Are Insurance Companies and Big Pharma to Blame for the Opioid Epidemic?

A pharmacy in Kermit, West Virginia – home to not quite 400 people – had 3 million prescriptions of hydrocodone (Vicodin) within the span of 10 months.

Meanwhile, McKesson, the company that distributes this prescription, came in 6th on the Fortune 500 list in 2018.

Is big pharma fueling the opioid crisis?  Many argue that they have used questionable marketing practices to push highly addictive drugs.

And what about the insurance companies that should be carefully reviewing the type and quantity of prescription drugs they’re paying for. Should they be held liable for the opioid epidemic crisis in the U.S. because they didn’t do more to check their overuse?

Let’s start by looking at the genesis of this crisis. Were the efforts of big pharma deliberate? And why has the government largely overlooked their activities – because the opioid crisis didn’t begin today. It has been steadily growing into a looming Goliath, largely unchecked by government efforts.

Brief History of the Opioid Epidemic

The first cases of opioid abuse were documented in the ‘90s when death rates began to increase due to opioid prescription abuse. Apparently, pharmaceutical companies had been able to convince doctors that opioids could be used in the treatment of non-chronic pain, without the risk of addiction.

Pharmaceutical companies conceded that the drugs could produce pseudo-addictive behavior, but made sure to distinguish this from actual addiction and maintained that this was nothing to worry about. By the turn of the century, 86% of prescription opioids in use were for non-chronic pain.

The problem has continued to grow as people have found creative ways to get opioid prescriptions, or to get the drug illegally. Last year alone, 42,000 opioid-related deaths were recorded.

Starting in 2016, select states began passing laws to curb opioid abuse.  Recent legislation has made it possible to sanction doctors for unwise opioid prescribing practices.

Are these laws working in stemming the opioid crisis? A 2018 study by the IQVIA Institute for Human Data Science reports the following: “A 22 percent decrease in opioid prescriptions nationally between 2013 and 2017 reflects the fact that physicians and other health care professionals are increasingly judicious when prescribing opioids.”  However, gains here have been countered by a surge in overdoses from the illegal synthetic opioid fentanyl.

Who’s to Blame

Clearly, addicts will always find alternative means to prolong their habits, even if prescribed opioids aren’t available. So why should big pharma be held responsible if they can’t control the illegal actions of addicts?  Big pharma wants out of this blame game, but there are a few sticking points to keep in mind.

For starters, who got them addicted? And why, even after seeing the effects of opioid addiction, has big pharma continued to flood the market with opioids despite oversight warnings (the drug industry has been known to turn against doctors and other health care personnel who sound alarms about the addictive nature of prescription opioids)? Why have they tried to lobby their way out of oversight – essentially agitating for an end state where big pharma supervises big pharma?

Answers to questions like these are why it’s hard to move the pointing finger away from big pharma.  Let’s take a closer look at the details.

Why Big Pharma and Insurance Companies Should be Held Liable for the Opioid Epidemic

• Paving the path to addiction. Illegal opioid abuse typically begins after addiction to prescription pills. Society is probably always going to have people who actively seek illegal drugs for various reasons. And in the 1960s, most opioid addiction did stem from people who did heroin first. But in recent years, things have flip-flopped, and most people who start using heroin begin their addiction journey at the doctor’s office.

A report published in Drug and Alcohol Dependence showed that in 2008-2010, 82.6% of frequent nonmedical users who used heroin in the past year reported using opioid pain relievers prior to heroin initiation. Big pharma seems to be selling addiction-triggering substances in the form of pain killers.

• Aggressive marketing. The scientists at pharmaceutical companies know the addictive properties of their drugs, and yet they’ve aggressively marketed their products to doctors, downplaying their potential for harm. Studies have shown a positive correlation between increases in pharmaceutical marketing and increases in opioid addiction in certain regions.
• Lobbying (and some would argue buying) politicians. As the opioid epidemic crisis has grown, big pharma has steadily ramped up its lobbying efforts by spending millions of dollars on political campaigns. Some of these efforts have even been directed at the U.S. Food and Drug Administration (FDA), the very organization that is supposed to provide oversight. They’ve deliberately manipulated laws to ensure that they can keep prices high, forcing those who can’t afford their products to look for illegal alternatives.

As far as insurers go, there’s a strong case that they are no better. They’ve been complicit by keeping silent instead of raising flags over the amount of prescription opioids their customers were using. In fact, in some cases, they have been willing to pay for prescription opioids but not for medication for opioid withdrawal.

Thanks to growing concern over the gravity of opioid abuse, particularly with President Trump declaring it a national emergency, more stringent laws are now being applied to big pharma and their distributors.

When it comes to holding big pharma responsible, lawsuits are popping up to demand that opioid makers change their practices. As of this writing, 44 states have brought suits against Purdue Pharma, the makers of OxyContin.  As these suits develop and companies like Purdue feel it where it hurts, we should see a tapering off of pharmaceuticals immorally profiting from the addictions they foster.

To sum it all up, are they liable? Yes. And the results are devastating.

Should we hold them responsible?  Absolutely. If companies like Coca-Cola can be held responsible for deceptively advertising the health effects of soda, then so can big pharma, which should be in the business of protecting lives—not shattering them.