Pushing Narcotics for Profit

While the USA are jailing drug cartel bosses to life imprisonment, other drug-pushers are being let off with fines.

The US opioid crisis has claimed more than 400,000 lives and the corporations that supplied those pills turned a blind eye to the harm they were causing. Oklahoma’s attorney general is not only suing the pharmaceutical giant Johnson & Johnson for $17bn but accusing it of killing people. Mike Hunter accused the company of a “cunning, cynical and deceitful scheme” to ramp up narcotic painkiller sales as part of a web of drug firms that created the biggest drug epidemic in American history as profits surged. Mike Hunter, told the civil trial that Johnson & Johnson played a leading role in “the worst manmade health crisis in the history of the country and the state”. Calling the trial a “day of reckoning” for the company, Hunter accused the company of “destroying lives and families”.“How did it happen?” Hunter asked. “Greed.”

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.

The companies worked in step to change medical culture and practice by influencing doctors, researchers, federal regulators and politicians. 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 skewed studies 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.

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. Release of DEA data showed that one company, Mallinckrodt, took more than one-third of the oxycodone and hydrocodone market, selling 29bn pills in the six years to 2012. 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…” Mallinckrodt sold nearly 29bn opioids in the six years to 2012, taking 38% of the US market. Actavis was not far behind while Endo sold 11bn opioid tablets. Among Endo’s drugs was a high-strength opioid, Opana, that it was forced to pull from the market because it was killing so many people.

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. 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. A former head of the DEA division responsible for monitoring prescription drug distribution, Joe Rannazzisi, has previously told the Guardian that he attempted to launch criminal prosecutions against McKesson and other distributors but he ran into the power of the industry’s political lobbying and was blocked by justice department officials.

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.

The opioid makers have denied wrongdoing and, among other things, sought to place blame for the epidemic on doctors overprescribing drugs.