The similarities between the public health scourges of tobacco and painkiller addiction are striking.
The industries involved denied there was any problem as long as possible, even as the catastrophic medical evidence mounted.
Now, perhaps, the similarities should continue with the opioid industry paying to help solve the problem it created, just as the tobacco industry has been doing for more than two decades.
Cigarette butts are just one of the ugly aspects of nicotine addiction, and now the tobacco companies are paying for them big time.
During a congressional hearing 25 years ago, top executives of the seven largest American tobacco companies at the time testified that they did not believe cigarettes were addictive. They claimed they had done unpublicized research on humans and animals concerning nicotine and addiction and denied a link.
They acknowledged that nicotine levels could be and were controlled by altering the blends of tobacco, but stated it was done to enhance flavor, not to promote addiction. They also said evidence linking cigarettes and lung cancer, heart disease and other health problems was not conclusive.
The medical community was already convinced there was a definite connection as the death toll continued to rise.
In 1998, the Tobacco Master Settlement Agreement was reached between the four largest U.S. tobacco companies and the attorneys general of 46 states. The companies agreed to curtail or cease tobacco marketing and to pay in perpetuity compensation to the states for the medical costs of caring for patients with smoking-related illnesses.
Each state was given latitude in how to use the money to provide education along with prevention and treatment for those addicted to nicotine and smoking.
During the same period, overdose deaths rose nationally from 16,849 in 1999 to 70,237 in 2017. (2018 figures not yet released) Collectively, it’s estimated that 702,568 Americans have died from drug overdoses, including those involving prescription opioids and illicit drug use.
Confiscated opioids and syringes on Kauai.
Courtesy of Kauai County
We now know that the use of opioids risks addiction in a significant portion of patients, and studies have shown that over 80% of heroin users had used opioid pain relievers procured from family, friends or personal prescriptions.
Limiting these prescriptions requires a concerted effort to provide alternatives for pain management along with education to patients and physicians about the dangers of these medications, and treatment options for those who have already become addicted to opioids.
Lawmakers are beginning to take action, but perhaps what we really need is an Opioid Master Settlement Agreement with all of the states, just like the tobacco accord.
The major companies that provide the prescription drugs, both by production and distribution, would be forced to pay, indefinitely, for the treatment for those addicted to their products, and for the education and prevention efforts to keep new patients from getting hooked.
Already, top executives of Insys Therapeutics, a company that sold a fentanyl-based painkiller, have been found guilty of racketeering charges after bribing doctors to prescribe their product and misleading insurers about the patient’s need for the drug.
But this is just the beginning.
Purdue Pharma, a privately held company of the Sackler family, has been in the spotlight recently as past recipients of their philanthropic donations began rejecting their money to protest the family’s involvement in the promotion of opioid use by their company.
Lawsuits could be stuck in courts for decades while thousands of people die every year from overdoses, and others get addicted to the dangerous drugs due to a lack of education about the risks and limited treatment alternatives.
A cooperative settlement between all American states and territories and the top pharmaceutical companies might provide a more immediate solution. Drug rehabilitation centers could be funded and built where the need is the greatest, without waiting for each state to find the money. Preventive efforts by way of educational campaigns and medical professionals could be started. Completion of additional training for those who are prescribing the medications could be tied to licensure, and the cost of the courses paid for by these settlement funds.
States could receive grants to provide greater access to methadone treatment, which can be paired with inpatient or outpatient support programs to help patients recover from their addiction to opioids.
Settlement money could help train physicians who can provide the services necessary, even in rural communities through portals like telemedicine.
New research could probe alternative pain treatments, with the development and distribution of products by a government-run nonprofit pharmaceutical distributor so that the main benefit is to patients, not the very industry that has profited in the billions by contributing to the problem.
A tobacco-style opioid settlement might just be the way to ease society’s burden from the crisis, and put money these companies generated to better use for the health of everyone.
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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.