American Overdose: The Opioid Tragedy in Three Acts

by Chris McGreal

pharmaceutical companies spend more than $5 billion a year pushing their products on television in the only country that permits medical advertising other than New Zealand. Most viewers now spend far more time watching drug ads than seeing their doctors. The target audience is older Americans planted in front of the evening news or General Hospital. More than 70 percent of commercial breaks on the CBS Evening News show at least one drug ad.

PHARMACEUTICAL COMPANIES SPEND more than any other industry to buy political influence. Drug makers poured close to $2.5 billion into lobbying and funding members of Congress over the decade to 2016. Nine out of ten members of the House of Representatives and all but a handful of US senators have taken campaign contributions from drug manufacturers seeking to affect legislation on everything from the cost of drugs to how new medicines are approved.

Drug industry lobbyists on Capitol Hill far outnumber members of Congress. Pharmaceutical companies spent $280 million on buying influence in 2017. The industry group Pharmaceutical Research & Manufacturers of America (PhRMA) was among the five biggest spenders on lobbying in Washington that year, allotting more than $25 million to employ 169 lobbyists on Capitol Hill. One hundred and twenty of them had a background in the federal government or Congress as staff or elected officials.

The impact of so much drug company money coursing through Congress is not always visible to the average American, even if it can have an impact on their pockets and lives. In 2003 Congress passed a law largely written by the pharmaceutical industry preventing the federal administration from doing what almost every other government in the developed world does—negotiate prices for drugs paid for with public money. The legislation also threw up barriers to cheaper imports. The result is that federally run programs such as Medicare and Medicaid must pay whatever the drug makers demand. Manufacturers hide this extortion behind the spurious claim that foreign imports endanger the quality and safety of medicines in the United States. That assertion looks increasingly thin in the face of price gouging, such as the surge in the cost of EpiPen antidotes to allergic reactions.

In 2012 the American Pain Foundation hurriedly shut its doors after the US Senate Finance Committee announced it was investigating the influence of pharmaceutical company money on supposedly independent advocacy groups. The foundation said it was shutting shop “due to irreparable economic circumstances.”

No one really knows how many have died from an overdose either caused by opioids or in combination with other drugs: the official count is 350,000 between 1999 and 2016. By 2018 deaths from drug overdoses had risen to more than 200 people a day, and were the single largest cause of mortality for people under the age of fifty. Some studies predicted that the toll could double or worse over the next decade, killing a half-million more Americans if the spread of heroin and fentanyl cannot be contained.

Fifteen years after Purdue Pharma launched its video promoting OxyContin as safe and effective, the Milwaukee-Wisconsin Journal-Sentinel tracked down the seven patients who appeared in it praising the drug. Two became addicted and died using opioids. Another person who became hooked lost her job and her home before finally overcoming her addiction to OxyContin. Three patients said the drug had worked for them. The seventh declined to answer the newspaper’s questions.

It would be a mistake to conclude that responsibility for the opioid epidemic lies only with the greed of the drug companies or that it is shared solely with corrupt doctors and pharmacists who profited from mass prescribing. They were facilitated by politicians, regulators, and a broader medical industry with an agenda or that chose not to see. The opioid makers were helped in that because, for many years, the primary victims were those it was easy to look away from—the “dumbass hillbillies,” as Willis Duncan put it. Purdue may have targeted some of the poorest parts of Appalachia because that’s where the data said opioids were already being prescribed. But it proved a convenience that these regions were among the most marginalized in the country and the easiest to stigmatize as the drug makers pursued the disreputable tactic of blaming the victims for their addiction.