Alt-Health: Who’s Responsible for Opioid Addiction?

As adults, we are responsible for the choices we make. But when we ask trusted caregivers for help and are given instead a prescription that leads to our doom, we are no longer making choices; we are being manipulated and used. Herein lies the real tragedy of the opioid epidemic: Its victims did not exactly volunteer for their own addictions.  Those responsible for planting the seeds of this epidemic were the pharmaceutical companies themselves, and the physicians who prescribe their drugs.

While this may sound like a conspiracy theory from Oliver Stone, the National Institute on Drug Abuse at drugabuse.gov concurs. An article posted in 2014 states: “Several factors are likely to have contributed to the severity of the current prescription drug abuse problem. They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.  These factors together have helped create the broad ‘environmental availability’ of prescription medications in general and opioid analgesics in particular.”

Not all doctors made the transition from trusted healer to pusher, but the rewards were great for those who did. An article published in The New York Times on March 17, 2018 sheds light on the mechanisms of corruption. In 2013, Dr. Gordon Freedman, a physician practicing on Manhattan’s Upper East Side, was already a top prescriber and paid promotional speaker for Subsys, a spray form of the highly addictive painkiller fentanyl made by Insys Therapeutics. That year, Insys offered to increase the cash it was paying Dr. Freedman if he would increase the number of new patients prescribed Subsys. The doctor soon became one of the highest paid reps and top prescribers of fentanyl in the nation. Later, in a federal indictment unsealed in March 2018, it was revealed that Insys paid Dr. Freedman, and others, more than $100,000 annually, in return for prescribing millions of dollars worth of the company’s painkiller product. Dr. Freedman and four other New York doctors were charged with participating in a bribery and kickback scheme and Insys was indicted for funneling illicit payments through a sham “speakers bureau.” In this scheme, doctors were paid for purportedly giving educational presentations about the drug; most of these presentations were nothing but social gatherings at high-end Manhattan restaurants. All five doctors charged denied culpability and were released on $200,000 bail. Unfortunately, the addicts created by this pharmaceutical marketing campaign are left with a life-long struggle.

Kick-backs are not limited to opioids; they extend across all profitable drug genres. If you go to the government website openpaymentsdata.cms.gov/summary, you will find that in 2016 (last comprised data summary) a total of $8.19 billion was spent on promotional payments, by 1,479 drug companies. On the receiving end, over 630,000 physicians were paid nearly $4 billion in cash and investments, with an additional $95 million for research studies. 1,146 teaching hospitals were also included on company payrolls, each of which received an average of $723.66 million, with an additional $870 million for research. If you look back further, you will discover that  payments by pharmaceutical companies have literally doubled since 2013, when the annual spending total was a mere $4.08 billion.

The size of the kickback payments may have been the source of an outbreak of outrage when, as of January 16, the state of New Jersey made it illegal for any one doctor to accept more than $10,000 annually from pharmaceutical companies, and placed an additional $15 spending cap on complimentary meals. An editorial in Medical Economics by Keith L. Martin, content channel director, called this ruling “simply regulatory nonsense” and declared that NJ legislators have “created an atmosphere that not only hurts physician compensation for assisting pharma in new scientific endeavors…but also harms patients.” Mr. Martin went on to say that “fear of racking up a $15.01 lunch tab for a meal means no more ‘lunch and learns’ on new prescriptions and likely a reduction in samples for patients who cannot afford medications.” This tirade brings up some interesting points.

If your doctor is a good one, he or she reads clinical studies on medications they prescribe. However, many physicians receive most of their information about prescribing drugs directly from drug company representatives. Considering that aggressive marketing by pharmaceutical companies is a reality in our country, these “lunch and learns” set the stage and opportunity for pharmaceutical companies to influence doctors to prescribe whatever drugs the pharma rep offers incentives for. Although it doesn’t receive the same publicity, another epidemic is still climbing beneath the cover of opioid deaths: benzodiazepines, prescribed for anxiety and insomnia, have reached social acceptance and broad dispersion that rivals that of painkillers and heroin. Though they have several known safety risks, they are routinely prescribed far longer than the single month advised, a practice leading to overdose, falls, fractures, motor vehicle accidents and addiction.

That America is drug-dependent is undeniable, but it is equally true that we were given no small pressure by the pharmaceutical companies and the doctors who are their willing pawns. Even health based pharmacies such as CVS sell individual physician prescribing information directly to the drug manufacturer companies, who then use this information to target physician prescribers. So…who can you trust? Well, my friend Dr. H is angered by such practices and abhors the whole kick-back system: “The act of accepting a gift obliges the receiver to give something back to the giver.” My guess is, find a pissed off doctor who won’t prescribe Oxycodone no matter how much you beg … and that’s the guy you can trust.