MARGOLIES: Government shares blame in opioid crisis

Rich Margolies

In the July 9 interview with Rutgers professor David Knoll “Opiod crisis: Are drug companies largely to blame,” he presented current events regarding the popular movement to blame pharmaceutical companies for the current opioid epidemic. This trend is rising in popularity for one simple reason: People know that the pharmaceutical companies have the deepest pockets and will chase that. But let’s take a look at the real root cause of the problem and what steps can be taken to reduce the likelihood of recurrence.

First, much of the epidemic is not from people that had a severe injury or ever had pain. The largest group of abusers are the junkies that have found a cheaper way to get high. Let’s not kid ourselves about this. Sure, there is a large population that got addicted because of an injury, but that is not the majority. Who is to blame for the junky experience? Take your pick; bad genes, lack of opportunity, bad parents, no job, etc. Bottom line… the individual.

Second, sadly we overlook that the federal government is largely to blame for this issue as well. How? The government is the entity that pushed for cheaper and more available treatments. Drugs like Oxycontin and Vicodin have been generic prescriptions for 20 years. A bottle of 30 pills can be had for less that $5. No pharmaceutical company advertises its generic product in a trade magazine, in print, or on the air. There is no army of sales reps that are pushing doctors to write scripts. Had these products not been generically offered, they would never have been made so widely available and doctors would not have prescribed them because they knew the cost would be out of reach.

The federal government controls the supply chain for these products. Pharmaceutical companies must apply each year for permits to produce and transport Class II narcotics. They must ask for permission to ship so many kilos of product based on some data (usually sales forecasts). Each company submits a form with every shipment, so the Feds are fully aware of the quantity in advance.

If the Drug Enforcement Agency and other federal agencies saw that the supply was growing at dangerous pace, they could have easily limited the number of permits or the number of kilos it approved for transport. The Feds could have simply said “no, we don’t want 1,000 kilos produced, we only want 200 kilos produced.” Why didn’t the DEA do this? Perhaps the drug lobby influenced this, but the responsibility is with the government.

The FDA could have removed opiods such as Vicodin and Oxycontin for use in treating chronic pain. Newer products, also narcotics, are much better for chronic pain because they deliver the drug at controlled levels, but also because these drugs cannot be crushed or cooked down for the quick high that the addict needs. So, why hasn’t the FDA acted to remove some opiods from the market since there are alternatives? The answer is simple: These drugs are more expensive (not on generic formulations yet) and most of the cost of these treatments are paid by Medicare and Medicaid.

Federal and state governments did nothing to track and limit these transactions and conduct data-mining exercises. In every state, there are CVS, Rite Aid and Walgreens drug stores on every corner. They all can sell Class II narcotics. The Feds and states have complete control over this. They have to issue licenses for each of the stores, even though they are part of the national chain. Imagine an environment in which you could purchase on opioid Class II narcotic in only 10 percent of these stores? Don’t we already do this with liquor? Perhaps even a better approach would be to allow Class II narcotics to be purchased only at a hospital pharmacy, where there would be a chance that a trained professional could notice the signs of addiction.

Doctors deserve much of the blame too. But sadly the system also is at fault. Doctors have less time with patients now and go for the quick fix or give the patient simply what they want.

Rich Margolies, of Brick, is a quality director with Siemens AG, Glasgow.