On April 21, 2016, at the age of 57, award winning pop star Prince was found dead at his Paisley Park recording studio and home in Chanhassen, Minnesota. Coroners reports indicate that Prince died from an overdose of fentanyl that was self-administered. Fentanyl is a highly potent synthetic opioid analgesic that shares similar characteristics to morphine. However, fentanyl has been proven to be 50 to 100 times more potent than morphine. Fentanyl is a schedule II prescription drug that is primarily prescribed for patients suffering from severe pain, or to regulate the pain of patients following surgery. The death of Prince made national news and brought into focus what the CDC has now termed an epidemic, prescription opioid abuse. An investigation of the cause and factors that sustain the epidemic reveals that drug companies have played a significant role in sustain prescription drug abuse considering the monetary value that lies in the vice for the pharmaceuticals. On the other hand, regulatory bodies and the federal government have a share of the blame assigned to them. The state and regulatory bodies have been slacking on dispensing their duties to curb the opioid epidemic. It is not only pharmaceutical companies motivated by corporate greed that have contributed to the opioid epidemic, but also the inability or failure of state and regulatory bloods to act within the system to avert the crisis.
Corporate greed has been widely blamed for the propagation of the opioid epidemic. However, as Bradley observes, at its most basic level, corporate greed must have some moral standing and help the public for it to be effective. It is important to acknowledge that there are always corporations that will cut corners and even break the law to expand their incomes. While the government has put in place measures to curb the situation, the available regulations are not effective because the scourge persists. The continued prevalence of the opioid epidemic is an indication that possibly, the government aids and abets the criminal goals of drug companies. Subsequently, it can be argued that wile corporate greed facilitates the opioid epidemic; it is only made possible with the help of outside forces, such as the government. This does not relate to the opioid epidemic, but rather that corporate greed cannot be the only culprit when it comes to the problem.
Skeptics may argue that the opioid epidemic is not a real occurrence and only raised by parties looking to settle scores with government and pharmaceuticals. However, the epidemic does not only exist in the United States, but also in Canada. Fischer and colleagues observe that the size and impact of prescription opioid (PO) misuse and harms (including rising demand for PO disorder treatment) have been under close scrutiny and record in Canada (12). The authors observe that while there is little evidence to warrant for PO dependence treatment, opioid maintenance therapy (OMT) - mostly by means of methadone maintenance treatment (MMT) has been put on the front line as the default line treatment for PO-disorders (12). The authors state figures from Ontario where at least fifty thousand patients most of them young adults are enrolled in MMT, leading to a MMT-rate that is 34 times greater than that of the United States.
In Ontario, community-based MMT providers are given generous incentives within the system of public fee-payer that has sent the MMT in Ontario into a quasi-treatment industry (Fischer et al., 12). There have been no efforts to avail other products other than MMT such as detox, tapering, behavioral and other options that feature minimal intrusion, or are cost effective and offer therapeutic assistance at least for sub-sets of PO-dependent individuals. The authors contend that provided the wide ranging burden of PO-dependence coupled with its unique socio-demographic and clinical profile, there is need to develop and implement an evidence-based stepped-care model for PO reliance treatment in Canada where MMT is encompassed but is not the primary but most probably a last option for treatment. The authors contend that the model will enable evidence based practice for the best outcomes especially in regions where PO misuse and disorders have been increasing.
The research put forward by Bradley and Fischer puts into perspective the fact that the prescription opioid (PO) misuse pandemic is not only the direct result of corporate greed but also a multifaceted event that involves government and regulatory bodies. Dineen and James in their article argue that they appreciate the two sides that prescription opioids offer (7). While prescription opioids offer a useful tool in the treatment of pain in patients, they are at the same time potentially harmful when they are misused by patients or other individuals or wrongly prescribed. The authors observe that there has been a recent increase in opioid-related morbidity and mortality that have caught the attention of authorities and researchers prompting more inspection of prescribing practices especially by law enforcement, supervisory bodies, and state medical boards. Researchers argue that the 4D model used to describe physicians who wrongly prescribe opioids is outdated (Dineen and James 14). The physicians who wrongly prescribe opioids are described as dated, duped, disabled, or dishonest. The authors evaluate the strengths and weaknesses of the 4 D model and the impact of its execution. While they agree that corporate greed has a role in the opioid epidemic, they also believe that there is need for more evidence on mis-prescribers and a new model that describes them more accurately.
The multifaceted aspect of the prescription opioid abuse epidemic is further reinforced by researchers who state that corporate greed is not the sole factor that boosts the epidemic. Gatley Samuel in his dissertation argues that it is not only corporate greed that fuels the prescription opioid epidemic presently rampant across the United States, but also poor regulatory efforts, addiction, generously prescribing doctors, a surplus of pills available for sharing, and easy access to illegal drugs like heroin (2017). In his thesis, Samuel quantitatively analyzes the connections between these facilitators through construction of a System Dynamics model, in order to establish the effectiveness of policy mediation through Prescription Drug Monitoring Programs. Using the System Dynamics model, Samuel simulates the accessibility of doctors prescriptions to the two significantly different groups of prescription opioid patients. One group is the patients who have long-term pain while the other group is patients prescribed opioids for short-term pain. The patients with long-term pain see their tolerance and appetite for opioids grow gradually but they constantly feel they are having too little medication. Subsequently, they tend to take larger doses meaning higher quantities. The short-term pain patients may find that they have been prescribed more drugs than they require. Samuel argues that such instances also contribute to the prescription opioid epidemic presently rampant across the United States.
The observations made by Samuel are of paramount importance. First, while corporates supply the drugs, doctors are responsible for prescribing them to patients. Doctors may knowingly or unknowingly aggravate the situation by their prescription habits. Patients who genuinely need the medication may be turned into addicts due to increased dependence on the drug arising from prolonged use as described by Samuel. For instance, short-term pain patients may find that they have more pills than they need. The pills may then end up in the hands of family, friends or other individuals close to the patient. The drugs can then be used for purposes other than the prescribed. Long term pain patients on the other hand develop tolerance to the drugs and end up increasing their dosage n frequency of use. As a result, dependency and addiction may ensue contributing to the pandemic.
Similarly, while corporates may be responsible for malpractices in their business approach to opioids, malpractice from health professionals contributes to the opioid epidemic. According to Barnes and Stacey, nearly 17,000 people succumb to overdoses involving prescription opioids (375). The prescription opioids are primarily prescribed to treat pain and addiction. The Centers for Disease Control and Prevention ("CDC") according to Barnes and Stacey has declared prescription drug abuse to be a national epidemic. Barnes and Stacey further observe that at least twenty percent of college students have used stimulants at some point in their studies for nonmedical use (375). Biologics have been identified as a possible solution to provide an alternative to prevent prescription drug abuse. However, the authors note that gray market activity poses a significant risk to the activities towards reduction of prescription drug abuse (Barnes and Stacey 375). Gray market activity is carried out by bad actors in the health industry that are widespread. The authors call for criminal liability for these actors under various legal doctrines. The authors also call for education among consumers on the negative effects and risks associated with gray market medicine.
Hirsch notes how there is not one source to blame for the opioid epidemic, but many groups that are at fault. He says that besides the corporations, the physicians that must prescribe the drug are like innocent bystanders because they dont have too many other options but to do as they are told. Hirsch says beyond that there are 4 co-conspirators, Purdue Pharmaceuticals (company that makes oxycontin), the Joint Commission, Press-Ganey, CMS and hospital administrators. This article supports the idea that corporate greed is not the only area for blame. It brings up many points with evidence about different groups participating in unison to create this epidemic, and to back each other up so that not one group is to blame. In the muddle that is the debate on opioids, the pharmaceuticals get away with their trade, government absolves itself of the blame and health professionals continue to dispense opioids with no accountability.
Refuting Argument
On the other hand, some argue that corporate reed is solely to blame for the opioid epidemic. Bredderman recaps a speech given by New York Citys Mayor, Bill de Blasio, talking about how corporate greed is to blame for America. The article uses many of de Blasios quotes and many stats on the big pharmaceutical corporations that are being blamed. To begin with, the argument that corporate greed is solely to blame is based on the premise that pharmaceuticals play a major role in influencing the choices that doctors have to prescribe medication. Using their resources, pharmaceuticals are able to entice health professionals to prescribe the drugs they manufacture while at the same time their contribution to the economy and possible bribery makes the government turn a blind eye.
The same argument is supported by John Oliver who contends that the greed in pharmaceuticals has single handedly contributed to the epidemic. Oliver quotes the 2007 case of Purdue Pharma that paid $634 million in fines after executive admitted they purposely misled clients over the addictiveness of OxyContin. In addition Oliver blames the corporates for aggressive marketing techniques citing an instance where a 2003 GAO report established that Purdue Pharma offered doctors 34,000 coupons for free OxyContin prescriptions, in addition to OxyContin fishing hats, stuffed plush toys, coffee mugs with heat activated messages, music compact discs, [and] luggage tags.
Counterargument
While it is true that corporate greed plays a role in the opioid epidemic,...
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