Everyone knows cigarette smoking is bad for your health. Since the early-1950s the medical community noted the negative consequences such as emphysema, COPD and lung cancer. However it took almost 50 years for the legal acceptance of responsibility by the major tobacco companies that was detailed in the Master Settlement Agreement of 1998.
This settlement stated that due to the significant public health concerns and increasing health care costs to care for those who smoked cigarettes, and the added burden to state and federally funded insurance programs such as Medicare and Medicaid, the major manufacturers agreed to pay an initial amount and annual payments in perpetuity totaling billions of dollars to each of the states and territories subject to the agreement.
In addition, marketing was restricted and targeting of youths prohibited, while funds were to be used for educational programs to focus on the dangers of smoking and tobacco avoidance.
Overdoses are now the most common form of accidental deaths in many states.
Cory Lum/Civil Beat
If the tobacco companies were held responsible for the extra health care costs of the smoking community, why aren’t the pharmaceutical companies being held liable for the current opioid epidemic?
The opioid crisis has wreaked havoc on thousands of people in the United States. Overdoses are now the most common cause of accidental death in many states, overcoming even motor vehicle accidents.
Statistics show that for 2015, there were more than 52,000 overdose deaths in the United States, enough to fill Aloha Stadium. Almost half of those were from prescription drug overdoses with medications such as oxycodone and hydrocodone. There were an additional 12,000 deaths from heroin use.
Why should pharmaceutical companies bear responsibility for heroin addicts? Studies have shown that prescription painkiller use is a risk factor for heroin use.
Back in 1996, when Purdue Pharmaceuticals developed a long-acting version of one of the most dangerous drugs, oxycodone, it was marketed as having a low potential for addiction. The medical community went along with this, basing its information on a five-sentence letterpublished in the New England Journal of Medicine in 1980 that stated it was doubtful that these medications would lead to dependence.
After making billions of dollars in profit for drugs that are potentially lethal, there is no shared responsibility.
In 2001, the Joint Commission: Accreditation, Health Care, Certification rolled out a Pain Management Standards plan, requiring providers to do frequent assessments of pain eventually leading to its nickname as the “fifth vital sign.”
Opioid prescriptions continued to reach new heights.
Purdue executives admitted guilt in 2007 to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused. The $600 million dollar fine was paid to federal and state agencies, but there is no evidence it went toward establishing drug rehabilitation facilities in the U.S.
All of this led to the continued increase in the prescribing of opioid painkillers, with some states having low rates of prescriptions and others having a much higher number. Not surprisingly, the more prescriptions that were written, the greater the rates of overdoses in those locations.
With all of this in mind, states have been passing laws and providing funding to give first responders the availability of naltrexone to reverse the effects of opioids in the midst of an overdose.Single dose nasal spray delivery of Narcan costs $150. The auto-injectorEvzio, $4,500 for a two pack. Relying on individual state budgets to provide this remedy for ambulances and other first responders is becoming an increasingly expensive proposition.
Treatment centers for those who want to quit their addiction are also increasing in numbers, but there still aren’t enough nationwide.Average costs for treatment range from $1,000 to $20,000. Some well-known centers could cost up to $60,000 for a two- to three-month stay.
For those who have private insurance, coverage may be available. But many chronic drug users may not be able to hold down a job, and Medicaid picks up the cost for many of the addicts who wish to undergo treatment. This provides taxpayer dollars to help treat addiction.
However, none of these costs are currently covered by the manufacturers of the drugs. After making billions of dollars in profit for drugs that are potentially lethal, there is no shared responsibility.
Other medications that have been found to cause harm result in reparations. Merck paid $4.85 billion dollars to settle lawsuits over its former product Vioxx after it was found to cause heart attacks, strokes or even death.
Pfizer paid out $75 million after the trials regarding the former antibiotic Trovanwas found to cause liver failure, and the trials done in Nigeria led to children becoming disabled. Although liability was in question, the settlement provides for future care of those affected by the medication.
The makers of Oxycontin, Vicodin and others should provide funding to deal with the effects of their drugs as well. The funding can be structured like the tobacco settlement, with money given to the states to provide naltrexone, drug treatment programs and educational funding initiatives to help everyone learn about the dangers of these potentially deadly medications and how to avoid abusing them.
The precedent has been set with other dangerous drugs, and with the half-century-long fight against tobacco.Now it’s time to hold the pharmaceutical companies responsible for their addictive medicines as well.
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Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.