In comments yesterday I was made aware of this New York Times article on the striking surge in drug overdose deaths in 2016:
AKRON, Ohio — Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.
The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.
The article is pretty horrifying. I recommend you read it in full to get an idea of the scope of the problem.
I don’t know whether the incidence of opioid addiction is rising dramatically (the available data seems to suggest tha the number of deaths due to overdose are rising a lot faster than the rate of use) but it appears that a lot of the deaths due to overdose are a consequence of fentanyl, an opioid more than three orders of magnitude more potent than morphine. Fentanyl is being sold as other, more expensive but less potent drugs, e.g. OxyContin, Xanax, even cocaine. Abusers may think they’re taking these other drugs when they’re actually taking the more deadly fentanyl.
Fentanyl is not something that can be made by a casual cook. My reading on its synthesis suggests that it requires a pretty fair level of sophistication and a lot of the fentanyl hitting the streets is coming into this country from China.
The editors of the Washington Post have come out in support of a lawsuit by the state of Ohio against pharmaceutical manufacturers for their role in the increase in opioid abuse:
OHIO ATTORNEY GENERAL Mike DeWine filed a lawsuit against five leading opioid painkiller manufacturers May 31, accusing them of misleadingly minimizing the real addiction risks associated with the powerful pills, thus triggering the nationwide epidemic of opioid addiction and death. Mr. DeWine brought his case in an Ohio state court, choosing as his venue the courthouse in Chillicothe, a small city whose struggle with the addiction crisis was the subject of a heartbreaking report by The Post’s Joel Achenbach.
This suit joins similar efforts against the drug companies filed by jurisdictions as different as Everett, Wash., which has charged Purdue Pharma with failing to blow the whistle on massive diversion of its product to that city’s black market, and the Cherokee Nation, which is suing pharmacy chains and their wholesale suppliers on similar allegations. We hasten to add that all of the companies accused, Purdue Pharma included, deny any wrongdoing, and argue that they work hard to comply with federal regulations and prevent the improper use of their products. It is also true that, even though the opioid lawsuits are often compared to the litigation that ultimately held Big Tobacco accountable, prescription opioids have legitimate health uses, unlike cigarettes.
The fact remains, however, that more than 183,000 people have died in the United States from overdoses related to prescription opioids between 1999 and 2015, according to the federal Centers for Disease Control and Prevention. Such deaths were rare prior to the 1990s, when prescription opioids became commonly prescribed for non-cancer pain — at the urging of the pharmaceutical industry’s marketing teams. Mr. DeWine’s lawsuit and others like it might not be equivalent to the tobacco lawsuits, legally or morally, but they express widespread and understandable public feeling. They amount to a cri de coeur in the courtroom.
I understand the concern but this suit makes me nervous. It seems to me that physicians are a much more proximate source of the problem than pharmaceutical companies. As many as 75% of opioid abusers begin as users of prescription painkillers.
If this suit against pharmaceutical companies prevails, can a suit against medical doctors and/or hospitals be far behind?
I watched Dr. Drew in a waiting room discuss this a few weeks ago. He emphasized:
1) The coverage focusing on rural-white Northeast is misleading and obscuring a national health crisis effecting everyone.
2) The efficacy of the Oxycotin family as a pain reliever is short-term (two weeks?) and shouldn’t be prescribed long-term.
3) While he thought there was much blame to go around, overlooked was the role lawyers played in pushing liability for failure to treat pain.
If 2 is true, then there is a lot of potential liability for doctors. 3 is interesting, but I don’t think there needs to be external cause for doctors prescribing pain relief medication when someone comes to them in pain.
The public nuisance suits against distributors in West Virginia are interesting. It sounds like in rural areas this family of drugs is distributed to specialist or non-customary retailers in inordinate amounts. There is a federal law requiring distributors to report suspicious orders to the DEA. The lawsuits are based upon old common law that will turn on creation of unreasonable public health hazards.
If so many of the overdoses are caused by fentanyl masquerading as other prescriptions, how can the drug companies be at fault? That dog don’t hunt.
If the dog won’t hunt, not too worry, the visions of big attorney fees (AGs generally hire private firms for this) and money to be disbursed to worthy causes (look up where the money from the tobacco settlement went) will fix that right up.
Fentanyl is a problem. It is fairly easy to obtain. Carfentanil is much worse. Almost impossible to reverse. It was being sold in China up until a few months ago w/o needing a prescription IIRC.
Lots of blame to go around, but the drug companies really did claim, and push studies claiming, that their newer drugs were not addictive, when they knew that they were. Some drug company execs have already served jail time. Probably some more should, or at least face big financial penalties. Cannot fond th reference right now, but if memory serves, our drug companies manufacture way more narcotics than are legally subscribed. They have to know drugs are being used illegally.
Doctors? Yes, some are ordering drugs illegally and inappropriately. Some should face punishment. A lot more just need help in some form so they can stop ordering the drugs. I have a light day tomorrow because i have meetings tomorrow, but I checked ahead on the patients at that facility. Every pt is on narcotics in some form. A lot of this is similar to the problem we have faced with antibiotics. If you don’t order the narcs for the pt, they don’t come back. You get low satisfaction scores, etc. Docs need the cover so that they can NOT order narcs and not suffer for doing the right thing.
Steve
Yes, PAIN!. What do you use? Aspirin, Aleve? Maybe you are to young, or too sedentary, to have joint pain. Me, I’m old, work very hard physically, and look forward all day long to the slow, easy comfort of Old Milwaukee. I know it’s wrong, but, keeps me going. Makes me wonder if heroin addicts drug of choice should be legalized and standardized, like beer, less overdoses, I bet.
I’ve taken practically everything (on prescription) at one time or another. Now I don’t even use NSAIDs unless it’s absolutely intolerable.
I’m fortunate in having had a lifetime of martial arts training. I just zen my way through things that would incapacitate others.
Oh the irony of opiates coming from China causing a crisis here. It was British exports of opium into China (and the problems opium caused) that was a proximate cause of the opium wars that led to a “century of humiliation”. I do think the Chinese government will work with the American government to stamp out any trade — but Chinese history shows that alone won’t fix the crisis here.
Its a pretty depressing situation – there are articles showing that the opioid crisis is a major cause in the shortening of lifespan among white Americans.
For who is liable, there are many causes and actors to blame. A few drug companies, e.g. Purdue Pharma, seemed negligent in developing and marketing opioid medications. It seems medical regulators and medical societies did not appreciate or ignored the risks in opioids; there is the infamous letter to New England Journal of Medicine in 1980 that stated without context that risk of opioid addiction was low. There are the irresponsible (criminal?) “pill mills”. And society too – the socio-economic ills that have plagued American society probably contributes to people looking to escape their pain through substance abuse.
I think that if there’s one message of the huge number of Americans who are now on SSDI it’s the large number of people who met the criteria of disability but nevertheless continued to work–that supports Gray Shambler’s point. As people work past what was laughingly called “retirement age” into their 70s and beyond, we’re going to see a lot more of that.
Can someone explain to me how a physician can with a straight face claim to not know opioids are addictive?
That doesn’t absolve patients of their drug seeking behaviors, but give me a break.
Now? I don’t see how anyone could believe it. In the 90s when this started? The drug companies really had very convincing presentations. They were promoting pain as the 5th vital sign. Lots of talk about how we were under treating pain.
Now, I suspect we will swing back too far the other way. Meh. Nature, or was it Science, had an article a few years ago about the search for narcotics that do not cause respiratory depression. That certainly seems possible. Not so sure about developing ones that are not addictive.
Steve
In my county in Ohio, which is rural, the county hospital has bought up all the private practices in the county, and the physicians are now employees of the hospital. The hospital would be a more attractive deep pocket target for a suit than individual physicians, and the long-established rule that employers are responsible for the actions of their employees would provide the rationale.