Rings of Poison: The Opioid Epidemic

By Shiven Sharma
Shiven Sharma is a fourth year student at the University of Pennsylvania studying Biology with a minor in French studies. ​

​Due to the prevalence of opioid-caused morbidity and mortality, questions have arisen regarding the source of such outcomes and lenient policies that enable its prevalence.

Over the past four years, the opioid crisis has become increasingly prevalent despite efforts to mitigate it. Every day, nearly 130 people die from opioid overdoses, through a variety of sources such as prescription pain relievers, heroin, or lab-made opioids (e.g. Alfentanil).[1] Opioid overdoses from patient prescribed drugs seem to be the most problematic of the aforementioned as roughly 21 to 29 percent of patients using chronic pain medications have reported misusing them, while 8 to 12 percent go on to develop an opioid disorder.[2] Nationally, the opioid overdoses have spiked by 54 percent in approximately 16 states. [3] As a result of this increase, many have been incarcerated for such abuse. Perhaps more shockingly, nearly half the state and federal prisoners meet the criteria for substance abuse disorders. According to the World Health Organization (WHO), the Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence recommends that prisoners receive sufficient healthcare when suffering withdrawal symptoms.[4] Unfortunately, the vast majority of prisoners go untreated during their substantial periods of imprisonment, which tends to cause repeat offences upon release.

With such devastating consequences, certain questions arise – How did this begin? Who is culpable? What measures are being taken?

During the late 1990s, pharmaceutical companies began supplying a plethora of drugs for various ailments, the majority of which pertained to pain relief. They did so with the guarantee of effectiveness, minimal side-effects, and no addictive abuse. This was clearly erroneous, and the repercussions still being witnessed today. In July 2019, Johnson and Johnson (J&J) was accused of accepting “zero-responsibility” for the widespread addictions.[5] Two pharmaceutical companies, Pharma of Connecticut and Teva Pharmaceutical of Israel settled for $270 million and $85 million respectively prior to entering trial.[6] With the sole defendant being J&J, the trial was meant to target two specific drugs synthesized by J&J. These were Duragesic, a time-release opioid patch, and Nucynta, a capsule – both allegedly the main cause of the epidemic in Oklahoma.

In trial, the Oklahoma Attorney General Mike Hunter opened by accusing J&J of fraud for the sake of greed, stating that the company embarked on “a cynical, deceitful multimillion-dollar brainwashing campaign” selling opioids as a sort of “snake oil.” In counter, a medical expert for the defense stated that “[The drugs] provided medically necessary medications for the treatment of terrible, terrible problems. Those treatments were approved and regulated by the FDA.” It should be noted that future trials will contain medical expert testimony from both sides. As an aside, the courts allowed testimony from those personally affected by the epidemic. For instance, a Connecticut businessman Gary M. Mendel who was gravely affected by the epidemic gave powerful statement in court about the death of his son, stating: “This is not about my son anymore; my son has passed. This is about everybody’s son, all people. The system needs to be changed.”[7]

It seems as though the opioid policies thus far have proven inadequate. One such policy is The Opioid Fraud and Detection Unit. In theory, the plan sounded promising, with 12 districts opting to participate in the program, notably the Southern District of Ohio and the Eastern District of Michigan. Additionally, 12 Assistant U.S. Attorneys would be placed in each of their respective districts with the sole purpose of investigating and prosecuting health care fraud related to prescription opioids. [8] In 2017, the year of its enforcement, former U.S. Attorney General Jeff Sessions emphatically stated, “If you are a doctor illegally prescribing opioids for profit or pharmacist letting these pills walk out your door and onto our streets […], we are coming after you.”[9] Despite this promise, the opioid epidemic has gone unmitigated. In fact, in January of 2019, The National Safety Council found that, for the first time in history, the odds of dying from opioids in the U.S. is now greater than dying of a vehicle collision.[10]

This is simply one set of issues being addressed, but further regulation must tighten up on drug advertising and the FDA screening of the drug should undergo intensive cohorts while performing specific Drug Liability screenings prior to moving forward with approval. Without such adjustment, the seemingly positive linear trend of opioid use could continue indefinitely.

The opinions and views expressed in this publication are the opinions of the designated authors and do not reflect the opinions or views of the Penn Undergraduate Law Journal, our staff, or our clients.

References
[1] National Institute of Drug Abuse. “The Opioid Overdose Crisis.” January 2019. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis#ten (Accessed July 16, 2019)
[2] CDC/NCHS “National Vital Statistics System, Mortality.” CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC. May 2018. https://wonder.cdc.gov. (Accessed July 16, 2019)
[3] National Institute of Drug Abuse. “Medications to Treat Opioid Disorder.” June 2018. https://www.drugabuse.gov/publications/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system (Accessed July 16, 2019)
[4] National Institute of Drug Abuse. “Medications to Treat Opioid Disorder.” June 2018. https://www.drugabuse.gov/publications/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system (Accessed July 16, 2019)
[5] Feely, Jeff & Bloomberg. “Johnson & Johnson Accused of Dodging Liability for Its Alleged Role in Opioid Epidemic.” July 15th, 2019. https://fortune.com/2019/07/15/johnson-and-johnson-opioid-suit-oklahoma/ (Accessed July 16, 2019) [
6] CNN Library. “Opioid Crisis Fast Facts.” July 2, 2019. https://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html (Accessed July 16, 2019)
[7] Feely, Jeff & Bloomberg. “Johnson & Johnson Accused of Dodging Liability for Its Alleged Role in Opioid Epidemic.” July 15th, 2019. https://fortune.com/2019/07/15/johnson-and-johnson-opioid-suit-oklahoma/ (Accessed July 16, 2019)
[8] Feely, Jeff & Bloomberg. “Johnson & Johnson Accused of Dodging Liability for Its Alleged Role in Opioid Epidemic.” July 15th, 2019. https://fortune.com/2019/07/15/johnson-and-johnson-opioid-suit-oklahoma/ (Accessed July 16, 2019)
[9] The United States Department of Justice. “Attorney General Sessions Announces Opioid Fraud and Abuse Detection Unit.” August 2, 2017. https://www.justice.gov/opa/pr/attorney-general-sessions-announces-opioid-fraud-and-abuse-detection-unit (Accessed July 16, 2019)
[10] CNN Library. “Opioid Crisis Fast Facts.” July 2, 2019. https://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html (Accessed July 16, 2019)