March 16, 2016
We are in the middle of an opioid and heroin epidemic, which is killing ever increasing numbers of Americans at an astonishing rate.
In 2014, almost 30,000 people died from heroin and opioids (also called narcotic prescription painkillers), exceeding those who died from car accidents during the same year, says the Centers for Disease Control and Prevention (CDC).1
Prescriptions for opioids have risen by 300 percent over the past 10 years and fed the heroin epidemic as the tolerance of opioid addicts surpasses their allotted prescription dosage and/or they are no longer allowed to refill their prescription.
In April of 2015, the U.S. Drug Enforcement Administration (DEA) also noted that “Controlled prescription drug abusers who begin using heroin do so chiefly because of price differences.”2
Most people know there is a prescription painkiller epidemic underway but few realize how much the government is enabling it, how much taxpayers are subsidizing it, and how this is the root cause of the current heroin epidemic.
Conflicts of Interest Color Pain Treatment
In February, Senator Ron Wyden (D-OR) wrote a letter to Sylvia Burwell, the head of the Department of Health and Human Services (HHS), about the glaring conflicts of interest at the Interagency Pain Research Coordinating Committee, convened as part of the Affordable Health Care Act3 to improve pain-related treatment strategies.4
Questions began to arise when members of the panel objected to federal suggestions that doctors reduce opioid prescriptions for chronic pain.5 According to the Associated Press, conflicts at the Interagency Pain Research Coordinating Committee include:
“[T]wo panelists work[ing] for the Center for Practical Bioethics, a Kansas City group which receives funding from multiple drugmakers, including OxyContin-maker Purdue Pharma, which donated $100,000 in 2013.
One panelist holds a chair at the center created by a $1.5-million donation from Purdue Pharma. The other has received more than $8,660 in speaking fees, meals, travel accommodations and other payments from pain drugmakers …
A third member of the panel is a director with the U.S. Pain Foundation, a nonprofit that receives most of its funding from drugmakers, including a $104,800 donation from Purdue Pharma in 2014, according to IRS Records cited by Wyden.
Two other panelists are connected to the American Chronic Pain Association, another nonprofit that receives substantial funding from drugmakers, including Pfizer Inc., AstraZeneca Plc, Teva Pharmaceuticals Industries Ltd. and AbbVie Inc.”
Big Pharma Money Responsible for Loosening US Drug Policies
The panelists, who appear to be foxes guarding the hen house, are not the only experts developing drug policies while taking opioid makers’ money.
In 2009, the American Geriatrics Society changed its guidelines to recommend “that over-the-counter pain relievers, such as ibuprofen and naproxen, be used rarely and that doctors instead consider prescribing opioids for all patients with moderate to severe pain.”6
Half the panel’s experts “had financial ties to opioid companies, as paid speakers, consultants or advisers at the time the guidelines were issued,” reporter John Fauber writes.
The University of Wisconsin’s Pain & Policy Studies Group also took $2.5 million from opioid makers even as it pushed for looser use of narcotic painkillers.7
Federal officials have also been intensely lobbied by a drug company-funded group called IMMPACT whose stated goal is “improving the design, execution, and interpretation of clinical trials of treatments for pain.”8,9
For a fee that could be as high as $35,000, IMMPACT promises to get drug company representatives into invitation-only meetings of government officials and academic leaders, often at elegant places, where they can lobby NIH researchers and FDA officials one-on-one.
The public and press are not included in the meetings, which date back to 2002. Both Purdue Pharma, which makes OxyContin, and Janssen, which makes the opioids Duragesic and Nucynta, have acknowledged the value of IMMPACT.10
Many Opioids Makers Rely on Taxpayer Funded Programs for Profits
According to the Office of the Inspector General (OIG) for the HHS, spending on opioids in the Medicare system, which of course is funded by our tax dollars, grew at a faster rate than spending for all drugs. It writes:11
“Between 2006 and 2014, spending for commonly abused opioids grew from $1.5 billion to $3.9 billion, an increase of 156 percent …
Growth in spending for these opioids outpaced both the growth in spending for all Part D drugs (which grew 136 percent) and the growth in the number of beneficiaries receiving Part D drugs (which grew 68 percent).12 …
The total number of beneficiaries receiving these opioids grew by 92 percent, compared to 68 percent for all drugs, while the average number of prescriptions for commonly abused opioids per beneficiary grew by 20 percent, compared to 3 percent for all drugs.”
Clearly, not only are many Medicare recipients receiving opioids (no doubt thanks to groups like the American Geriatrics Society) they are receiving multiple prescriptions for them.
Even more concerning is the fact that many Medicare patients are being prescribed opioids for reasons other than cancer pain or terminal illness, the traditional uses of these strong medications according to published source.13 In some states over 40 percent of Medicare patients receive opioids.14
Government Paid-For Over-Dispensing of Opioids Is Widespread
According to the OIG, thousands of pharmacies are believed to be over-dispensing opioids within the Medicare system and likely involved in fraud.15
At least 1,432 retail pharmacies showed questionable activity, including 468 that had triple the average percentage of prescriptions for commonly abused opioids.16 In the case of one pharmacy, reports the Detroit News:17
“58 percent of the prescriptions it billed to Medicare’s program were for commonly abused opioids, compared with the nationwide average of 6 percent. The pharmacy billed opiate prescriptions for 93 percent of the Medicare patients it served last year …
Pharmacies with high percentages of prescriptions for narcotics raise flags about potential billing for extra drugs that are never dispensed and diverted for resale, or otherwise used inappropriately, according to the report.”
Medicaid programs, also supported by taxpayers but administered by states, also reveal excessive opioid use and probable fraud.18 In 2010, 359,368 Medicaid enrollees received an opioid prescription amounting to over 2 million prescriptions and again suggesting many prescriptions per patient.19
In 2009, 41.4 percent of Medicaid-enrolled women filled an opioid prescription compared with 29.1 percent of privately insured women, offering further proof that opioid makers are relying on public funds for their sales and profits.20
Millions of Tax Payer Dollars Used for Opioid Prescriptions
While Medicaid programs likely provide generic combinations of the active ingredient in OxyContin, hydrocodone, to patients, which cost about $28 for a 120-day supply (compared with $632 brand name OxyContin),21 taxpayers are still paying at least $56 million for Medicaid opioid prescriptions.
The cost of the opioid prescriptions does not take into consideration state-run drug treatment programs and services that are required if and when enrollees become addicted.
In December 2015, Purdue, the maker of OxyContin, settled an ongoing lawsuit brought by the state of Kentucky for $24 million over presenting OxyContin as “nonaddictive.”22 Purdue contended that the pill slowly releases the drug over 12 hours when swallowed, omitting the fact that, when crushed, OxyContin lost its time release protections and created an instant high.
“State officials said that led to a wave of addiction and increased medical costs across the state, particularly in eastern Kentucky where many injured coal miners were prescribed the drug,” reported the Associated Press. (Purdue substituted an abuse-deterrent version in 2010.)23
The 2015 settlement is similar to one Purdue Pharma agreed to in 2007 with the state of West Virginia, when it agreed to pay out $634 million for “fraudulent conduct caused a greater amount of OxyContin to be available for illegal use than otherwise would have been available.”24