The years-long legal battle with pharmaceutical companies regarding their part in the ongoing opioid epidemic might be coming to a head today, as the top six companies being held accountable negotiate a potential settlement. Should that settlement be agreed upon, it’s estimated to reach close to $50 billion. But given the damage opioids have done to the country, is $50 billion enough?
Starting in 1996, Purdue Pharma heavily marketed its drug OxyContin, an opioid, as a non-addictive painkiller with more power than acetaminophen and ibuprofen. Obviously, only one of those claims is true. Since then the prescription opioid market has boomed, making manufacturers ungodly amounts of money and distributing highly addictive painkillers to millions of Americans. Between 2006 and 2012, 76 billion oxycodone and hydrocodone pills were prescribed and distributed.
Due to increased first-hand experience of the dangers of over-prescription of opioids, numbers of prescriptions began dropping. Numbers peaked in 2012 with 255 million prescriptions, but have lowered to 191 million in 2017. While this looks like a significant drop, prescription rates are still much higher than they need to be.
In an interactive map released annually by the CDC, users can see numbers of prescriptions per 100 people in a county for any year from 2006 to 2017. Bell County, Kentucky, was lucky to see a drop of over 50 prescriptions per 100 people between 2012 and 2017, unfortunately, that just dropped the number from 281 to 228 prescriptions per 100 people. For context, Bronx County, New York, only had 26.4 prescriptions per 100 people in 2017, a drop from 38.1 in 2012.
The damages from the epidemic have had a wide-ranging impact on the American economy, which the Washington Post estimates have cost the US upwards of $631 billion.
What Makes up the $631 Billion
Dangerous drugs come with a variety of costs, from treatment to decreasing work efficiency to wrongful death. The Washington Post story breaks down part of their estimate to the costs of treatment and wrongful death, $205 and $253 billion, respectively. The remaining costs relate to decreased work efficiency, absenteeism from work and family, and drug-related incarceration.
Due to these high numbers, the $50 billion settlement doesn’t even cover half of the losses estimated to have hit federal, state, and local governments ($186 billion).
How Prescriptions Lead to Damages
Opioids are highly addictive, which is known to the CDC, doctors, pharmacies, pharmaceutical companies, PBMs, pop-culture icons, and just about anyone who has been alive in the past 10 years. Unfortunately, this doesn’t stop doctors from prescribing doses that are higher and more ongoing than recommended for safe usage.
Worker’s compensation and workplace injuries are places where addiction and damages start for a lot of people. Injuries that occur due to physical work can require weeks, months, or even years of physical therapy to fully recover, and pain can often slow down or stop the employee from returning to work. Opioids give the opportunity to return to work quickly without the pain. Unfortunately, the prescriptions provided by workers’ compensation are often much higher than recommended, with workers refilling prescriptions for over 90 days after an incident. According to the CDC, 45% of opioid claims were due to injuries that had been sustained over 2 years prior.
The chemical dependence of the brain on opioids and natural tolerance build-up over time makes long-term prescriptions dangerous and less effective than advertised. According to the National Safety Council, patients who have been using prescription opioids for over 3 months are highly likely to already be dependent and have a built-up tolerance. The CDC notes that this is detrimental to the economy, as workers with a pain medication disorder miss an average of 29 days per year, almost 3X the 10.5 day average for regular employees.
While workplace injuries are the root of many opioid addictions, any injury or surgery can lead to addiction. Those who have sustained moderate to severe auto accident injuries and need to get back to work are likely to be prescribed opioids, as are those who have undergone minor surgery. I got all four wisdom teeth out just over a year ago and got a nice bottle of 15 Vicodin for my struggles; I ended up disposing of at least 4 of them once I had recovered and no longer felt like I needed serious painkillers. Point being, patients in pain cannot be trusted to deny opioids of their own free will. This is why doctors and pharmaceutical companies need to be held accountable for medical malpractice when refillable prescriptions are given for non-chronic pain (and even chronic pain, given the human ability to build up tolerance).
What’s the Proper Response
As shown in cases like lawsuits against JUUL for advertising addictive nicotine products to children, holding companies accountable beyond settlements is incredibly difficult in America. $50 billion is an astronomical amount and would greatly help state and local governments treat and fight opioid addiction, but is only a fraction of the amount that opioids have already cost the country. Ideally, protections would be put in place and enforced to ensure only those who desperately need addictive and destructive substances and provided with them. Ideally, the people responsible for pushing opioids as non-addictive and constructive for chronic pain despite all evidence to the contrary would be put in jail and would have all assets stripped away. But then again, ideally, we wouldn’t be in this situation in the first place.