Issue #10 March 2021
One year ago, in March 2020, my Drug Policy Alternatives post was titled “Three Legal Drug Industries: Three Public Health Crises”. It was a reference to the alcohol, tobacco, and pharmaceutical industries and their international, multi-decade onslaught on the public’s health amidst their unruly campaigns of profiteering. On other occasions, I have written about how the legal cannabis industry appears to be following a similar trajectory. I have noticed that when others write about the similarity, they typically leave out the pharmaceutical industry. Perhaps this is because pharma is, after all, not an industry serving up recreational biochemical self-indulgence. It provides products that restore health and happiness, make many agonies less so, and even save lives. All true.
But there is a dark side to this industry. I imagine that there is no one reading this who is not aware of the opioid crisis that continues to sweep across Canada, the United States, and other countries. The crisis is now well into its second decade and appears to be worsening during the COVID pandemic – a pandemic within a pandemic. These are challenging times.
I also imagine that most people reading this are familiar with the role that Purdue Pharma played in the opioid pandemic. Recognizing Vancouver as an exception, opioid dependence was not a widespread problem in Canada in the first half of the 1990s. Then came Purdue’s opioid painkiller, Oxycontin. That changed everything. An aggressive, deceptive, and illegal marketing campaign misled and rewarded prescribers looking for an easy fix for their patients suffering from pain. The numbers of dependent people quickly rose. Then came the overdoses, and the deaths.
When government regulation, late to the dance as it often is, began to bring in more restrictive measures on oxycodone medications, two things happened. First, prescribers switched to fentanyl and that had a downward impact on Purdue’s oxycodone sales. Members of the Sackler family, who own Purdue, instructed their people to put the marketing machinery into high gear. Yes, with the overdoses and deaths piling up, they did that. The second occurrence was that those in the illegal drug trade coveted a piece of the fentanyl action and got busy. Through an unintentional, disconnected partnership, Purdue and the illegal trade together forged an avarice-driven pandemic that spiralled beyond containment by the customary regulatory control mechanisms.
I worry when people talk or write about the solution to the street drug crisis being the establishment of a safe supply. I know what they mean, and I know they mean well. What is critical to understand, however, is that the opioid crisis is one born with all the customary boxes for safe supply checked off.
Legal opioid medications were:
• invented by qualified scientists working for government-regulated pharmaceutical companies
• manufactured by qualified technicians working for government-regulated pharmaceutical companies
• evaluated in clinical trials conducted by qualified scientists employed by reputable research organizations, and publishing in reputable, peer-reviewed journals
• approved by a government regulatory body
• marketed by professionals working for government-regulated pharmaceutical companies
• prescribed and dispensed by licensed health care providers accredited by their respective professional colleges.
Within the rubric of widely accepted drug policy orthodoxy, that sounds like a very safe supply. What could possibly go wrong?
Well, lots. And it did.
Between January 1, 2016 and June 30, 2020, the opioid epidemic in Canada has seen 21,824 hospitalizations and 17,602 deaths. (There were also many deaths and hospitalizations before 2016, but we do not have official counts.) We all know that these stark statistics, as disturbing as they are, do not come close to capturing the anguish of families affected by the deaths. As for the widely accepted drug policy orthodoxy, it is in dire need of a reformulation. Yes, an illegal drug trade is not ideal, and sometimes it is dangerous. The criminalization of drug users is also ineffective and dangerous. But handing the drug supply to corporations is not the solution.
We must also recognize that the opioid numbers do not come close to the numbers that have been posted for alcohol and tobacco for many decades. But, as Andrea Woo at the Globe and Mail, once pointed out “It’s not a contest.” She is right. The brutal injustice within the opioid pandemic does not arise from the numbers. It arises from the horrific fact that this crisis was set in motion and sustained by a legal government-regulated company that could choose profits over lives. Purdue has recently settled thousands of class actions with a single settlement for $8.1 billion to resolve all claims in the United States. That figure does not come close to covering the financial costs of the plaintiffs and state treasuries. It does not come close to the profits that Purdue made from selling the product. And it is an even far greater distance from addressing the anguish and suffering that will persist for years – largely because an extraordinarily wealthy family believed that it needed to become even more wealthy, and had the right to do so, at whatever the cost to others. I suggest we all linger on that thought for a moment.
Purdue, the company, paid a financial settlement for the choices that were made. But a company is just a legal construct. It cannot make choices. People make choices – on behalf of the legal construct. And no one is buying into the carefully crafted, legally vetted, after-the-fact admissions of having made “mistakes”. In the corporate world, executives are rarely held criminally accountable for irresponsible decisions that cost lives. No one is going to prison for the opioid massacre. With this kind of license, the people who make choices at Purdue will not be deterred in the future. Neither will the people in charge at other pharmaceutical companies. Neither will the people running tobacco, alcohol, or cannabis companies. Why should they?
This is the reason I include pharma, along with alcohol and tobacco, as another cautionary tale when I write or talk about the emerging criminally oriented legal cannabis industry. It is not cannabis, nor cannabis users, that should concern us. It is the people who wish to profit – too immensely – from producing and selling it.
If there is anyone who regards Purdue and the opioid crisis as an isolated case within the pharmaceutical industry – just a single bad apple in the otherwise health-enabling cart – they would do well to read “Pharmaceuticals, Corporate Crime, and Public Health” by Dukes, Braithwaite, and Moloney. The authors, with work experience in the pharmaceutical industry, in international regulation, and in public health, have diligently mined content from all the right peer-reviewed journals, court cases, and government/health/justice agency investigations, over a half century. They describe illegal and unethical conduct at no less than 64 pharmaceutical companies in 31 countries, across all populated continents. It is not just a single bad apple, or two, or a dozen. Much of the world-wide, corporate drug industry orchard is afflicted with a lawless, uncaring blight. Government regulates this blight, too little, too slowly, and too permissively. Those are the problems with our “safe supply”. All true.
With spring’s approach, requests for online presentations are coming in. I look forward to an opportunity to talk with you about organizing a drug policy education event. The time is right.
Hamilton Ontario Canada
March 5 2021