Guest Column: The Opioid Scene, An American Tragedy, Update, by Sue DeGregorio-Rosen, RN, CLNC

Abstract of Human Head Brain Vector Silhouette. Source: drugabuse.com

Attached is an article I wrote in 2018. The opioid drama continues to strike families under the systemic rubric of “pain management” and affecting so many of those who are constitutionally incapable of recovery. Working in the medical profession I am encountering the immediate and tragic effects of opioids on a regular basis. What was relevant in 2018 remains more so in 2019.

The opioid drama is an American tragedy steeped in lies. The tragedy is estimated to cost the United States a trillion dollars within the next year. Thousands will feel its effects in detox and rehab centers, not to mention our prison systems.  The death toll will be close to 100,000 Americans, regardless of the push to teach families and friends to take on the roles of “first responder,” armed with Narcan. President Trump has declared this epidemic a public health crisis, but he has not asked Congress for additional monies.

That leaves states, counties, cities and taxpayers to cover the tragic politicized errors of government agencies who through corporate influence approved the foundations of the current opioid scenario. What is the role of Big Pharma in this? There are 12 pharmaceutical companies that have been named by Forbes that are making billions. And the death toll is increasing.

“We kept seeing our crime problems and overdose deaths going up every year. We got no response for anyone with the federal government,” Mayor Paul Billups of Ceredo, West Virginia, told The Daily Beast. “They didn’t have a plan, so we decided to come up with a plan. We decided caring for people is more important than marketing and profits.”

Ceredo is one of about 250 states, counties, and cities that have filed lawsuits against multiple pharmaceutical companies and distributors of opioid prescription pills that are blamed for turning pain patients into heroin addicts.

Richie Webber is one such victim turned advocate. He was a star high-school track and football athlete 10 years ago, Webber got injured and was given pain medication, Oxycontin that led to his heroin addiction and two nearly fatal overdoses. Webber has been clean for about three years working along with a community group in his native Ohio to help people like him get treatment.

“I find it really odd when the pharmaceutical companies that make pills like OxyContin claim they are non-addictive and just help people with pain,” he said. “Well, let’s look at it from my perspective. We’ve helped more than 300 people get into rehab this year, and 90 percent of them started with prescription pain pills. That’s non-addictive?”

The FDA approved the drugs that Big Pharma created, in particular, Purdue Pharmaceuticals, The defendant named in most lawsuits is Purdue Pharma, which introduced OxyContin in 1996. The drug is a pain medicine based on a morphine derivative that Purdue stated was non- addictive. In the 90’s it was first prescribed for patients with cancer or deep bone pain. The later part of that decade pain became the 5th vital sign, scripted by the Joint Commission Accreditation Committee, mandating that all patients were to be asked “on a scale of 1 – 10, describe your level of pain”. Doctors and nurses were to document on each patient and treat that patient according to a subjective question. Vital signs are not subjective. Vital signs are objective. By the turn of the century, doctors had to treat chronic and even minor pain with these harmful substances.

By the year 2005, we were in the throes of the worst opioid epidemic since the American Civil War. We have been subject to danger, harm to our communities, families broken and devastated, increased health insurance costs, increased police and hospital/ER use, increased use of our prison system and loss of life.

Lawsuits are filed all over the country, from Seattle, Washington, to Rutland, Vermont.

“All we are looking for is a little justice in all this,” Pete Orput, the Washington County attorney in Minnesota told The Daily Beast on why his county joined other counties in the state filing suit. “We just want some payback. For years we have heard the pharmaceutical companies tell us they have nothing to do with the addiction. I resent what they have told us, and I resent what they have done in our community.”

The defendant named in most lawsuits is Purdue Pharma, which introduced OxyContin in 1996. “What happened was compassion became conflated with opioid prescribing, so a doctor who wasn’t willing to prescribe opioids was viewed as withholding and sadistic,” said Anna Lembke, a professor of psychiatry and behavioral sciences and author of Drug Dealer MD: How Doctors Were Duped, Patients Got Hooked and Why It’s So Hard to Stop.

In a statement, Purdue Pharma said: “We are deeply troubled by the prescription and illicit opioid abuse crisis and are dedicated to being part of the solution. As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge… We vigorously deny these allegations and look forward to the opportunity to present our defense.”

Opioid prescriptions tripled between 1999 and 2016 and so too did overdose deaths. In 2016, 42,249 people in the U.S. died of opioid-caused overdoses, according to the Centers for Disease Control and Prevention—more than deaths from breast cancer that same year. The White House Council of Economic Advisers (CEA) last November estimated the cost from the opioid crisis was about $500 billion in 2015.

“It is accepted and there is little doubt that too many of these drugs were put into the marketplace and sold beyond their legitimate needs,” Kessler told The Daily Beast. “The vast majority of people get addicted because of prescriptions, and we need to tighten the distribution and make the manufacturers of these drugs more responsible for what they have placed in the market…This is a public health issue, and we need to get better control on how much of the drug is placed in the market. These lawsuits may call better attention to those goals.”

Pharmaceutical companies in the past have settled lawsuits like these (including Purdue Pharma) and treat their fines as a cost of doing business. It’s about capitalism and profit.

Will Big Pharma be forced to pay?  Blame? Is it the corporate structure of such companies? Just the amount of funding that might go to the families of the deceased could be huge. From 1999 to 2015, more than 183,000 people have died in the U.S. from overdoses related to prescription opioids. How is that possible? Why did the American Medical Association ( the AMA) wait 20 years before requesting the removal of pain as it’s 5th vital sign from its standard of care?

Kenneth Feinberg, the attorney who oversaw the Sept. 11 victims fund l, as well as similar appointed jobs with the BP offshore oil cleanup and the Boston Marathon bombing, said any settlement would need to be combined with congressionally approved funding to “have a better idea of whom to and how much is distributed.”

“But getting anything through Congress is a chore,” Feinberg said. “If Congress enacted and appropriated enough money to deal with this crisis, a lot of these lawsuits would disappear.”

Meanwhile, we continue to witness the decay of our society caused by the FDA, Big Pharma, the DEA, the JCAHO, because once a patient can no longer access prescription drugs what are the options?  Heroin, stealing, robbing, selling their bodies, disturbing and disruptive scenarios mount for people to remain free from the chilling and painful effects of withdrawal, risking their lives, again, with the possibility of using fentanyl tainted drugs that are available online in the crypto-markets.

“What we need now, more than anything else, are people willing to serve as uniters, people in our communities who can rally others for the greater good, reject cynicism and winner-take-all politics, and embrace the more difficult work of this generation: to unite our country in common cause” – Cory Booker, US. Senate.