Capitalism gone wrong: how big pharma created America's opioid carnage

As Oklahoma’s attorney general, Mike Hunter laid out his indictment against one of the biggest corporations in America, he made a point of saying that he was not hostile to big business.

“The fact that I am a Republican, a conservative and a believer in capitalism and the marketplace does not require me to turn a blind eye when corporations hurt people,” Hunter told a state court.

When a politician who once worked for the banking industry’s lobby arm, and who sided with oil companies against environmental regulations, is not only suing a multinational for $17bn but accusing it of killing people, something has gone awry.

Last week, Hunter wrapped up a two-month long trial of the pharmaceutical giant Johnson & Johnson that shed new light on the extent of the pharmaceutical industry’s complicity in driving the US opioid crisis, which has claimed more than 400,000 lives. Oklahoma’s attorney general accused the company of a “cunning, cynical and deceitful scheme” to ramp up narcotic painkiller sales as one of a web of firms that created the biggest drug epidemic in American history as profits surged. The companies worked in step to change medical culture and practice by influencing doctors, researchers, federal regulators and politicians.

Days after Hunter spoke, another wave of revelations brought into focus how other pharmaceutical firms rushed in to exploit what grew into an $8bn a year industry.

A federal judge in Ohio released secret data showing that a raft of corporations flooded the country with more than 75bn opioid pills over just six years, and targeted regions already worst hit by the epidemic. The data makes clear how drug manufacturers and pharmaceutical distributors kept on ramping up deliveries even as alarm bells rang at surging overdose deaths and amid warnings from the Drug Enforcement Administration.

Some of the companies are immediately recognisable to the American public, such as high street chains Walmart and CVS. Others are not well known outside the business world even if they count among the biggest corporations in the country, including the drug distributor McKesson, whose CEO was the highest paid executive in the US as opioid deliveries reached their peak. They all raked in huge profits from a country awash in narcotic painkillers.

The same Ohio court later released a batch of emails that are shocking in their callous disregard for the human cost of the surging epidemic.

Taken together, the various legal revelations amount to a damning indictment of a swathe of the drug industry that wielded considerable influence over the practice of medicine in America at the expense of huge numbers of lives.

Not just a few rogue companies

Until recently, the public spotlight fell on Purdue Pharma, which is owned by some members of the Sackler family, for its part in creating and driving the epidemic with its high-strength opioid pill, OxyContin. It ramped up sales with a highly effective campaign in the early 2000s to change medical practice to make narcotics the default treatment for long term chronic pain and increase prescribing.

But as the Johnson & Johnson trial revealed, responsibility went much wider.
Hunter’s team presented evidence that the company’s marketing department set out to steal part of OxyContin’s market with the same high-pressure sales tactics used by Purdue. This included targeting doctors already prescribing large amounts of opioids, particularly OxyContin.

At the same time, the company was working in tandem with Purdue to influence medical practice, federal regulators and politicians to promote the mass prescribing of opioids in a way no other country has seen. The two companies were competitors but also collaborators.

They made false claims for the safety of the drugs, not least in manipulating scientific papers to promote the spurious assertion that there was a less than one percent risk of addiction from narcotic painkillers. The manufacturers funded academic studies that hewed their way and doctor training that emphasised opioids as the default treatment for pain.

Much of it was done at arms length, with cash injections to ostensibly independent medical societies and with aggressive lobbying on Capitol Hill by the industry’s trade group to resist efforts to rein in prescribing even as the epidemic grew.

The industry provided much of FDA’s income through the fees it paid for drug approvals and the relationship was closer than many thought healthy including some of the people working for the agency who claimed it was in the pocket of big pharma.

None of this was caused by a few rogue companies. It was a strategy by the opioid industry. Purdue was the big winner early on. By 2000, it was selling more than $1bn of OxyContin a year. Sales had doubled within another couple of years and went on climbing.

But last week’s release of Drug Enforcement Administration data showed that within a few years other drug makers jumped on to the bandwagon to push generic opioids into every corner of America. One company, Mallinckrodt, took more than one-third of the oxycodone and hydrocodone market, selling 29bn pills in the six years to 2012.

Mallinckrodtalso features in the communications released by the Ohio court and first published by the Washington Post.
They included a 2009 email sent by Mallincrodt’s national account manager, Victor Borelli, to notify Steve Cochrane, a sales executive at a drug distributor, KeySource Medical, that a shipment of oxycodone tablets was on its way.

Cochrane replied: “Keep ’em comin’! Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are…”

Borelli wrote back: “Just like Doritos keep eating. We’ll make more.”

Similar emails have been exposed by the lawsuits against Purdue Pharma and at the Johnson & Johnson trial.

The companies have disavowed the views expressed in the messages. But they are perhaps a better reflection of their true attitude toward the opioid epidemic than the public relations campaigns unleashed by Purdue and Johnson & Johnson to absolve themselves of responsibility.

Earlier this month there was another little noticed milestone in corporate accountability. A British company, Reckitt Benckiser, paid the largest-ever civil settlement over the opioid epidemic – $1.4bn – to settle a federal indictment accusing it of practices similar to those used by Purdue Pharma and Johnson & Johnson.

A Reckitt Benckiser subsidiary had been pressing doctors to prescribe its opioid by falsely claiming it was safer and more effective than similar medicines on the market. Except this time, the opioid was Suboxone, a drug to help those addicted to prescription pills or heroin cope with withdrawal.