Responsibility for America’s opioid crisis has to be found out. Local governments have taken the large pharmaceutical companies to court for that, but a better way for determining responsibility is to draw a distinction between the crisis of addiction and the crisis of overdosing to death. The two are very different.
The overdosing-to-death part of the crisis was caused by aggressive ignorance by policy-makers, technology, and globalized trade.
First, trade: You know how you see pictures of a penniless refugee wearing a “Ford, Built Tough” tee shirt? His tee circumambulated the world before winding up on his back, from Bangladesh where it was made to, say, Texas, where it was sold. Then, it went around the world on the rag picker circuit. By the time the refugee wears it, it must be valueless. Imagine the barriers a highly value-added product, like heroin, can vault (value-added by thousands of times). Heroin is in the global supply chain, same as the tee.
Technology brought us Fentanyl, a perfect smuggler’s product: powerful enough to create tens of thousands of doses in a package small enough to be mistaken for plant food. Notice how many Amazon boxes the delivery services are moving? Imagine finding that little package in those.
Aggressive ignorance was when the government, stoked by crisis-biased media, perceived there were “too many addicts,” and decided to crack down. What’s the right number of addicts? Nobody even asked. Legal addicts, made criminals overnight by pen-stroke, were driven into the new globalized distribution chains of the new Fentanyl, served out by criminals who try to dose it correctly. With the result that many were killed, and many will continue to be killed.
“Big Pharma” serves as a convenient scapegoat for all this. But they are only responsible for the addiction part of the crisis. You will get little argument from me that they were not duly diligent in their ethical responsibilities to their patients (and the subject of another piece). I will also testify that opioids are incredibly safe drugs when used properly. I use them often in my work as a paramedic. Indeed, Purdue created (or thought they created) a boon to all mankind: Oxycodone was made with a slow-release encapsulation that dosed pain management out to the sufferer gradually. This was where the notion of “not possible to abuse” came from. Relief of suffering was the original mandate of all medicine, and it is not trivial.
But, abusers learned that the tablets could be pulverized and thus their time-release defeated. Big Pharma is not responsible for this because companies are rarely held liable for a product abused outside its intended use: Ford is not responsible for deaths from hot-rodding (Big Pharma might be liable, however, for being slow to notice the trends of abuse).
The most important lesson here is in the nature of all evolutions of government failure (or rather, absence of evolution): we have a remedy from Big-Pharma. The government sued Big Pharma with one hand, while utterly failing in its regulatory duties with the other: every greedy prescription created a control number that the government tracks, by law. They didn’t notice the abuse. They set up a whole department to notice, and to regulate when things got out of hand, and they didn’t. Where is our remedy for that?
A remedy might look like refraining from using the legal system to prosecute clinicians trying to apply the myriad known successful management strategies, like Harm Reduction, and Heroin Assisted Treatment. The laws shut down evolutionary possibilities for treatment . Had we taken those addicts made criminals overnight, and put them in rehab, we would be further on track to mitigating the crisis. If we had done that with the ghetto overdoses of twenty years ago, we’d have been further along still.
Big Pharma will never be the same. Lessons were learned, an evolution was made on the problem of opioid addiction (just don’t ask severe pain sufferers if it works for them).
Changes to the makers of the overdose-to-death part of the problem? Don’t hold your breath.
By the way, will it surprise anyone to learn that Big Pharma bribed those same regulators?
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