Per the Centers for Disease Control and Prevention, from 1999 to 2021, almost 645,000 people died from an overdose involving any opioid, which includes legal and illegal pain medication. In this three-part article, we explore the different waves of substance abuse, most of which are connected to opioids. The problems began with prescription opioids, which then led to increased overdose deaths, and then later the illegal production of synthetic opioids, followed by polysubstance use and stimulants. The COVID-19 pandemic itself may have even created a new wave within the opioid epidemic. It is scourge after scourge of substance abuse and addiction with no real end in sight.
Pain Medication Solves All
The first wave within the past 30 years connected to prescription opioids is going back to the late 1990s. During this time, there was an increase in prescribing, resulting in overdose deaths. Prescription opioids were the culprit, which included: natural opiates, semi-synthetic, and methadone. Healthcare providers began using opioids in the 1990s to treat chronic pain, which was not related to cancer. At that time, more opioid prescriptions were written for more days per prescription and in higher doses. The number of opioids prescribed in the United States peaked in 2010, but the damage had already been done. Also, it was in 2010, when the second wave of the opioid epidemic began.
Prescription opioid-related deaths increased sharply from 1999 through 2010. Higher amounts of opioids were prescribed in counties with a larger percentage of non-Hispanic whites. Also, prescribing rates were higher in counties with a higher prevalence of diabetes and arthritis, higher rates of unemployment, and Medicaid enrollment. However, there was substantial variation in prescribing patterns at the county level. The underlying argument driving the increased prescribing was pain specialists, and advocacy organizations in the country said the nation faced an epidemic of untreated pain. The American Pain Society advocated for the recognition of pain as the fifth vital sign, per an article in the Pharmaceutical Journal.
The trend started with professional and consumer groups pushing for the increased use of pain medication. Pharmaceutical companies, specifically Purdue Pharma, began to heavily market OxyContin, which is a brand name for oxycodone. Sales reps from Big Pharma visited doctors across the nation, leaving free samples and invitations to all expenses paid symposia on pain management. Unfortunately, the marketing strategies downplayed the addictive nature of OxyContin. In much of the promotional campaign done by Purdue Pharma, Purdue claimed the risk of addiction from OxyContin was minimal. A harmonious and lucrative relationship began among pharmaceutical companies, politicians, and some physicians.
Sale Reps Advising Physicians—Big Pharma Paying Lobbyists and Politicians—Everyone Made Money
The global sales of OxyContin(oxycodone) increased from US$48 million to US$2.4 billion between 1996 and 2012. The number of prescriptions in the United States increased by 300% between 1991 and 2009. The U.S. consumed 99% of the world’s hydrocodone, 81% of the world’s oxycodone, and 60% of the world’s hydromorphone. Perdue Pharma introduced OxyContin in 1996, and it was aggressively marketed and highly promoted. In 2004, OxyContin became the leading drug of abuse in the United States. Between 1996 and 2001, Purdue held more than 40 national pain management and speaker training conferences in Arizona, California, and Florida.
The seminars led to drug companies being able to target physicians who were the highest prescribers for opioids across the country. Also, it helped identify physicians with large numbers of chronic pain patients. Furthermore, the database identified doctors who were the most frequent prescribers of opioids. It was the best market research done for a product, which resulted in the death of hundreds of thousands of Americans. The fuel was a lucrative bonus system encouraging sales reps to increase sales of OxyContin. Then physicians were targeted by sales reps, and eventually, everyone started making money. Purdue paid $40 million in sales incentive bonuses to its sales reps in 2001.
Money Talks and You Know the Rest…
Pharmaceutical companies spend more than any other industry to influence politicians. Over $2.5 billion was spent lobbying and funding members of Congress over the past decade. There are very few members of the House of Representatives and U.S. Senators who have not taken campaign contributions from pharmaceutical companies. These contributions influence legislation regarding the cost of drugs and the approval of new drugs. Unfortunately, despite lawsuits at the state level, nothing changes—every year, hundreds of millions of dollars flow to lobbyists and politicians. The money has one purpose, to shape laws and policies that benefit the pharmaceutical industry.
During the massive marketing and prescribing of OxyContin, the more opioids doctors prescribed, the more money they got paid. Doctors received vast sums of money from opioid manufactures to speak, consult, and perform other services. The more they prescribed to patients, the more they were paid by manufacturers, per an analysis done within the Harvard Medical School. Unfortunately, much of this information was not necessarily vastly publicized knowledge until 2014/2015. It was a combination of brilliant marketing, taking advantage of people in pain, downplaying the addictive nature of the drug, and throwing money everywhere. Overall, everyone involved made money, and so began the opioid epidemic, and an American made drug addiction problem.