As fentanyl deaths soar, big questions on Big Pharma’s role in pushing drug

Heroin-Fentanyl-vials-NHSPFL-1600x900-300x169A Missouri  Senator has accused Insys Therapeutics, a major drug maker, of conducting a sneaky campaign to get more pain-wracked cancer patients to use its synthetic and super powerful opioid drug, thus helping to fuel the wildfire spread of increasingly lethal and debilitating prescription pain killers.

Sen. Claire McCaskill and investigators from a Senate committee, as well as federal prosecutors, have painted a harsh picture of how Insys created a special unit to boost sales and use of Subsys, its spray form of the potent painkiller fentanyl.

Through an elaborate ruse—which included carefully crafted scripts and bogus phone numbers—Insys workers contacted prescription benefit management (PBM) firms, making them believe they were patients seeking a required pre-approval for their doctors to prescribe them Subsys.

The drug maker reps, oh, so carefully, convinced the PBMs that they were suffering pain so significant, typically from cancer, so that they would qualify for the firms to let doctors order Subsys. PBMs have taken on a huge role in medicine, ostensibly to help corporations and insurers keep costs down by added oversight over physicians’ dispensing of drugs and medical services. The firms themselves, however, reap profits by not only taking a percentage of any purported savings they can document but also by receiving payments of middle-man discounts and reimbursements from drug makers.

Insys had denounced its workers who have been caught up in ploys to get approvals for fentanyl prescriptions, saying the employees’ actions were wrong, violated company policy, and led to dismissals.

But McCaskill and Senate investigators say they can show, for example, how the actions of Insys workers led to the over-prescription of fentanyl and other potent drugs to a New Jersey woman who died of an overdose.

Indeed, fentanyl packs such a wallop that it is blamed for a soaring number of overdose deaths linked to the nation’s opioid drug abuse epidemic. The New York Times, based on its scrutiny of records, has reported that “fentanyl and its analogues … continue to push the death count higher,” increasing 540 percent in the last three years such that, “Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamine. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the HIV epidemic at its peak.”

News organizations and state officials already have investigated and implicated Big Pharma in pushing potent painkillers nationwide, with the inundation of communities and states with medications less powerful than fentanyl creating the opioid drug abuse epidemic. It also now has pushed high-seekers to illicit street drugs like heroin. That fentanyl might be following a similar path, with its way paved by Big Pharma, is chilling, especially considering its potency (see photo comparing how little fentanyl, as compared with heroin, constitutes a lethal dose).

In my practice, I see the huge harms that patients suffer while seeking medical services and the havoc that dangerous drugs can wreak. It’s unacceptable that 64,000 Americans died of overdoses in 2016—more people than were killed by peak car-related deaths in 1972 or by peak gun deaths in 1993. The opioid drug epidemic’s toll reaches much further, including, new research shows, a staggering economic debilitation of American workers:  The rise in painkiller prescriptions between 1999 and 2015 drove a 20 percent or so drop in men’s workforce participation and 25 percent of women’s, according to newly published research by a respected economist.

Federal authorities need to step up their drug-fighting efforts to at least match the intensity of officials in many of the most harmed states. Presidential leadership, beyond Tweets and almost buffoonish comments, also would be useful. It’s good to see congressional activity, but here, too, more is needed. And, of course, we are way beyond the time when doctors and hospitals need to take major steps to attack the opioid drug abuse. If Big Pharma also can’t clean its act up, federal lawmakers and prosecutors should take appropriate punitive steps.

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