How the Pharmaceutical Industry Profits Off Pain
Updated: Dec 10, 2020
Introduction and Preamble
A U.S. Centre of Disease Control report in 2018 showed that about 128 people in the U.S. are dying every day from overdosing opioids. About half a million people have died from opioid-related causes since 2000. This is an article that looks into Purdue Pharma, the main producers of commonly used opioids such as Fentanyl and Oxycontin. These controlled drugs are addictive, enabling potential abuse. Users that can no longer get access to expensive over the counter opioids will then resort to cheaper and stronger alternatives such as Heroin.
As of November 2020, Purdue Pharma has settled with the U.S. Department of Justice for $8.3 billion, pleading guilty under counts of conspiracy to defraud U.S. officials and paying illegal kickbacks (illicit bribes to facilitate certain actions) to doctors.
Purdue Pharma, the Lex Corp of real-life
Purdue Pharma is a privately held pharmaceutical company that produces drugs such as oxycontin, fentanyl & codeine. The company was structured on a foundation of aggressive marketing with the sole goal of dominating the market with its products. One of its founders Arthur Sackler managed to convince the Journal of American Medicine Association to utilise coloured advertisement for the opioid Valium. He is described as many to be the founding father of medicinal marketing, and Purdue Pharma is seen as one of the first drug discovery and producing empires.
After establishing Purdue as the forefront of pharmaceutical commercialisation, the Sackler family has adopted dubious ways to maintain their annual billion-dollar revenues. Since 1998, Purdue Pharma has spent more than 12 million dollars in political lobbying to ensure that efforts to enact prescription medication regulations will be futile. The most recent lobbying efforts by Purdue Pharma are in the U.S. Prescription Drug Pricing Reduction Act 2019 and the Ensuring Compliance Against Drug Diversion Act of 2019. Another way that Purdue can leverage influence is to have government insiders in federal agencies. Dr Curtis Wright was a doctor who was working for the U.S. Food and Drug administration in the Drug Evaluation and Research . 2 years later, he resigned and was promptly given a senior position in Purdue for drug research. Coincidentally, it was during his tenure where the drug Oxycontin, Purdue’s piece de resistance, was approved.
Purdue Pharma was also able to establish ties with medical students, physician trainees through sponsorships. Such actions allow Purdue Pharma to exert influence and hold a monopoly in the research, production and commercialisation of drugs. In the 2019 lawsuit, the Attorney-General of Massachusetts Maura Healey was able to derive certain internal emails through court filings that detail what persuasion techniques sales representatives are coached by the big corporation. Even though the company acknowledged how addictive its drugs are, sales representatives were encouraged by fat commissions to coax doctors into prescribing more pain-killers to patients even when unnecessary. To quote a memo circulated by the Tennessee branch of sale representatives
"$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!" - 1996 June Sales Review.
Purdue’s personal group of drug dealers, Doctors
Corrupt doctors were arguably the main catalyst towards the exponential spread of oxycontin use in the U.S. Purdue sales representatives and affiliated doctors are described by activists to use similar methods Casinos use on big-time gamblers. Sales representatives push for more prescriptions by providing monetary incentives to doctors that prescribe the most Oxycontin and they share commissions with doctors that are willing to give more prescriptions. There are even collusions between both to collect patient information and purchase patterns to be quantified into data utilised to target patients that buy the most pain-killers. These actions are a huge contravention of medical malpractice and ethics laws, governed in Australia, the Health Practitioner Regulation National Law Act; and in New Zealand, the Health Act 1956.
Many of these doctors were charged with criminal charges. In Florida v Graves, Dr James Graves was a doctor that has his own pain management practice, and he was charged with racketeering, unlawful prescription of controlled substances and several counts of manslaughter. The courts described his practices as selling opioids for cash with overly lax discretion and no proper assessment of the patient’s medical needs. He was subsequently sentenced to 63 years in prison. In People v. Tseng, a much more serious case, Dr “Lisa” Tseng Hsiu-Ying was sentenced to 30 years to life on murder and unlawful prescription counts. The Drug Enforcement Administration sent undercover agents to Dr Tseng’s practice and they were able to uncover $6.6 million of revenue from selling the opioids. Dr Tseng had 3000 medical records at her clinic, and 14 of those patients died from an opioid overdose. The causal link here is that Dr Tseng has been prescribing her patients with up to 100 pills of Oxycontin and 2-milligram Xanax, the strongest form of Xanax in the market.
The big picture of Humanity
At the height of the opioid epidemic, Purdue blamed the abuse of Oxycontin on the users who abused it. A sociological study was done on recent Presidential speeches that consist of campaign promises involving the opioid epidemic. Instead of blaming the opioid user’s conduct, both President Trump and Bush have attributed the root cause of the opioid epidemic to Big Pharma. Both candidates have an extremely strong voter base in the rural white demographic, which is ironically also the demographic that suffers the most from the opioid epidemic.
This is a different recollection to the crack epidemic that is scourging the African-American community in the US. Nancy Reagan facetiously said, “Just Say No”, a term with underlying overtones trying to blame the crack epidemic on the dysfunctionality of the African-American family. Furthermore, Richard Nixon’s former Chief Domestic Advisor John Ehrlichman has confessed in a 2016 Harper Magazine issue that the war on drugs disproportionately targeted and impacted people of colour. A semantic analysis was also conducted on newspaper articles, and the results show that drug-related reports with minorities were often actively exhibited with racially charged terms such as “Black, Hispanic, Haitians”.
The lack of criminalization and draconian law enforcement efforts in the opioid epidemic compared to the crack epidemic illustrated a double standard. People must start realising that it is not the fault of the patients, but the systemic streamlining of hard drugs into the daily usage of innocent, medically untrained patients.
Cartel theory: opportunity makes a thief
The current dilemma in the medical community is the exclusivity from patenting life-saving medicine is killing lives. There is fear that companies will patent the Covid-19 vaccine and subject governments to high monopoly prices. Industry leaders have rebuked the argument by putting the counter-argument:
"People have to pay for innovation"
This was not a strong argument as a Geneva policy watchdog Intellectual Property Watch has recently reported that pharmaceutical companies are not willing to make R&D costs transparent, and rare reports are often bloated with imprudent spending and cost. Director of MSF (Doctors without Borders/Médecins Sans Frontière), Rohit Malpani has also stated that taxpayers and other philanthropic activities fund up to 50% of R&D conducted by pharmaceutical companies. That figure will only continue to rise following government stimulus such as Operation Warp Speed, where the U.S. Congress has given $10 billion dollars to pharmaceutical companies conducting research on Covid-19 experimental vaccines.
Bi-partisan legislation such as the Make Medications Affordable by Preventing Pandemic Pricegouging Act is a great way to prevent pharmaceutical companies from reaping all of the profits paid by the efforts of the taxpayer. It introduces a profit threshold that drugs that are manufactured with taxpayers money. The TRACK Act (Oversight of COVID-19 Biomedical Taxpayer Investments Act) is also another strong legislation tool that provides a check on pharmaceutical companies by enforcing stricter transparency levels on their spending.
Journal articles, books and essays
M. Scandlen, "Graves Guilty: Pace Doctor Convicted in 4 Drug Deaths," Pensacola News Journal, February 20, 2002, available at <http:// www.pensacolanewsjournal.com/news/ 022002/Local/St001.shtml>.
D. Douglas, "Physician Receives Nearly 63-Year Prison Sentence for OxyContin Deaths," BNA's Health Law Reporter, 11, no. 13 (March 28, 2002): 469.
Sunshine, Abraham; Olson, Nancy Z.; Colon, Ariel; Rivera, Juana; Kaiko, Robert F.; Fitzmartinfirst7=Robert F., Ronald D.; Reder; Goldenheim, Paul D. (July 1996). "Analgesic Efficacy of Controlled‐Release Oxycodone in Postoperative Pain". Journal of Clinical Pharmacology.
Testimony of Paul Goldenheim: OxyContin: balancing risks and benefits". Hearing of the Committee on Health, Education, Labor, and Pensions, United States Senate. 12 February 2002.
Biancofiore, Giandomenico Luigi (1 September 2006). "Oxycodone controlled release in cancer pain management" (PDF). Therapeutics and Clinical Risk Management
Feldman, Robin. (2019). Drugs, Money, and Secret Handshakes: The Unstoppable Growth of Prescription Drug Prices. 10.1017/9781108687676.
Florida v. Graves, No. 01-422-CFA (Fla. Cir. Ct. Feb. 20, 2002)
People v. Tseng - B270877 - California Department of Justice
New York v Purdue Pharma LP et al No. 400016/2018 the New York State Supreme Court (NB: 26 states sued Pharma in total)
Schedule 8 Standard for the Uniform Scheduling of Medicines and Poisons (Australia)
Schedule I of the Controlled Drugs and Substances Act (Canada)
Part I of Schedule 1 of Hong Kong's Chapter 134 Dangerous Drugs Ordinance (Hong Kong)
Oxycodone is listed as a Class A drug in the Misuse of Drugs Act of Singapore, which means offences in relation to the drug attract the most severe level of punishment. (Singapore)
Oxycodone is a Class A drug under the Misuse of Drugs Act. For Class A drugs, which are "considered to be the most likely to cause harm", possession without a prescription is punishable by up to seven years in prison, an unlimited fine, or both. (UK)
Under the Controlled Substances Act, oxycodone is a Schedule II controlled substance (United States)
In New Zealand, oxycodone was approved by Medsafe in 2001 and the oral forms (controlled and immediate-release) were subsidised on the New Zealand Pharmaceutical Schedule from 2005. (New Zealand)