Every crisis provides an opportunity, as the saying goes.
Big Pharma, always angling for the next blockbuster drug, is making the most of the opioid crisis. The industry is introducing new drugs—and raising the price on older generics—that treat the effects of opioid addiction. In this way it can reap additional profits from the opioid epidemic that it helped to create.
While America wrestles with the worst drug crisis in its history, Big Pharma eyes even bigger profits.
The U.S. opioid painkiller market is worth an estimated $10 billion per year. The emerging market for drugs that treat opioid side effects, addiction, and overdose is already worth half that much. And it is poised for major growth in the years ahead.
It should come as no surprise that drug companies put profits before the public welfare. But Big Pharma’s attempts to capitalize on the worst drug crisis in U.S. history shows how nothing is off limits for the industry in its quest to create top-selling medications.
Drugs That Treat Opioid Side Effects
One of the most controversial moments of Super Bowl 50 did not occur on the field, but during an advertising spot.
The black and white ad—sponsored by AstraZeneca, Daiichi Sankyo, the U.S. Pain Foundation, and others—showed a forlorn man reacting to visual reminders of his constipation while a narrator intoned, “If you need an opioid to manage your chronic pain, you may be so constipated it feels like everyone can go… except you.”
Opioid induced constipation (OIC), the narrator explained, is “different, and may need a different approach.”
That approach, according to the commercial, was the use of medication—such as AstraZeneca’s and Daiichi Sankyo’s Movantik—specifically designed to treat OIC.
The Super Bowl ad spurred a backlash (and humorous takes) on social media, with many saying that it normalized opioid use. Vermont Governor Peter Shumlin tweeted that Big Pharma had “no shame” and was trying to “exploit a crisis for profit.”
.@AstraZeneca spent millions to air a Super Bowl ad normalizing long-term opiate use – A shameful attempt to exploit a crisis for profit
— Peter Shumlin (@GovPeterShumlin) February 11, 2016
But the ad was a success: AstraZeneca reported that Movantik prescriptions increased by one-third in the months following the Super Bowl. A single Movantik pill retails for about $10.
Opioid induced constipation reportedly afflicts 40-90 percent of opioid users. Researcher Jonathan Moss came up with an OIC treatment in the late 1990s to help cancer patients taking opioid painkillers. Drug companies, however, were not interested in a product that targeted such a limited patient pool.
As the opioid epidemic spread, drugmakers changed their tune. Now they are scrambling to enter a market that has blockbuster potential.
There’s a Pill for That
In 2014, AstraZeneca’s Movantik was the only OIC drug available. Today there are six name brand OIC drugs. By 2019, there could be as many as eight.
The market for OIC drugs in Western Europe and the United States is expected to grow from $67 million in 2016 to more than $650 million by 2019, including $563 million in the U.S. alone. Incredibly, the U.S. has less than 5 percent of the world’s population but consumes 80 percent of all opioids.
The U.S. has less than 5 percent of the world’s population but consumes 80 percent of the world’s opioids.
Until recently, doctors advised opioid patients to moderate their painkiller intake or use non-drug interventions such as changes in diet or exercise to treat constipation. Critics say that offering a drug for a condition caused by a drug not only encourages patients to continue using opioids unabated, but also incentivizes further drug use.
“The pharmaceutical industry literally created the [OIC] problem,” Dr. Andrew Kolodny of Physicians for Responsible Opioid Prescribing told the Washington Post. “They named it, and they started advertising what a serious issue it is. And now they’ve got the solution for it.”
Dr. Kolodny explains the vicious cycle of drug use that can trap opioid users as they try to balance out from the side effects of the potent painkillers.
“Many patients wind up very sedated from opioids, and it’s not uncommon to give them amphetamines to make them more alert. But now they can’t sleep, so they get Ambien or Lunesta. The amphetamines also make them anxious, paranoid and sweaty, and that means even more drugs,” he said.
Other common opioid side effects that may require medication include nausea, central nervous system effects (such as cognitive dysfunction and agitation), and pruritus (itch).
Drugs That Treat Opioid Addiction
In 2014 (the most recent year for which data is available), nearly 2 million Americans abused or were dependent on prescription opioids. Even a single opioid prescription can lead to long-term opioid use. As many as 1 in 4 patients who are prescribed opioids struggle with addiction.
Treatment for opioid addiction is critically important due to the risk of overdose deaths. In 2015, more than 15,000 people died from prescription opioid overdoses.
Drugs to treat opioid addiction have been around for nearly a century. Methadone—itself an opioid—was first manufactured in the 1930s in Germany as a less-addictive alternative to morphine. Methadone made its way to the States after World War II and was produced by Eli Lilly under the brand name Dolophine.
In the 1950s doctors began using methadone to treat opioid dependence. This trend strengthened in the 1960s as heroin-addicted American soldiers returned from Vietnam. Today, about 500,000 people are participating in methadone treatment programs for opioid addiction.
Since the onset of methadone is mild, it doesn’t produce the euphoria that other opioids do. But it reduces drug cravings and prevents the harsh withdrawal that often triggers an addict’s relapse.
Methadone treatment programs are controversial. Some believe “Just Say No” doesn’t work and that the programs are a pragmatic way to fight addiction. Others claim that replacing one opioid addiction with another doesn’t solve the underlying problem.
Then there is the financial angle. Methadone clinics can cost up to $76 per day per patient. Government-subsidized methadone treatment costs taxpayers more than $1 billion per year. In 2016, the federal government pledged more than a billion dollars to states for medication-assisted opioid dependence treatment (i.e., methadone treatment).
Those who oppose using public funds for medication-assisted treatment say it is unfair and unethical that taxpayers subsidize drug companies and for-profit treatment programs that provide legal opioids to addicts.
Jeff Sessions called the $1.3 billion false billing scam “the largest health care fraud takedown in American history.”
This summer the federal government announced a crackdown on healthcare fraud involving opioid treatment programs. That announcement followed a Justice Department takedown of a $1.3 billion false billing scam that Attorney General Jeff Sessions called “the largest health care fraud takedown in American history.” Of the 412 defendants, 120 were charged with opioid-related crimes.
As investors pour big money into addiction treatment and fraudsters try to cash in on false opioid billing, it would appear that the opioid crisis is providing financial opportunities for more than just drug companies.
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