Dear Colleagues! This is Asrar Qureshi’s Blog Post #722 for Pharma Veterans. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on WordPress, the top blog site. Please email to firstname.lastname@example.org for publishing your contributions here.
This series of blogposts is based on multiple sources, links to some of which appear at the end.
Johnson & Johnson is the third company which is implicated in the opioid crisis directly. Their story is by far the most damning in the entire cycle of crisis.
In 1980s, J&J needed a reliable supply of opium for a popular product, Tylenol with Codeine. Having the reach of a multinational, they found and acquired a business in Tasmania, Australia, which grew and processed poppies. They grew the business further, and even developed a new strain of poppy called Norman in 1994 that produced a core ingredient for oxycodone. J&J had more supply than their own, so they negotiated with Purdue Pharma and became their supplier for oxycodone raw material. For years, J&J supplied more than 60% of all active ingredients for opioids manufactured and sold in the US. J&J therefore became a stakeholder and interested party to promote the use of opioids.
Fentanyl was created un 1959 by Dr. Paul Janssen as an intravenous painkiller. It is considered to be 50-100 times more potent than morphine. Johnson & Johnson is the original manufacturer of the drug. As discussed in previous posts, fentanyl added fuel to the fire of opioid addiction. J&J also marketed its full range of opioid analgesics, fentanyl, tapentadol, and tramadol. As the epidemic opened much greater business, generic fentanyl from China, India and Mexico was trafficked into the US.
Between 2000 and 2011, J&J sales representatives aggressively targeted doctors in Oklahoma and other states and promoted the use of opioids as widely as possible. They specifically targeted those doctors who were already prescribing painkillers and actively reinforced that the opioids were safe and effective for everyday use and in all kinds of pain. They sent their representatives dozens of times to pain clinics who issued more prescriptions to continue and increase the flow of prescriptions.
J&J designed special sales stories or ‘hooks’ to specifically target women and war veterans returning after tours of duty.
Along with the prescribers and patients, J&J had a detailed influence map with which it targeted every level of state government with marketing spins to make sure their opioids stayed on all approved lists. They told state leaders that their drugs were safe and effective, and no restrictions should be placed on their use.
J&J interacted with and funded many front groups of the pharma industry to spread the false impression of safety and promote unrestricted use of opioids.
As early as 1994, J&J hired a lawyer to meet with the congress and try get more relaxations in rules for importing opioids from Australia where they were growing poppy. The same lawyer authored a Consensus Statement in 1997 – a document that called for widespread use of all opioids for chronic pain and claimed that addiction with opioids was rare. The document was widely distributed.
J&J continued to aggressively promote its opioids despite warning from its own medical advisory team about risk of abuse and addiction.
Newborn babies became unsuspecting victims of opioid use for no fault of theirs. Pregnant women who were taking opioids had high level of drug in their blood and it passed on to the fetus. When the baby was born, it was already addicted to opioids, but no one would even think about it. They suffered from Neonatal Abstinence Syndrome – NAS, which was just like adult withdrawal symptoms. Withdrawal is a horrible condition, and every addict goes through this in the rehab. However, their withdrawal is monitored and controlled with various treatments, but the newborn’s withdrawal goes undiagnosed, and the child suffers terribly.
The sum up is that J&J worked deliberately and strategically to promote the business of its own brands directly and of those to whom it supplied material. It is a tale of utter disregard for human life, and exploitation at all possible levels. However, being one of their own, these companies are never banned to do business. They are penalized with fines which they pay easily from shareholders money.
J&J agreed to pay $5 billion to the settlement, along with three distributors/wholesalers, AmeriSource Bergen, Cardinal Health, and McKesson, who will contribute $21 billion. In all, it is a $26 billion settlement, and much of this amount shall be spent on healthcare and drug treatment programs designed to ease opioid crisis.
Another contributor to opioid crisis has been the insurance industry. Private and public insurers decided in 1990s to designate methadone as the first-line drug for chronic pain, based only upon its extremely low cost. Being an opioid, it contributed to addiction and drug abuse. It might also have been preferred to non-opioid analgesics due to the same reason. In the interest of cost-containment and profitability, the health insurance industry has contributed to the opioid crisis in the USA by refusing to pay for therapies which could reduce the harm associated with opioid prescribing.
The abuse problem is compounded by the fact that if the supply of opioid drugs is restricted too hard, it forces people to look for alternatives on the market. In a way, it increases the severity of addiction because patient gets economical, smuggled, generic versions of branded opioids.[Quote] Research suggests that these cuts often haven’t helped people with pain. One study of millions of medical records, which compared the timing of state opioid regulations and reductions and could therefore suggest causality, found that opioid reductions actually led directly to increased disability, decreased productivity, rising medical costs and more pain. Another study found that among veterans who had their opioids stopped involuntarily, 9 percent became suicidal, and 2 percent actually tried to take their own lives. Even worse, other research shows that rather than minimizing overdose risk, cutting access to medical opioids nearly triples the odds of overdose death among people in pain. [Unquote]
To be Continued……
Disclaimer: Most pictures in these blogs are taken from Google Images and Pexels. Credit is given where known; some do not show copyright ownership. However, if a claim is lodged at any stage, we shall either mention the ownership clearly, or remove the picture with suitable regrets.