Opioid epidemic burns bright when democracy dies in greed and ignorance

Over 60,000 Americans die every year in the opioid epidemic. During such a dire national health emergency, we expect our government by the people and for the people to defend the lives of the American people over the drug industry’s profit margins. But sometimes, especially when it escapes the scrutiny of the free press, democracy dies in greed and ignorance. When the drug distribution lobby is involved, however, tens of thousands of American patients perish from the Earth too.

Since 2015, the opioid epidemic killed more Americans than the entire Korean, Vietnam, Iraq, and Afghanistan Wars combined. In fact, drug overdoses are now the leading cause of death for all Americans under the age of 50. It is one of the greatest health crises of our time, and unlike a natural epidemic, it is the drug distribution industry, along with our enabling government and health care providers, who are almost entirely inflicting this scourge upon us. 

{mosads}A joint Washington Post-60 Minutes story over the weekend showed exactly what happens when a bipartisan Congress puts greed over humanity in the middle of a raging opioid epidemic. Former DEA administrator Joseph Rannazzisi revealed how three drug distribution companies, namely Cardinal Health, McKesson, and AmerisourceBergen colluded with Congress to “allow millions and millions of drugs to go into bad pharmacies and doctors’ offices that distributed them out to people who had no legitimate need for those drugs.”

These companies used their powerful lobbyists to work with Rep. Tom Marino (R- Pa.) and Rep. Marsha Blackburn (R-Tenn.) to push a law through Congress that crippled the DEA.

The Ensuring Patient Access and Effective Drug Enforcement Act of 2016 effectively stripped the DEA of its powers to freeze shipments of suspicious sales of hundreds of millions of opioid pills to vulnerable patients.

In essence, it allowed drug distributors to make massive profits peddling dangerous, addictive drugs like oxycodone and oxycontin unchecked to vulnerable Americans at the cost of their lives. Given the law’s obviously detrimental impact, it is shocking that it passed with such broad bipartisan support.  

It was the power of greed and ignorance.

Those who crafted the law not only received thousands of dollars in drug lobby campaign contributions but also masterfully slid it underneath the clueless eyes of a Congress and President who did not even bother to read it. Worst of all, either due to collusion with the drug lobby or due to shocking ignorance and neglect for the American people, even the DEA and Department of Justice did not object to a bill that directly crippled themselves. It sailed through Congress by a parliamentary process with unanimous consent, a procedure reserved for both non-controversial bills, and apparently, evil ones too.

“To get Congress to pass a bill to protect [the drug lobby’s] interests in the height of an opioid epidemic just shows me how much influence they have,” said Rannazzisi. It is a damning indictment of how dangerous corporate lobbies are to our democracy.

In fact, the drug lobby spent over $102 million to pass this law, with the three biggest players being the Pharmaceutical Research and Manufacturers of America contributing $40.8 million, CVS Health throwing in $32.5 million, and the National Association of Chain Drug Stores dishing out $8 million. They did so on behalf of the three drug distribution companies that control 90 percent of the market.

Meanwhile, Tom Marino was set to become our nation’s nominee for drug czar at the time. Marsha Blackburn is still set to run for Senator of Tennessee to replace Bob Corker. These campaigns are obviously not cheap, and drug lobby contributions obviously welcome. Fortunately, the freedom of our press did what our government and health care providers could not. It uncovered a severe injustice and protected our most vulnerable patients.

Not only has the Washington Post-60 Minutes investigation spurred serious talks on Capitol Hill for repeal of this law, it also prevented the grave injustice of having Tom Marino become our nation’s next drug czar. President Trump withdrew Marino’s nomination on Monday, proving that if democracy dies in darkness, it can be rescued in the light.  

But while it is easy to only blame the drug companies and corrupt government officials, they are not the sole entities responsible. Like all big issues, it is not that simple.  

In fact, as a resident physician in Tennessee, one of the hardest hit states in the opioid epidemic, I too am guilty for contributing to this problem. Within a culture where patient satisfaction and demand for pain control often overrides concern for fostering addiction, I have prescribed drugs like oxycodone on a regular basis to my patients who demand it.

Sometimes, I have even gotten in trouble with my attending physicians when patients complain they did not receive enough pills. Angry phone calls and subsequent formal reprimands can reinforce a sense a fear that not prescribing opioids is worse than simply giving what our patients want. But we all swore a Hippocratic oath to do no harm, and the easy way out is always not the most ethical one. I need to do better for my patients. My colleagues need to do better. We all need to change for the American people.

Unlike AIDS or cancer, America’s opioid epidemic is entirely self-inflicted. It is fueled by the drug companies’ greed, our federal government’s collusion and ignorance, and the irresponsibility of health care professionals who often dispense opioids out of fear or just simple laziness. With so many powerful interests at play, it is perhaps more dangerous than a naturally occurring disease because this one is within ourselves.  

Dr. Eugene Gu is a resident physician at the Vanderbilt University Medical Center and president of the Ganogen Research Institute. He graduated from Stanford University with honors and holds an M.D. from the Duke University School of Medicine.