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Fueling The US Opioid Epidemic, U.S. Giant Companies Took Secret Payments Allowing Free Flow Of Opioids
The United States is in the grip of an opioid epidemic that has lasted nearly 20 years. During that time, an estimated 400,000 people have died from overdoses that included opioids – either heroin or prescription painkillers.
And as it turns out for years, the U.S. pharmacy benefit managers (PBMs) took payments from opioid manufacturers, in return for not restricting the flow of pills.
Even as tens of thousands of Americans overdosed and died from prescription painkillers, the middlemen collected billions of dollars in payments, as per a report on Tuesday.
The details of these backroom deals “expose a mostly untold chapter of the opioid epidemic and provide a rare look at the modus operandi of the companies at the heart of the prescription drug supply chain,” noted the report.
The PBMs exert extraordinary control over what drugs people can receive and at what price. The three dominant companies — Express Scripts, CVS Caremark and Optum Rx — oversee prescriptions for more than 200 million people and are part of health care conglomerates that sit near the top of the Fortune 500 list, according to the report.
The PBMs are hired by insurers and employers to control their drug costs by negotiating discounts with pharmaceutical manufacturers, but they often pursue their own financial interests in ways that increase costs for patients, employers and government programs, while driving independent pharmacies out of business, it said. Regulators have accused the largest PBMs of anticompetitive practices.
“The middlemen’s dealings with opioid makers reveal a lesser-known consequence of this pay-to-play system: seemingly everything — including measures meant to protect patients and curtail abuse — can be up for negotiation,” it added.
The Opioid Epidemic
“Pill mills,” or clinics where doctors unscrupulously hand out prescriptions for powerful opioids like oxycodone, oxycontin, hydrocodone, and fentanyl at volumes far exceeding the need of the patient population, began proliferating in the early 2000s, and have since been one of the main targets of a federal crackdown.
U.S. Drug Enforcement Administration (DEA) agents have arrested doctors and other employees at these facilities, attempting to shut down the steady supply of unnecessary drugs into communities.
Some physicians started to write fewer prescriptions for these painkilling drugs to avoid unwanted attention from law enforcement, and in 2016, the Centers for Disease Control and Prevention (CDC) released new guidelines on prescribing opioids for chronic pain, with restrictions on the amount of painkillers an individual can be prescribed.
Irrespective that the CDC officials noted that the guidelines apply to all adults with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
Unfortunately, many practitioners took a broader interpretation of the recommendations and began further decreasing their prescriptions for opioids, afraid they’d be found in violation of the guidelines. Some reduced their patients’ opioid prescriptions, while others abandoned patients who needed more than the average amount of pain management medications.
The Scope of the Epidemic
The beginnings of the opioid epidemic trace back to the 1990s, when what the CDC describes as the first wave of the crisis kicked off with a substantial increase in prescription opioid overdose deaths.
That was followed by a second wave starting in 2010 that involved rapid increases in heroin overdose deaths.
Now, the U.S. has entered a third, deadlier wave, caused primarily by synthetic opioids and illicitly manufactured fentanyl – an extremely potent painkiller. During this time, pill mills and unscrupulous clinicians were able to hand out opioid prescriptions that far exceed patient need with limited oversight, which contributed to increases in patient overdoses and deaths.
As the opioid epidemic peaked in 2017, the DEA and other law enforcement agencies targeted those clinics and overprescribing physicians.
State governments began simultaneously tackling the problem from the patient side. Prescription Drug Monitoring Programs use electronic health records to determine whether patients are “doctor shopping” – seeking drugs from multiple prescribers – and visiting multiple pharmacies or filling extra prescriptions.
While many overdoses occur in individuals using the drugs recreationally, it’s clear that overprescribing also has contributed to the epidemic. Over the past few years, though, pharmaceutical companies that manufacture opioids have been accused of deceptive marketing tactics that misled prescribers and patients about their drugs’ safety and addictive potential.
As of September 2019, multiple manufacturers, including Purdue Pharmaceuticals, Johnson & Johnson, and Allergan, have been fined billions of dollars for their role in fueling the opioid epidemic.
Taking Measures
In July 2016, President Barack Obama signed the Comprehensive Addiction Recovery Act into law.
It represented the first major federal addiction legislation in 40 years and allocated $181 million per year to support efforts toward prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal.
Among its many sections, the very first, section 101, requested the formation of an “inter-agency task force” led by the U.S. Department of Health and Human Services (HHS) to develop guidelines for safely prescribing medicines to patients with acute and chronic pain.
Earlier this year, the HHS Pain Management Best Practices Inter-Agency Task Force released its final report on acute and chronic pain management best practices, which called for “a balanced, individualized, patient-centered approach.
This included tailoring pain management to the needs of special populations, such as active-duty military personnel and veterans, children and adolescents, and patients with SCD, cancer-related pain, or receiving palliative care.
The Last Bit
West Virginia is currently the state with the highest drug overdose death rate in the United States, with 91 deaths per 100,000 population in 2022. Although West Virginia had the highest drug overdose death rate at that time, California was the state where the most people died from drug overdose. In 2022, around 10,952 people in California died from a drug overdose.