Carcinogens Shmarshminogens—Live in the Moment (Why Purdue Pharma’s punishment was overly harsh)

cigarette stick on pile of coins

So you think those Oxycontin bastards got what they deserved for their role in the opioid crisis—an $8.34 billion settlement and the dissolution of the company? Maybe you’re right. But my question to you is this: what are you smoking?

Purdue Pharma admitted that it knowingly and intentionally conspired to aid and abet doctors dispensing the extended-release opioid without a legitimate medical purpose. They’d been the target of numerous earlier lawsuits dating back to at least 2004, in which billions of dollars were also paid out. These lawsuits all circle back to one thing—Purdue Pharma’s role in precipitating the opioid crisis.

America has long had a love affair with “The War of Drugs”—burdening our prison system for decades with non-violent drug offenders. Many states had (or still have) “three strikes” laws, mandating repeat offenders serve life sentences for trumped up crimes of drug trafficking. The vast majority of those inmates were just scoring off their own meager supply, not trafficking. The tide has been changing from punishment to treatment the last decade, though, all the while pursuing that unattainable goal of prevention.

Yet America’s opioid crisis rages on.

In 2012, the first state laws to legalize marijuana were enacted. In the recent election, a few states had drug issues on their ballots that were understandably overlooked by national media. Oregon passed a bill legalizing the possession and personal use of ALL drugs in limited amounts. We’re talking the big boys: methamphetamines, psilocybin, even cocaine and heroin.

America has a culture of “Got a Problem? Take a Pill.” Open Grandma’s medicine cabinet and you’re likely to have 20 pill bottles tumble out? She started with just diabetes and blood pressure meds, but they caused side effects. So, she got 2 more prescriptions to treat those, which lead to their own troubles, thus more meds. Soon she’s cachectic because there’s no room left in her stomach for sustenance after swallowing all those damn pills. It’d be best to just toss all her meds in the trash and start from scratch with new drugs that don’t cause her any side effects. Oregon has begun clearing out America’s medicine cabinet—getting rid of arcane drug laws saddling America with a crippling side effect: world’s highest incarceration rate.

Yet America’s opioid crisis rages on.

We are a nation built on freedom—proud to allow consenting adults to make their own decisions. For decades these decisions have been made outside the purview of law. You could purchase your poison of choice on the corner for a dime from a Jesse Pinkman-esque character circa Breaking Bad: Season 1, or pay a premium for the “Blue Sky” from a kingpin in a $20,000 suit with a $150,000 Patek Philippe on his wrist. [I’ve never done an illegal drug in my life, so I’m relying on TV and movies here.] In either case, those drugs are not governed by any regulatory body, and they sure aren’t held to any Good Manufacturing Practice standards. Street drugs have way more addictive potential, and are far more dangerous, with much wider ranges of potency than Oxycontin.

An $8.34 billion fine makes you think Purdue Pharma executives were out on the playground giving tweens their first hit for free, trying to get them addicted. Obviously, that’s not the case. I can’t understand how a company that legally produces a medication that has relieved chronic pain for millions of people is ruined, while Joey Two-Strikes can start a new routine of shooting unregulated, unprescribed heroin—consequence-free—outside the Bend, Oregon Blockbuster. Does this seem right?

Physicians are allowed to prescribe an FDA approved medication for any reason they see fit. Without a legal prescription written by a prescriber, filled by a pharmacist, and ingested by
a willing patient, Oxycontin would just sit untouched on shelves. Drug manufacturers have no way of getting their products to customers without prescribers as intermediaries. The doctors that prescribe, and the patients that take the medications, must share in the blame for precipitating the opioid crisis. Yet, the manufacturers of Oxycontin are the only ones bearing any responsibility. Does this seem right?

And America’s opioid crisis rages on.

I see a second major inconsistency with this lawsuit. The cumulative fines to Big Tobacco companies make Purdue Pharma’s $8.34 billion seem like small potatoes. These carcinogen factories have paid out $100’s of billions in fines and settlements over the past couple decades, yet they stay solvent. How is this possible? Maybe Big Tobacco spends more money on lobbying. Nope. The pharmaceutical lobby outspends them by a factor of 10. I do know two things: 1) prohibition doesn’t go over very well, and 2) there’s a lot of taxes on each pack of cancer-sticks.

Whatever the reason, cigarettes persist—despite having, literally, zero in the way of health benefits, and a very bleak long-term downside. Oxycontin causes addiction in a small percentage of people, along with acute overdose and death in a very small number of users. In short: opioids can kill quickly, but do so rarely; tobacco kills slowly, but certainly. We too often live for the moment, focusing on short-term outcomes while relegating long-term consequences for another day. Purdue Pharma is out of business after helping millions of people, yet tobacco companies thrive as they kill their customers over decades. Does this seem right?

With the heavy push of Narcan and other naloxone products, a great stride has been
made to decrease narcotic overdose deaths. These medications works by rapidly reversing the effects of opioids—allowing the return of that essential act of our biology: breathing. There is, as of yet, no antidote I know of that will rapidly cure the plethora of cancers caused by smoking. Yet cigarettes persist.

And America’s opioid crisis rages on.

So, you still think Purdue Pharma got their just deserts for the role they played in the opioid crisis? The settlement stipulates that Oxycontin will continue to be made elsewhere, so patients that legitimately need the drug can still benefit from it. Plus, future proceeds will fund efforts to help curb America’s raging opioid crisis. So, I guess, yeah, come to think of it . . . You’re Probably Right.

[019] November 18, 2020