The Opioid Crisis

The Opioid Crisis

Beginning in the early 2000s, a severe drug crisis involving the usage of opioids swept the nation. Opioids are powerful painkillers that, in addition to relieving even the most crippling of pains, produce a sense of euphoria in the user [6]. While this category of drug contains many legal drugs, including oxycodone, hydrocodone, morphine and several others that can be used when prescribed by a physician, it also includes many illicit substances such as heroin [6].

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The opioid crisis is widely recognizable in the United States. Since 2000, the number of drug related deaths attributed to opioids and synthetic opioids has nearly tripled [7]. Heroin, which has been illegal in the U.S. since 1924, is still a commonly abused drug [5]. Heroin overdoses are increasing steadily, contributing to the opioid crisis, but heroin is only a part of the problem. Recently, a more potent version of heroin, fentanyl, legally entered the U.S. drug market.

Fentanyl is a synthetic opioid that is 50 times more potent than heroin and 100 times more potent than morphine [9]. While deaths due to heroin overdoses have indeed steadily increased, synthetic opioid overdose deaths have skyrocketed. From 2015 to 2016 alone, deaths in the U.S. from synthetic opioid overdoses, other than methadone, increased by 100% [9]. Thus, the most important step in solving this crisis is imposing more strict regulation on the sale and prescription of these dangerous synthetic opioids.

The fentanyl problem is complex, in part because it did not begin on the black market. Pharmaceutical companies, such as Insys Therapeutics, Purdue Pharmaceuticals and Janssen Pharmaceuticals, discovered fentanyl and began producing fentanyl-based drugs to prescribe to patients with unrelenting pain [4]. In 2012, the U.S. FDA approved Insys’ fentanyl-based drug, Subsys, for patients with breakthrough cancer pain (i.e., pain that cannot be controlled by other prescription painkillers) [4]. Around this same time period, the FDA approved several other fentanyl-derived drugs for similar patients.

As opioid related deaths continued to increase drastically, a Senate Committee began to investigate the five principal producers of opioid prescription painkillers [4]. Janssen Pharmaceuticals Inc. stopped promoting opioid products in 2015 [2]. Later, Purdue Pharmaceuticals was the first company to be slammed with allegations of misconduct including misleading prescribers and downplaying the drugs’ addiction risk [1].

Purdue, effective February 12, 2018, agreed that they would no longer push their opioid drug, OxyContin, to doctors and also significantly cut its sales staff responsible for pushing this dangerous drug [1]. While this result seems fairly late in the crisis, it is indisputably better late than never.

Most recently, the U.S. Department of Justice joined whistleblower litigation accusing Insys Therapeutics Inc. of using unethical methods to promote their fentanyl-based drug, Subsys [8]. Accusations against Insys include scheming to bribe doctors to prescribe Subsys since 2012, despite being aware of the drug’s dangers [8].  

Patients receiving prescriptions for these painkillers, if not for end of life pain relief, often face a life of addiction following their prescription. Prescriptions are, obviously, too easily obtained for these drugs given their danger and potency. The ease at which patients can overdose on prescription opioids is alarming, and even if used properly, these drugs can become a gateway into the abuse of other opioids or to the use of higher drug doses.

This problem is complex and in order to resolve it, everyone in the industry-- pharmaceutical companies, salespersons and doctors alike-- need to continue to take responsibility for their actions. Large pharmaceutical companies need to be held accountable for their actions. They should advertise their drugs accurately, clearly stating their dangers, and marketing them honestly to doctors. They must clearly outline that these drugs are to be prescribed to patients who truly cannot find another solution to their pain.

Doctors likewise should take responsibility for their actions. They should not prescribe drugs on the basis of bribery, and they should be wary to prescribe these dangerous opioids unless absolutely necessary.

Doctors are highly regarded in society and people trust and depend on them to act ethically in providing medical care. Upon taking the Hippocratic Oath, doctors promise to do no harm and to adhere to the ethical principles that govern medicine—namely beneficence and nonmaleficence. As the opioid crisis continues, it is important that doctors continue to act according to these principles and prescribe opioids only when absolutely necessary and when to do so would be acting in the patient's best interest.

As national attention has been drawn recently to this crisis, there is hope in resolving the situation. Many more Americans are now aware of the danger of opioids and synthetic opioids, and both pharmaceutical companies and doctors have learned that their actions have consequences. Pharmaceutical companies, sometimes with the help of legal action, are slowly beginning to realize that marketing these dangerous drugs inaccurately is immoral. There is still far more progress to be made, but if doctors and pharmaceutical companies act according to the ethical principles by which they ought to be governed—beneficence and nonmaleficence—then opioids will become less commonly prescribed and the number of deaths due to overdoses will gradually subside.

References

1. Bacon, John. "78 OxyContin maker's culture change starts today: No more promoting opioids." USA Today, 11 Feb. 2018. USA Today, www.usatoday.com/story/news/nation/2018/02/11/oxycontin-maker-cuts-sales-staff-wont-hawk-drug-docs/327251002/. Accessed 15 June 2018.

2. Feeley, Jef, and Jared S. Hopkins. "Opioid Settlement Talks Heat Up as Drugmakers Reduce Marketing." Bloomberg, 5 Mar. 2018, www.bloomberg.com/news/articles/2018-03-05/opioid-settlement-talks-heat-up-as-drugmakers-reduce-marketing. Accessed 15 June 2018.

3. "Fentanyl." U.S. Drug Enforcement Agency, www.dea.gov/druginfo/fentanyl.shtml.

4. Firger, Jessica. "Opioid Crisis Driven by Shady Drug Company Tactics, Investigators Say." Newsweek, 20 Nov. 2017, www.newsweek.com/opioid-crisis-driven-shady-drug-company-tactics-716856.

5. "Opioid Crisis Fast Facts." CNN, 27 May 2018, www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html.

6. "Opioids." National Institute of Health, www.drugabuse.gov/drugs-abuse/opioids. Accessed 15 June 2018.

7. "Overdose Death Rates." National Institute of Health, Sept. 2017, www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.

8. Raymond, Nate, and Jonathan Stempel. "U.S. joins whistleblower case against Insys over kickbacks." Reuters, 14 May 2018, www.reuters.com/article/us-insys-opioids/u-s-joins-whistleblower-case-against-insys-over-kickbacks-idUSKCN1IF31M.

9. "Synthetic Opioid Overdose Data." Centers for Disease Control and Prevention, 16 Dec. 2016, www.cdc.gov/drugoverdose/data/fentanyl.html.

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