The Opioid Epidemic from 1980 Onward in My Words
It has been a bit since I have said anything about the Opioid epidemic. Such was brought on by companies and distributors (more like PBMs) claiming it was harmless and non-addicting. I do want to catch up and see how the Sacklers made out. Whether the Gov finally put the screws to them or did they walk away with much of their funds made from supplying various opioids and claiming it was harmless (I know . . . the second time I said this). Some history on how much of the epidemic started.
By itself OxyContin and the availability of it did not cause the drug abuse epidemic. The easy sale of OxyContin, the easy prescription of it, and the claim of narcotic drugs being used in hospitals being nonaddictive led to it being abused. Except, sales did not mention hospital setting. In particular, one sentence was overused to sell OxyContin minus the words in hospitals.
“We conclude that despite the widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”
The last sentence as taken from the Porter and Jick statement to the Editor in 1980 with two words crossed out. Yep. it goes back that far and it is still an issue. So what about this Porter and Jick (both doctors) brief letter ( to the right) that was published?
From the 2017 correspondence to the Editor entitled; “A 1980 Letter on the Risk of Opioid Addiction,” the authors, by utilized bibliometric analysis of data derived from the number of citations of the 1980 letter from the date of its publication until March 30, 2017. The authors analyzed the relationship between the 1980 letter and it’s conclusion(s) with other document’s conclusions citing the 1980 letter. The analysis can be seen in Fig. 1 Number and Type of Citations below.
Six hundred and eight (608) citations of the 1980 letter were identified (Fig. 1) of the index publication. Also noted was a sizable increase in citations after the introduction of OxyContin (a long-acting formulation of oxycodone) in 1995. 439 (72.2%) authors of articles cited the 1980 letter as evidence addiction was rare in patients treated with opioids. 491 (80.8%) authors of articles did not note the patients described in the letter were hospitalized at the time they received the prescription and left readers to assume these were out-patients.
Obviously, the letter was cited more than 600 times. This chart (above) was a part of New England Journal study which you can find here: “A 1980 Letter on the Risk of Opioid Addiction,” New England Journal of Medicine, April 2017. It took thirty seven years to rebut this letter’s fraudulent use.
From 1999 through 2015, more than 183,000 deaths from prescription opioids were reported in the United States and millions of Americans are now addicted to opioids. I am going to move on from this foundation to something newer. In fact, it is reported November 2024 in the Baltimore Banner by Madeleine O’Neill.
“Jury finds drug companies liable in Baltimore opioid crisis,” The Baltimore Banner
and “Drug companies found liable in Baltimore’s opioid crisis, must pay $266M in damages.”
They probably have the funds but this is far greater than what had happened in West Virginia. W.Va. Court Rules in Favor of Drug Wholesalers, namely AmerisourceBergen Drug Co., Cardinal Health Inc., and McKesson Corp. They claimed . . . The claim was based off of the numbers of pills shipped to the county and the city. The Wholesalers claim . . . :“they ‘just’ ship what the pharmacies order. ‘We just ship.’ We do not know where it ends up. Neither do we know how it is being used.”
Of course not except the numbers of the pills sent far exceeded what residents would use in Huntington WV. The Banner’s story . . .
“The drug companies, McKesson and AmerisourceBergen, will pay $192 million and $74 million respectively if the verdict survives a likely appeal.
The verdict means the jury of three men and three women found the two companies almost entirely responsible for a public nuisance caused by the misuse of prescription opioids in Baltimore. Jurors returned the verdict after nearly two days of deliberation.
The $266 million verdict brings Baltimore’s total winnings to more than $668 million, including over $400 million in settlements reached with other drug companies before the trial. The city will return to court next month for another phase of the trial, seeking billions more from the drug companies to remediate the effects of the opioid epidemic.“
The city used a similar argument as what Huntington WV used. “The city’s lawsuit alleged that McKesson and AmerisourceBergen failed to monitor and halt suspiciously large orders of opioids, which enabled the diversion of pills into the illicit market.”
The companies have a habit of over shipping. For example in Huntington WV, two of the same companies were shipping 122 doses per person to Cabell County and the city of Huntington. The population was approximately 100,000. Hydrocodone, oxycodone, etc. much of which was made by Purdue.
In this case, Baltimore won and of course the distributors will appeal the verdict. The billionaire owners of Purdue Pharma will be protected from lawsuits linked to the US opioid crisis in exchange for a $6bn. Purdue’s fine is really not enough as they basically claimed OxyContin was non-addicting. That was displayed in the detail in the beginning of this post.
I will probably updat all of my Opioid commentaries with a new detail. This is a rehash of what was out there from the past.
Is ‘Big Pharma’ To Blame For the Opioid Crisis? Angry Bear Some good numerics here.
Drug Overdose Death Rates in the US, Angry Bear Deaths 1999- 2021
Good post. We desperately need potent non-opioid analgesics.
Please don’t read this as disputing your points–I don’t. Just some related observations:
• concern over opioid addiction has also led to under-medication for pain;
• I was hospitalized for three days after a bike accident at the age of 47. I had an IV morphine drip that entire time, since I had a clavicle fracture, four broken ribs and a pneumothorax. Not only did I *not* become addicted, I threw up all the food I was able to eat during that time. Eventually, I found my way to hydrocodone, an opioid that allowed me to eat but suppressed the pain. I took it multiple times a day for an entire month and never became addicted.
From my research of the literature, drug and alcohol dependencies have a significant genetic component. Everyone isn’t the same.
Sadly, while there are drugs to wean people from opioid addiction (e.g., buprenorphine), there is active discrimination against people using these anti-addictive aids.
Joel:
This is an informative post drawn from the many I have written on Angry Bear. I can almost write from memory although I pull the exact words from prior posts along with the graphs.
The abuse of OxyContin came from salespeople selling OxyContin, hydrocodone, etc. as being nonaddictive. It all stems or much of it evolved from the abuse of the Jick and Porter brief letter or fining that opioids were nonaddictive when used in a hospital environment. Dropping the word hospital allowed them to sell the opioids as safe to use as taking an aspirin as kept in your bathroom medicine cabinet.
I did not like the woozy feeling I experienced when on a drug such as either mentioned, so I tough=it out.
Thank you for your comment and being on Angry Bear.
Bill
I will second the need for a new class of analgesics. Preferably one that is safe for failing kidneys. It has been almost a quarter century since opiates have been the only pain killer I am allowed to take. Unless I want to go on dialysis in the near future.
The war on opioids has consistently conflated addiction with physical dependency. They are not the same. Someone who is addicted will crave his drug (which may not be a medication) even when he is no longer physically dependent. Someone who is ok only physically dependent will stop taking the drug to eliminate the physical dependency.
Taking opiates in a hospital is obviously different from having a bottle of pills on the shelf. The dosage and timing are chosen to avoid the development of dependency. Omitting that from all the papers touting non-addictive was unconscionable. Believing it was more wishful thinking than rational.
The first years of the war on opiates did more harm than good. A lot of lives ruined for good intentions, assuming they were good.
Jane:
This was a post pulled from many I have written on Opioids and its abuse and addiction as promulgated by one company and the Sadlers/Purdue who recently paid a $6 billion penalty. The lies spread since 1980 promoting the nonaddiction of OxyContin, etc. can never be fully paid for by dollars. It warrants a greater punishment which we will never see. Thank ou for your comment.