1. America has never seen a public health crisis like the current opioid epidemic.

Last year, more than 64,000 people died of drug overdoses in the U.S., the majority from opioids like oxycodone, heroin, and fentanyl. That’s more than the number of people who died from HIV/AIDS in a single year at its peak (43,000), more than the number of people who ever died in a single year from car crashes (55,000), and more than the number of Americans who died during the entire Vietnam War (58,000).

The rise in opioid-related deaths began in the early 2000s with an uptick in overdoses from prescription painkillers. Then, around 2010, heroin overdoses began to rise as people addicted to painkillers started to lose their sources. And in the past couple years, overdoses from fentanyl, a cheaper and deadlier alternative to heroin, have spiked dramatically.

Unfortunately, the opioid epidemic is still getting worse. Opioid-related deaths increased even more from 2015 to 2016, and experts expect the situation to continue to worsen in the coming years. It’s so bad that the average life expectancy in the U.S. has actually begun to decrease for the first time in decades.

Meanwhile, the companies that manufacture opioid painkillers have seen their profits skyrocket. Big pharmaceutical companies like Purdue Pharma, Pfizer, and Johnson & Johnson are doing about $10 billion in opioid sales in the U.S. each year. Business has never been better!

2. Doctors used to be cautious about opioids, so Big Pharma launched a massive lobbying effort to get to doctors to prescribe them more often.

Opioids have been around for a long time. Opioid painkillers hit the market in the U.S. for the first time in 1898 with Bayer Co’s “Heroin” cough syrup. Decades later drugs like oxycodone and Vicodin were approved by the FDA for pain management. But with illegal heroin seen as a major public health issue for much of the 20th century, there was a sense of opiophobia in the medical field and many doctors were afraid to prescribe opioids because of their addictive nature. For decades, their use was largely confined to terminal cancer patients.

That changed in the 1990s, when Big Pharma launched a massive lobbying effort to encourage doctors to prescribe opioids more often. Instead of reserving the drugs for cancer patients, they wanted doctors to use them as long-term pain treatments for people suffering from relatively minor issues, like chronic neck pain.

The drug companies promoted their painkillers by purchasing advertisements and funding research in medical journals. They lobbied to get their opioid use recommendations in the pain management curriculum that was taught in continuing education courses for medical professionals at the time. A non-profit funded by the pharmaceutical industry, called the American Pain Society, campaigned to have pain considered “the fifth vital sign,” joining blood pressure, temperature, heartbeat, and breathing. Since 2001 the Joint Commission on Accreditation of Healthcare Organizations has required doctors to ask patients about pain in the same way that they are required to measure their patients’ blood pressure.

Throughout the mid 2000s, drug companies gave the non-profit Federation of State Medical Boards $825,000 to fund a model policy on opioids that would be promoted to medical policymakers in the state. The model policy encouraged aggressive prescribing of opioids and said that denying opioids is bad medical practice. By 2013, the policy was adopted by at least 35 state medical boards.

The companies also used their money and influence to convince policymakers that their products were not responsible for the emerging opioid epidemic. Between 2006 and 2015, the companies spent more than $880 million on lobbying and campaign contributions in Congress and statehouses across the country to fight opioid limits and defend medical policies that encouraged their use. That’s more than 200 times as much as interests advocating for stricter opioid policies spent during that period.

3. The DEA tried to crack down on drug distributors from diverting opioids to fraudulent pain clinics, but pharma-backed politicians passed a bill to strip them of their authority.

In the mid 2000s the Drug Enforcement Administration developed a strategy for stemming the illicit use of opioid painkillers by going after the companies that distribute the pills. For about 10 years the DEA levied fines on distributors that shipped opioids to businesses suspected of filling fraudulent prescriptions. In some cases the DEA was able to freeze shipments from these distributors in order to prevent pills from hitting the streets.

But in April, 2016, Congress passed a bill to limit the DEA’s authority and make it all but impossible for them to halt suspicious shipments of opioids.

The bill was drafted by Linden Barber, a former top lawyer for the DEA who had spent four years prosecuting opioid distributors for the government. After leaving the DEA, Linden spun through the revolving door and took a lucrative job at a law firm representing the very pharmaceutical companies that he had been prosecuting while at the DEA.

“If you have a DEA compliance issue or you’re facing a government investigation,” Barber says in a promotional video for the law firm, “I’d be happy to hear from you.”

Barber’s bill was introduced in Congress by Representatives Tom Marino (R-PA) and Marsha Blackburn (R-TN), who both represent districts with drug overdose death rates above the national average. The bill was passed unanimously by the House and Senate and signed into law by President Obama.

So why would Congress—especially Marino and Blackburn—sponsor a bill like this while their constituents are dying from the epidemic? The Washington Post provides details on the pharmaceutical money that greased the skids for the bill:

Political action committees representing the industry contributed at least $1.5 million to the 23 lawmakers who sponsored or co-sponsored four versions of the bill, including nearly $100,000 to Marino and $177,000 to [Orrin] Hatch. Overall, the drug industry spent $102 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports.

4. Drug companies poached from the DEA to weaken them and get a leg up on lobbying.

From 2005 to 2015, while the Drug Enforcement Administration was trying to crack down on illicit opioid use, the drug companies were working to weaken the DEA by hiring away DEA agents who had been the architects of the agency’s campaign against them.

According to a 2016 Washington Post investigation, “the pharmaceutical companies and law firms that represent them have hired at least 42 officials from the DEA – 31 of them directly from the division responsible for regulating the industry.”

Poaching the DEA’s employees was an effective way for the drug companies to weaken the DEA, and it also gave them a big advantage for changing government policy in their favor. By hiring from the DEA, the drug companies got employees who had connections to people who still worked at the agency overseeing them. These “revolving door” connections help make lobbying efforts more effective by giving access and providing a personal touch to otherwise transactional exchanges.

Indeed, it was a former DEA agent that drafted the bill, described above, that took away the DEA’s ability to freeze suspicious opioid treatments. If the drug companies didn’t have a former DEA agent with intimate knowledge of the laws and procedures involved in the agency’s operations, they likely would not have been able to draft legislation that looked innocent enough to pass in Congress, while being strong enough to defang the DEA.

5. Marijuana can substitute for opioids, so Big Pharma is spending millions to keep it illegal.

Marijuana is a good alternative to opioid painkillers. Studies have shown that it can effectively treat many of the types of pain that opioids are often prescribed for, and there are no known cases of deaths from marijuana overdoses.

In states where marijuana has been legalized, opioid overdoses have gone down. “Hospitalization rates for opioid painkiller dependence and abuse dropped on average 23 percent in states after marijuana was permitted for medicinal purposes,” Reuters reported in March 2017. “Hospitalization rates for opioid overdoses dropped 13 percent on average.”

That’s great news for combating the opioid epidemic. But for the companies that make opioids it’s a direct threat to their bottom line, so they are funding campaigns to stop states from legalizing marijuana.

In the 2016 election, Insys Therapeutics, the company that makes fentanyl (a deadly painkiller), spent $500,000 to defeat a marijuana legalization ballot measure in Arizona. It was the largest contribution ever made to an anti-legalization effort. The ballot measure failed.

Drug companies have also donated heavily to powerful politicians in states that are considering marijuana legalization. The Democratic Governors Association, a political group that helps elect Democratic governors, has received more than $18 million from Big Pharma over the past ten years. As a result, in liberal states where marijuana legalization is overwhelmingly popular, Democratic governors have stood in opposition. Instead they tend to favor approaches that only legalize marijuana for medical use in processed forms, something the pharmaceutical industry can control on profit on.

The industry has also provided funding to anti-marijuana academics. A 2014 investigation by Vice found that several of the leading academic researchers and writers that advocate against legalizing marijuana have taken money from companies that make and sell opioids. These individuals are treated as independent experts and given the opportunity to promote anti-marijuana talking points through op-eds and press statements while simultaneously taking consulting fees from major opioid companies like Pfizer and Purdue Pharma.

About Donald Shaw
Donald Shaw is a journalist covering lobbying and money in politics. He is based in Western Massachusetts.
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