Thomas Niedermueller, Associated Press
Chrisula Gaitatzi fills a box with pharma products at the GEHE AG in Stuttgart, southwestern Germany, on Wednesday, March 12, 2003.

SALT LAKE CITY — As Rochester Drug Cooperative — one of the nation’s largest pharmaceutical companies — faces federal criminal charges for its role in the opioid epidemic, many are asking whether Big Pharma should be the sole target in this widespread scourge.

Rochester Drug Cooperative’s federal charges reflect a new approach for the government in targeting the pharmaceutical industry and could prove a successful pivot in the opioid epidemic.

However, Zachary Siegel, criminal justice reporter for Medium.com, argues that blaming drug companies for the death toll in the opioid crisis “misdiagnoses the problems driving the epidemic.”

Siegel and others suggest the scope of the problem extends far beyond drug companies to a complex array of other culprits.

1. Drug company owners

In a civil lawsuit filed in March 2019, New York State accused eight Sackler family members of contributing to the opioid crisis, which has killed more than 200,000 Americans over the last two decades. The Sackler family owns Purdue Pharma, maker of the painkiller OxyContin.

The suit represents direct legal action against people rather than a company, suggesting individuals can be considered culpable parties in the opioid crisis.

Two former Rochester Drug Cooperative executives were also charged in the federal government’s suit.

2. Direct-to-consumer pharmaceutical marketing

According to medical writer C. Lee Ventola in an article in the Journal of Pharmacy and Therapeutics, the U.S. and New Zealand are the only countries that allow this type of marketing, in which consumers “ask their doctor” about the drugs they see in television and magazine advertisements.

The FDA regulates consumer pharmaceutical marketing, but critics cite concerns with lax and marginally enforced rules as well as a lack of guidelines for online marketing.

Ventola suggests that while the drugs we consume are shaped by U.S. regulatory structures and political incentives, the ways in which we learn about those drugs are less regulated:

“In recent years, the number of regulatory actions taken by the FDA against (direct-to-consumer pharmaceutical marketing) violations has fallen off dramatically, which could reflect better industry compliance but could also be a result of a decline in FDA oversight.”

3. Poverty

Although addiction plagues all income levels, poverty remains a substantial part of the opioid crisis.

Segel explains, “The 100 or so people dying every day from opioid overdoses ... were unlikely affected by a shady marketing campaign from 10 years ago. Families perpetually trapped in cycles of poverty and neglect ... need more help than a settlement from Big Pharma can offer.”

Although poverty’s connections to drug abuse have been examined, data show that the issues perpetuating poverty — such as lack of education, poor job prospects and chronic health problems — lead to increased risk and decreased disincentives for opioid use, according to the Institute for Research on Poverty.

Researchers at the Institute call this a “cumulative disadvantage,” and explain that the rural, economically depressed areas most ravaged by opioids are rife with it.

4. Health insurance companies

The health insurance sector also has a hand in the epidemic as it has made opioids less expensive than their safer alternatives.

Researchers at The New York Times and ProPublica found that most of the insurance plans they studied covered opioids and did not require prior approval for dispensing. Additionally, in many instances, doctors were given incentives to prescribe opioids because they offered faster relief at a lower cost.

Medicare and Medicaid also have pathways for approving addiction treatments that are more complicated than getting approval for the actual addictive substances. This has resulted in frustrated patients who often fail to get needed treatment because of hourslong wait times for insurance approval, according to that same report.

5. The medical community

Ultimately, some providers cannot avoid a portion of responsibility for the opioid epidemic.

In 2017, a group of doctors wrote a letter to the editor published in The New England Journal of Medicine analyzing a previous letter, published in 1980 in the same journal. They determined the 1980 letter was “heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy,” thereby contributing to the current crisis.

Although the 1980 letter did not provide evidence supporting opioid use, it was widely used to reinforce the idea that opioids were safe. The authors of the 2017 letter found that some doctors “grossly misrepresented” the earlier letter’s conclusions, with a marked increase in its citations after the introduction of OxyContin in 1995.

They state: “We believe that this citation pattern (by providers) contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy.”

The Rochester Drug Company's federal lawsuit suggests an opportunity for Big Pharma to be publicly questioned, a chance that could alter providers’ awareness of how they’re being peddled pharmaceuticals.

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Although there may not be sufficient avenues to hold all these groups legally responsible for their role in the opioid crisis, their participation does factor into the overall equation that needs to be addressed in order to turn the crisis around.

Rosalie Liccardo Pacula, co-director of the Rand Drug Policy Research Center explains:

“The opioid crisis is a perfect storm of problems within U.S. regulatory, industrial, social and economic environments.” Rand researchers state that because the opioid crisis is “an ecosystem of sorts … mitigating the problem will require a holistic approach.”