America has been trapped in a drug war for decades, despite having spent over $1 trillion combatting it. And it is not the Columbian drug cartels who are to blame but the American society itself.
The availability, addictive nature, and potency of opioid drugs in mainstream America has led to the worst narcotic crisis in American history - one that has killed hundreds of thousands of people and destroyed lives, businesses and families. The victims range from the chronically poor in small-town Hillbilly regions to middle-aged suburban moms, to New York bankers and a host of celebrities including musician Prince and actor Philip Seymour Hoffman.
The Government-Driven Opioid Epidemic
In the United States, more than 12 million people use opioid drugs recreationally. In 2010, 16,652 deaths were related to opioid overdose in combination with other drugs such as benzodiazepines and alcohol.
Whether people are getting their fix from cheap heroin/fentanyl smuggled from other countries or through prescription drugs like OxyContin®, the results are the same: broken families, shattered lives, addiction, and death.
How did the US get here? How did “the Land of the Free and the home of the Brave” end up in a situation where, on a single day in early 2017, authorities in Louisville, Kentucky, responded to 43 overdoses in a 24-hour period? Where 50 overdoses were recorded in a day in Philadelphia in late 2016?
The answer is both - depressing and surprising. The seeds of the opioid crisis were sown by FDA collusion with a pharmaceutical industry that subordinated humanity in exchange for massive profits garnered by addicting millions of Americans to their opioid based drugs.
Opioids Go Mainstream Fighting Chronic Pain
Not too long ago, opioids were relatively uncommon, both in the illicit drug trade and in the treatment of chronic pain. Medically, they were mostly used to control acute pain such as cancer pain or trauma but not chronic pain.
As street drugs, opioids were long ago overshadowed by cocaine and crack, and then later by methamphetamines. Heroin, the most common street opioid, was heavily stigmatized.
That began to change in 1995, when a pharmaceutical company called Purdue Pharma (https://www.purduepharma.com/) was able to sow the seeds for today's epidemic, largely assisted by inefficient, inept oversight by the federal government. How?
That year, the Food and Drug Administration (FDA) approved oxycodone for chronic pain – and not only for acute pain.
Oxycodone, sold under its trade name OxyContin®, is a semisynthetic, time released opioid, similar in structure and function to heroin and other opioids.
Oxycodone is the most widely recreationally used opioid in America. The U.S. Department of Health and Human Services estimates that about 11 million people in the US consume oxycodone in a non-medical way annually.
In 2007, about 42,800 emergency room visits occurred due to "episodes" involving Oxycodone. Diverted Oxycodone may be taken orally or ingested through insufflation; used intravenously, or the heated vapors inhaled. In 2008, recreational use of oxycodone and hydrocodone were involved in 14,800 deaths. Some of the cases were due to overdoses of the acetaminophen component, resulting in fatal liver damage.
From the moment the drug was approved, OxyContin® was backed up by an unprecedented, aggressive, and poorly regulated marketing campaign.
First, Purdue Pharma targeted busy primary care physicians - those less likely to be trained in safe pain management and usually with little time to manage complex pain cases. Purdue also trained their sights on doctors who already prescribed opioids regularly and saw the most chronic pain patients.
After that they expanded the range of conditions, selling OxyContin® to doctors on the idea that it was an acceptable solution for virtually any type of pain. Finally, they made the false claim that the drug was less addictive than other opioids because it was offered in a time release release capsule.
Sales Skyrocketed from $48 Million in 1996 to $1.1 Billion in 2000
The campaign worked. Sales of the blockbuster painkiller skyrocketed from $48 million in 1996 to $1.1 billion in 2000. By 2003, nearly half of OxyContin® prescriptions were written by primary care physicians. 12 Months later it became the most widely abused opiate in North America.
But soon after Purdue Pharma’s tactics came back to haunt it. In 2007, the company and three executives pleaded guilty to criminal charges. According to prosecutors, Purdue Pharma had intentionally lied above the addictive risk of the drug. The company was fined $634 million. But none of the executives responsible were sentenced to serve any jail time.
And the convictions did little to stop the flow of opioids into mainstream American communities. And they did not stop the sales success of Purdue. By 2015, the company was pulling in $2.4 billion annually from the sale of opioids, including OxyContin®.
And since then the situation has only gotten worse. Today, synthetic opioids like fentanyl which are much more powerful than pure heroin are devastating American communities. Fentanyl is the drug that killed 1990s pop hero Prince.
According to the CDC (Centers for Disease Control and Prevention), the death rate from synthetic opioids increased by 72.2% in a single year, from 2014 to 2015.
Corruption in the Open
And no one in the US is taking responsibility for the flooding of towns, cities and communities with powerfully addictive drugs.
The opioid epidemic which started more than 20 years ago is a crisis of greed and corruption as much as addictism.
The pharmaceutical industry in the US is the greedy element, Average Joe and Jane in the US are the easy to be made addicted ones and the US government is the corrupt factor.
So far, the pharmaceutical industry has found a willing partner in Congress to help protect the annual $9 billion trade in FDA approved opioid drugs.
Joseph Rannazzisi, the former head of the Drug Enforcement Agency’s office responsible for preventing prescription medicine abuse, told British newspaper “The Guardian” about the relationship between the opioid lobby and the government:
“Congress would rather listen to people who had a profit motive rather than a public health and safety motive. As long as the industry has this stranglehold through lobbyists, nothing’s going to change. "
Rannazzisi was specifically referring to a 2016 law called the Ensuring Patient Access and Effective Drug Enforcement Act. Rannazzisi claimed that this law designed to protect American individuals effectively gutted the DEA’s ability to regulate the dumping of opioids into disadvantaged communities.
According to the law, the DEA must issue a warning to clinics and distributors who are suspected of diverting opioids into the illicit drug market. No more.
So, all the law effectively did was to give distributors a chance to redirect their flow of drugs through new channels, with no accountability.
A Gift to the Industry
"This was a gift to the industry," he said.
More recently, states such as Mississippi, Ohio and Missouri have tried to stem the flow of opioids into their communities. In 2017, they sued multiple pharmaceutical companies, alleging that they downplayed the dangers of opioids while engaging in deceptive marketing. Other states followed.
In filing these lawsuits, the states are running up against an incredibly powerful lobby.
A 2016 joint investigation between the Center of Public Integrity and the Associated Press found that the pharmaceutical lobby spent $880 million over a 10-year period to roll back laws that make it harder to overprescribe opioids, limit distribution, and hold irresponsible manufacturers and distributors accountable. Overall, the industry is active in all 50 US states and contributed to about 7,100 candidates for state-Ievel offices operating through organizations like the Pain Care Forum and International Pain Foundation.
In a Nutshell
The current opioid epidemic is fueled by drugs such as OxyContin® (including generic oxycodone versions approved by the FDA), along with imported heroin and fentanyl. The easy availability of these drugs is no accident. Makers of these powerful opioids convinced government regulators that these oxycodone (synthetic heroin) drugs had a lower potential for abuse and were thus not only suited to fight severe acute pain but regular chronic pain – even moderate chronic pain (headaches, back pain, muscle pain, virtually any pain). A much bigger market of course than the closely confined acute pain market.
Dangerously addictive medications were approved by the FDA on that basis. The drug companies embarked on an unprecedented marketing campaign to identify doctors who would prescribe opioids and expand the list of conditions for which opioids can be prescribed.
The human cost of this government/industry campaign has been devastating: almost 100 people die every day from opioid overdose, and thousands more from broken families, destroyed careers, and shattered health.
In the face of this devastation, grassroots campaigns - largely driven by grieving parents - have sprung up to push for commonsense laws at the state federal level to regulate the prescribing and distribution of opioids.
These campaigns have proven no match for the pharmaceutical lobby, which has spent roughly $880 million over the past decade to squash any law regulating the industry.
The crisis has its genesis in the FDA approving OxyContin® in 1995, which enabled pharmaceutical companies to promote a range of oxycodone drugs as less prone to addiction and abuse.
As soaring overdose deaths made headline news, the FDA has taken steps to reduce oxycodone availability. Instead of curbing opioid consumption the opposite happened.
Addicts switched to much more lethal heroin and fentanyl in large numbers.
The result: Mainstream America has become populated with heroin addicts.
And the Future?
The global pain management therapeutics market is expected to expand at a 3.7% CAGR over the period between 2016 and 2024. At this pace, the market is expected to rise from a valuation of US$60.2 bn in 2015 to US$83.0 bn by 2024.
In the branded drugs segment, the top two companies, Pfizer,Inc. and Purdue Pharma LP, accounted for over 50% share in 2015. The overall share of the branded drugs manufacturers in the global pain management therapeutics market is expected to decline as established vendors will lose market share to emerging vendors and the competition in the generic drugs segment will further intensify.
The Global Pain Management Therapeutics Market is comprised of: Anticonvulsants, Antidepressants, Anesthetics, Non-steroidal Anti-inflammatory Drugs (NSAIDS), Opioids (Oxycodones, Hydrocodones, Tramadol, and Others such as Morphine, Codeine, Fentanyl, Meperidine, Methadone), Antimigraine Agents and Other Non-narcotic Analgesic
Main use cases are Neuropathic Pain, Fibromyalgia, Chronic Back Pain, Arthritic Pain, Migraine, Post-operative Pain and Cancer Pain
An alarming rise in the prevalence of chronic diseases is perceived to be the highest impact driver. The number of patients suffering from chronic pain is rising at a substantial pace globally. According to the WHO, nearly 116 million people were suffering from chronic pain in 2011 in the U.S. alone. According to another survey, one in five people in Europe suffer from chronic pain every year.
The rising prevalence of chronic diseases such as a variety of cancers and diabetes further contribute to the number of people suffering from chronic pain, encouraging the use of pain management drugs. Medications for alleviating the pain occurring from cancer therapy and from the intrusion of cancer cells in bones and other body parts, for instance, accounted for over 28% share of the overall pain management therapeutics market’s overall valuation in 2015.
The vast rise in the world’s geriatric population is also expected to emerge as a key growth driver for the global pain management therapeutics market in the years ahead. Aged people are more prone to diseases such as arthritis, joint or bone pain, epilepsy, depression, nerve damage, diabetic neuropathy, and a variety of injuries owing to low immunity levels or gene alteration. The global population of geriatrics (people aged more than 65 years) is expected to rise to 2 billion by 2050, accounting for nearly 22% of the projected global population by then. This demographic will lead to a substantial rise in the overall global demand for numerous pain management drugs, thereby driving the global pain management therapeutics market.
Bottomline: You ain’t seen nothing yet.