approved for which cause damage to patients. There are drugs such as Harvoni for Hepatitis C which, in many cases, is an actual miracle drug but…you don’t see the cost of $1,152.58 PER PILL on those ads. The EpiPen, an actual life-saving medication is now totally unavailable to the majority of those who need it to survive sudden attacks. Sarah Palin’s Death Squads apply here. Doctors also try to prescribe daily dosages of antibiotics as a prevention for one problem in a patient but which results in a tolerance buildup in the patient’s system and no alternative when antibiotics are needed for an additional health problem. Too many drugs, Opoids are a relatively new one on the market, are easily addictive resulting in a more serious health problem for users.

    Millions of Americans use computers which provide sources to research information before seeing your physician to educate yourself regarding your health problem and possible treatments and/or medication. The cost to do the research is included in your Internet billing and can save you unnecessary prescription costs and unnecessary expensive testing or surgery. Go to your physician armed with information about yourself, your knowledge regarding what your system will tolerate and and what it will not due to your medical history which physicians today too often ignore. Mine refuses to look into my records so we go through the same conversations at my annual exam and lab testing with my file in front of her on the computer. I have no prescription coverage in my Medicare supplemental so have to refuse expensive medications or those my system cannot tolerate and make two trips to the pharmacy (difficult for me due to disabilities) and repeated refusals for therapies I cannot endure and testing which has been done. The earlier testing was billed to Medicare. I won’t retell the story about my $22,000 sore toe. The “free” flu shots provided are not included in regular appointments; no scheduled appointment is needed but I do have to contact the clinic to have approval sent to the lab. The nurse takes my vitals, asks questions regarding my general health prior to the flu shot for which there is no charge BUT Medicare is billed for the time the nurse spent to give me the “free” flu shot.

    Sheila’s last paragraph fits here but rereading her entire blog is recommended.

  4. I smell a rat. Between Big Pharma and the war on drugs, the opioid epidemic had to happen. If we would legalize medical marijuana, a lot of this would end. I am a chronic pain patient and it is virtually impossible to get a needed prescription for pain meds thanks to this “epidemic”. I would much rather medicate myself naturally than with some chemical cocktail, but I guess I’ll have to move out of Indiana to a state that has some sense.

  5. The medical and pharmcological industries have indeed made great strides in the last century, but the main reason our lifespans have increased markedly is the major improvements in sanitation since about the middle of the 19th century. And switching from horses to cars certainly has polluted the air in cities, but the streets are fit to walk in.

  6. Big Pharma rules the Democratic National Party and the GOP. Hillary Clinton will do nothing to stop the cronyism. She is symbolic of the corruption in Washington.

    In Indiana, guess who runs Indianapolis? Eli Lilly.

    Guess who uses their stock value to pump millions into charter schools and reforms which have hurt public schools. Eli Lilly.

    Guess who was put in charge to study about all the pharmaceuticals flowing through our waterways? Eli Lilly.

    Guess who spends millions on prevention of diseases so Hoosiers don’t need diabetic drugs or end up needing expensive care at local hospitals? Nobody.

    What’s ironic is the Indiana Chamber leads a wellness initiative for corporations within our state where they regularly tout a 300% return on investments in wellness programs with employees.

    You would think a conservative state like Indiana would be leading the country on wellness initiatives or prevention. You’d think all our lawmakers who’ve advocated for a $2.1 billion bank account for a rainy day would push for wellness investments to triple our returns.

    We get nothing. Our state continues being a bottom dweller in the County Health Rankings.

    When you lead the country in youth and adult obesity, it means serious profits for insulin and diabetes drug makers. Guess who? Eli Lilly.

  7. The only way legislators can make rational decisions is if they have unbiased information. I have suggested in the past that businesses that spend money on lobbying be required to donate an amount equal to what they spend promoting their interests to groups championing the public interests. I know business executives will cry foul, that violates free speech but we have weight classes in boxing to keep the fights fair. Why not in the area of lobbying.

  8. The main reason our lifespans have increased is the reduction of infant mortality. As a society we need to understand that good health, just like any other good thing, takes work. I once had a friend, who is also a physician, ask about her patients, “What do they want me to do?” My answer was, “They want to be healed, miraculously, with no effort on their part.”

    That’s how we end up with an opioid epidemic.

  9. Indiana has a heroine problem because they won’t legalize pot. Period. End of story.
    Every single state with this problem has kept pot illegal. If the states start legalizing it, the Feds would be free to decriminalize but until the states make it okay, that will never happen. Why can’t the conservatives understand that? Drugs don’t come from Mexico, they are being grown all over the place, probably in your neighbor’s house or yard. Thankfully, Monsanto/Bayer doesn’t own those seeds, yet.

    This is the most important paragraph:
    “And someday–no doubt after I’m long dead–we might stop letting lobbyists make health policy, get Medicare for All or its equivalent, and join the majority of countries that have recognized that access to health care and lifesaving drugs should not be treated as profit-generating consumer commodities.”

  10. The Colorado Ballot referendum for Universal Healthcare is being opposed by both establishment Democrats and Republicans. http://www.counterpunch.org/2016/09/15/insatiable-the-democrats-must-attack-democracy-to-serve-corporate-power/
    The corporate power is nothing if not relentless. It knows no limits except those we can impose on it.

    The Democrat Party Platform refused to endorse Universal Healthcare.

    From the Intercept >> The fight against legalized pot is being heavily bankrolled by alcohol and pharmaceutical companies, terrified that they might lose market share. Roughly half of the money raised to oppose a ballot measure to legalize recreational marijuana in California is coming from police and prison guard groups, terrified that they might lose the revenue streams to which they have become so deeply addicted.

    Drug war money has become a notable source of funding for law enforcement interests. Huge government grants and asset-seizure windfalls benefit police departments, while the constant supply of prisoners keeps the prison business booming.

    Todd mentions Eli Lilly > From an IBJ Article dated August 3, 2009 > Susan Bayh former attorney at Eli Lilly and Co. Susan Bayh served on the Board Directors at WellPoint – It’s a good gig for Susan Bayh. Last year (2008), she earned $327,000 in fees, stock and stock options from WellPoint, according to IBJ research. There is much more but I think you get the point.

    So whether it is opposition to fracking, Universal Healthcare or legalization of pot the well funded Corporate Establishment will find one way or another to stifle it. When we go to vote we end up with Corporate Establishment Candidate R or D.

  11. INSYS Therapeutics, which makes a fast-acting prescription form of Fentanyl –one of the strongest and most highly addictive opioids and also makes a synthetic form of THC, the main hallucinogenic ingredient in marijuana, gave $500,000 to the campaign opposing November’s citizen ballot initiative to legalize marijuana in Arizona. That was the largest single donation to the anti campaign.

    https://www.washingtonpost.com/news/wonk/wp/2016/09/09/a-maker-of-deadly-painkillers-is-bankrolling-the-opposition-to-legal-marijuana-in-arizona/

    With that infusion of money, the anti-legalization campaign is now running slick TV ads full of false or distorted claims about how awful legalization of marijuana has supposedly been for Colorado. How’s that for protecting your market to sell prescription drugs that are way more deadly than pot?

  12. A practice of mindfulness, meditation, and self-regulation can work miracles on pain. However, this is only if a person establishes and maintains a a regular practice. Our ways of living often do not support us in living our lives with some self discipline. And our medical establishment does not seem to support us in offering a premium for making our sensible regulation of our life style choices more beneficial than choosing what is offered to us by marketeers.

    Why is it that in the senior level of insurance, Medicare Advantage insurance policies offers Silver Sneakers to their members, but Medicare does not? (this offers seniors free health club memberships so that they are benefited by attending to their own well being). Why is it that Health Savings Accounts are not offered to those on Medicare?

    Why are we not asking: ” Why it is that people desire to alter their consciousness with drugs and mind altering substances rather than living a conscious life?” Ask the users and see what they say.

  13. Joseph E. Stiglitz (born and raised in Gary, Indiana, and one of my favorite economists) won an international prize for his study of asymmetry of information between buyer and seller. Classical economists assumed perfect competition in the marketplace, but there has never been perfect competition in any market place. Thus drug companies advertise prescribed drugs (a no-no in most Western countries), take a deduction from their taxes for such costs, and your taxes and mine are raised (or added to the deficit for which you and I are also liable). We are paying for our own brainwashing, including those of us who do not and will not use a particular compound, and as to asymmetry of information, you are no match in those areas where you are within the lair of attorneys, CPAs, medical doctors etc. Asymmetry is baked in to the process and there is no “invisible hand” that will make all well. Market economies have no means short of government intervention to try to even out such asymmetries, but heavens! We can’t have that! Let the market decide, you know. Tsk!

  14. You do realize opiates (e.g. Heroine/opium poppies), predate by several hundred if not thousands of years, modern medicine not to mention modern medical sciences, and opium (e.g. Laudanum, opium in alcohol – 16th century) was a major medical preparation long before modern medical science. There were numerous rather extensive periods of what today we would call epidemics in opiate addiction – including two international trade wars motivated by such (I.e 1st and 2nd Opium Wars, 1839-1869) that predate modern, industrial oharmacology, all of the U.S. pharmaceutical companies, and all in an age when healthcare was both not free and not provided by the state. Opiates could be much cheaper, available and effect the lives of far more people if we just legalize the opium trade coming out of Afghanistan. The price of opiates would drop dramatically, maybe by as much as 90%, but no one is in favor of this. Limiting the supply will not reduce the addictions, it will only drive up the price — basic economics. As, oPium epidemics predate modern medicine, the present epidemic has less to do with the modern way in which drugs are delivered, than the general difficulty using compounds related to natural neurochemicals, from non-internal sources, safely without causing addiction — irrespective of the role of the profit motive. If it were totally the profit motive, why is heroine addiction much more of an issue in Europe where healthcare and treatment are free to patients? (Cocaine addiction is more of an issue here). If you could control the supply effectively, the war on drugs would have worked at eliminating demand. Instead, people treated through the system for chronic pain usually become frustrated by the controls, not the costs, and jump out of the system to street drugs for relief. The issue with legal drugs is more that we understand much less how to manage pain effectively; so, our tools run from modestly effective NSAIDs to morphine with relatively little in between despite years of research. Some problems are just not so simple. The system being free or not will not change the basic science or the relative cost/difficulty of making breakthroughs.

  15. So many great comments today!

    I have chosen to pay out of my pocket for some much safer bio-identical prescriptions, rather than purchase the typical pharmaceutical prescribed. Actually, the compounded rxs end up being less costly than those from the pharma industry.

    Unfortunately, many people refuse to spend their own money on safer alternatives and this is not because they can’t afford it. It is because they are used to insurance companies paying the cost, even if it is less safe. The thought of spending their own money on their health is not acceptable.

    With this in mind, it seems quite logical that millions of people in our country are voting for Trump – he is telling them that he can fix everything and it won’t cost them anything.

    Capitalism has continually worked against the general public in our country, while it has worked very very well for corporate interests. We deserve affordable health insurance and health care in this country, but how do we fight the moneyed interests?

  16. Nancy; my primary physician wanted to prescribe daily antibiotics to prevent UTIs, I refused knowing that, when needed for another problem the resistance build up in my system would prevent them from helping. I Googled info on cranberry treatment; love cranberries but berries and juice too acidic so opted for cranberry gelcaps from Walmart. One UTI in over two years; doctor prescribed $43 antibiotic which I refused, she then prescribed a $12 antibiotic which worked as it always did before I discovered cranberry gelcaps.

    Took a serious fall early this summer; talked to my nurse friend who said it sounded like a fractured tailbone, which had been my self-diagnosis. Good old Google gave the same diagnosis plus information that doctors rarely even request an ex ray due to the difficulty finding fractures in the four tiny bones which make up the tailbone. I followed instructions from Johns Hopkins, used Tylenol and/or Ibuprofen, spent 3-4 very uncomfortable weeks and back to normal. Strong medications, especially for pain, do not agree with my system; I must keep reminding my doctor of this so rarely tell her anything. Tylenol and Ibuprofen work for me.

    I am smart enough to know when I need actual treatment and do seek it, I have called a halt to expensive prescriptions and now refuse unnecessary treatment and repeated tests which are billed to Medicare at very high rates. I rarely even catch cold; am very healthy to be 79, deaf and disabled…a running joke in my family.

Comments are closed.