Since the 90s, America has seen a steady increase in opioid overdose deaths. In 2017, 70.237 people died from opioid overdoses , an increase from the previous year. Among the most popular opioids consumed in America is fentanyl, a drug sold not only on the legal market but also widespread in the country's underground economy.
This drug, which has proven to be a worthy rival to heroin, is 50 times more potent than the drug and even 100 times more potent than morphine . It is a synthetic opioid produced in China and then imported to America, and is one of the most powerful and effective painkillers ever. One of the most significant side effects of this drug, however, is the risk of addiction, which is why doctors should prescribe it very sparingly.
What is the American opioid epidemic?
In the United States, however, a disturbing social problem has developed, revolving around the use of these prescription drugs. Today, there are more than two million opioid addicts (OUD – Opioid Use Disorder), predominantly male (60%), approximately 30% between the ages of 18 and 34, half of whom are low-income, and 55% of whom are on Medicaid (a federal program providing assistance to low-income families). Since 1999, the number of prescription opioid overdoses in the country has steadily increased, becoming a veritable social scourge: for example, in 2021, fentanyl was responsible for 90% of the approximately 80.000 opioid-related deaths in the US.
A social reconstruction of the possible cause
Some studies demonstrate that direct marketing to physicians by pharmaceutical companies is widespread in the United States, a practice that has been associated with increased prescriptions of these drugs in certain counties. In fact, between 2013 and 2015, 1 in 12 US physicians was subjected to marketing campaigns for opioid drugs, and studies show that, especially among physicians providing care to patients through Medicare, marketing activity directed at them was directly correlated with a subsequent increase in the prescription of these opioids to patients.
Scholars Scott E. Hadland; Ariadne Rivera-Anguirre et al. attempted to conduct an analysis of the extent to which opioid marketing is associated with subsequent prescriptions and, consequently, overdose deaths. In a study approved by Brown University's institutional review board, they demonstrated that counties that received heavy marketing and an aggressive marketing strategy surrounding opioid sales subsequently experienced elevated overdose mortality from these prescription drugs.
The study on the marketing of pharmaceutical industries
Opioid prescription rates in this case were strongly associated with the burden of their marketing. In conclusion, based on these data, an association was identified between opioid marketing by the pharmaceutical industry and overdose deaths from these substances. In other words, the unregulated, uncontrolled, and excessive prescribing of these drugs by doctors (prescribed for common and trivial aches and pains) led to a mass development of opioid addiction that transformed into a mass slaughter of individuals from the American lower and middle classes on a national scale.
The subjects involved: the role of doctors
Today, doctors are a major source of prescription opioids for people who use them for non-medical reasons. As if that weren't enough, the use of illicit opioids (when doctors refuse to prescribe them) has led to the further development of an illegal market around these drugs.
As the recent Netflix series Painkiller demonstrated, certain drugs began to circulate and be legally advertised on the American market in the late 90s, thanks to marketing campaigns specifically designed by pharmaceutical companies (the case of Purdue Pharma with the drug Oxycontin is well-known). Despite being aware of the enormous risk of addiction resulting from excessive and prolonged use of these drugs, pharmaceutical companies, as early as the late 90s, began developing advertising campaigns focusing on the miraculous and beneficial effects of these drugs, capable of "giving happiness" to Americans.
This was precisely the strategy used to sell oxycodone, or Oxycontin : after the corruption of some members of the Drug Enforcement Administration (DEA), which approved the painkiller's market release, it began to circulate legally in the hands of ordinary citizens, athletes, injured people, and people with minor physical pain, thanks to the unregulated prescriptions of doctors induced by the pharmaceutical industry's aggressive marketing campaigns, but also corrupted by the percentages of profits they obtained from the prescriptions. This is how the much-cited contemporary American opioid epidemic began, which has now become a veritable social scourge.
The opioid situation today
Although the scenario just described has changed, with an overall reduction in opioid prescriptions by US physicians since 2010, due to reporting and increased awareness of the side effects of drug abuse, overdose deaths from illicit opioids are projected to rise to 67.900 annually, a 259% increase from 2015 to 2025. It should also be noted that current opioid prescription rates by physicians remain three times higher than in 1999 and have not declined rapidly in all those regions with high levels of opioid overdose deaths. The emergency therefore remains more acute than ever.
Furthermore, today, the social practices surrounding opioid use have changed compared to the past: for example, while historical trends show that the use of prescription opioids has always been a means of embarking on a path of abuse that then led to heroin use, today many more people are starting directly with the use of illegal opioids.
Increased danger of opioids
Not only that, but there has also been an increase in the dangerousness and lethality of illicit opioids, due to the combination of substances like fentanyl and methamphetamine in illegal production laboratories to produce pills. Drug manufacturers have also tended to combine a stimulant with a depressant (which causes the so-called speedball effect in users , increasing the risk of overdose due to its depressant effects on the respiratory system).
One example is the combination of fentanyl with cocaine or methamphetamine, a mix used by drug manufacturers to further addict users, who will do anything to purchase ever-larger doses. Today, fentanyl is therefore doubly dangerous from a social perspective: in addition to being consumed "singly," it is used by dealers to contaminate other stimulant drugs and to increase users' dependence on the drugs they sell. The outcome of all this is easy to imagine.
The responsibility of the pharmaceutical industry
In light of the above, the pharmaceutical companies' admission of liability for the millions of opioid overdose victims in America is crucial. Just a few years ago, a judge in Oklahoma found Johnson & Johnson responsible for the state's opioid crisis, ordering it to pay $572 million in damages.
As scholars Scott E. Hadland; Ariadne Rivera-Anguirre et al. have argued, pharmaceutical companies invest tens of millions of dollars directly marketing opioids to physicians each year , and companies would not spend all this money on marketing if they were not confident that it would increase prescription rates or at least that it would help maintain product sales levels.
Opioids: Between Marketing and Responsibility
The studies cited, therefore, demonstrate how pharmaceutical companies' marketing practices may have been one of the main factors contributing to the early stages of the American opioid overdose crisis, during which opioid overdoses were overprescribed and uncontrolled. As previously stated, a paradigm shift is underway today, as consumers are often more inclined to turn to an illicit opioid production market. However, this does not detract from the enormous responsibility and involvement that pharmaceutical companies have always had and continue to have in the birth and development of this American social scourge.
Even today, industry marketing to doctors may run counter to state-sponsored efforts to curb the overprescription of these opioids, and in light of this, perhaps U.S. policy should consider limiting the extent to which pharmaceutical companies can contribute to the inappropriate prescribing of these drugs by limiting their ability to develop aggressive advertising campaigns aimed at doctors and the public around drugs that are so dangerous to the physical health and lives of patients.
Mayla Bottaro
Bibliography
Hadland SE, Rivera-Aguirre A, Marshall BDL, Cerdá M. Association of Pharmaceutical Industry Marketing of Opioid Product With Mortality From Opioid-Related Overdoses JAMA Network Open 2019;2(1):e186007.
