The Center for Disease Control & Prevention stated that the U.S. had 33,091 deaths in 2015 related to opioids. The National Institute on Drug Abuse defines opioids as a class of drugs including prescription brands such as Percocet, Vicodin and Oxycontin, as well as synthetics including fentanyl, and the illegal drug heroin. In addition to relieving pain, these drugs are known to produce a “high” that creates their propensity for abuse. Colorado has unfortunately earned the second-ranking among states for highest rates of prescription drug abuse.
Cynthia Coffman, Colorado's Attorney General, is striving to find solutions to this problem. She has joined a group of her colleagues across the country to answer some questions including if drug manufacturers have played a role in the opioid epidemic, possibly through their marketing strategies. Officials say that they hope to gain a collective understanding of how to address the problem.
Patient Usage & Abuse
The typical user begins by obtaining the drugs via a prescription with the intention of relieving pain. Soon after, many users begin to have difficult side effects associated with withdrawal and realize they are addicted. Prescription data now shows that a significant percentage of our population is now potentially “over-medicated.”
One segment that has been heavily medicated is the veteran community. Many veterans experience PTSD and other varieties of trauma-based problems and have high rates of suicide. Research from the VA Center for Clinical Management suggests that prescription chronic pain medication, in addition to alcohol and other drugs, is playing a large role in this likelihood for suicide. Male veterans with alcohol or drug dependency are at a much higher risk, while females with addictions are six times more likely to attempt suicide.
Medical Provider Involvement
Drug manufacturers seek to build relationships with physicians to promote product sales. A ProPublica report recently showed that physicians who receive some monetary compensation from the pharmaceutical industry, such as those who make clinical presentations, tend to prescribe more brand-name medications than those who do not. A group of state attorneys-general sent a collective letter to the largest industry trade group, American's Health Insurance Plans, urging them to communicate with physicians to advance alternatives to opioids for the management of pain. In some instances, even over-the-counter products such as ibuprofen can be effective.
The trade group responded by saying that they have begun better monitoring of prescriptions and the prescribing habits of physicians. The encouraging news is that over the last year there has been a reduction in 30-day opioid prescriptions.
The Role of Drug Manufacturers
The drug manufacturing industry is now heavily advertising directly to patients in addition to their traditionally aggressive marketing efforts geared toward prescribers. Advertising is very common for drugs to treat depression, restless leg syndrome, impotence, insomnia and more on television, online and in print. The group of attorneys-general is scrutinizing the nature of ad campaigns particularly featuring opioid products. The dangerous nature of opioid medications is clearly evident, as they are the largest cause of death for Americans under the age of 50, with an estimated 2 million people who regularly abuse these drugs. Thus far, the majority of the attention and scrutiny has been directed at manufacturers, channels of distribution, pharmacies, and physicians; however, the potential ways that insurance companies contribute to the problem is now being explored.
Potential Contributions from Medical Insurers
A recent article in the New York Times indicated that ProPublica found many insurers offered more restrictive access to many non-opioid pain medications compared to their opioid counterparts, with additional requirements for access such as obtaining pre-authorization. In many cases, the drugs that are safer alternatives are simply more costly. The Department of Health & Human Services is researching potential problems with accessibility to the safer alternatives and options for treatment without drugs, such as increased physical therapy. Another concern is that many of the medical products that have shown to be effective for treating those with opiate addictions, such as Suboxone, have limited insurance provider coverage, leaving patients unable to cover the out-of-pocket expenses for them.