Today in America, the drug epidemic stands as the deadliest it has ever been, nearly doubling in the past five years. The emergence of the synthetic opioid fentanyl is now driving one of America’s greatest unfolding tragedies.
We should have seen it coming. As reported by the National Center for Biotechnology Information, in the mid-to-late 1990s, medical prescriptions for opioids started to increase sharply in this country. Soon, nonmedical opioid use also started its climb, followed by “death rates associated with opioid overdose” increasing in virtually every population group. CBS News reported that the Drug Enforcement Administration’s 2018 National Threat Assessment showed that “illicit fentanyl and other synthetic opioids — primarily sourced from China and Mexico — are now the most lethal category of opioids used in the United States.”
Major pharmaceutical companies, prescription practices within the health care system and just plain profiteers must also answer for their role in the current state of our nation’s opioid epidemic. Such a reckoning is underway. According to the Associated Press, “public nuisance claims are at the heart of some 3,000 lawsuits brought by state and local governments against drug makers, distribution companies and pharmacies.”
Among them, two Ohio counties are now in the process of suing five pharmacy chains for not stopping the flood of pills that resulted in hundreds of overdose deaths in their counties. The Guardian reported that the jury found “the pharmacies played an outsized role in creating a public nuisance in the way they dispensed pain medication into their communities.”
Drug companies in this and other cases contend that they cannot be blamed for the epidemic. Their role is that merely of suppliers of opioids that had been prescribed by doctors. In the Ohio case, they have countered by stating that pharmacies “should be the last line of defense to prevent the pills from getting into the wrong hands.”
Observers of the case believed that the verdict reached “could set the tone for U.S. city and county governments that want to hold pharmacies accountable for their roles in the opioid crisis.”
While some lawsuits have resulted in big settlements or proposed settlements before trials were completed, the outcome is not always clear-cut. The Guardian notes that, in a recent decision, “a California judge ruled in favor of top drug manufacturers in a lawsuit with three counties and the city of Oakland.” A recent decision by the Oklahoma Supreme Court “overturned a 2019 judgment for $465m in a suit brought by the state against drugmaker Johnson & Johnson.”
The state of Washington represents the first state action against drug distribution companies to go to trial. As reported by ABC News, Washington Attorney General Bob Ferguson chose to do so after rejecting “a half-billion-dollar settlement” offer by “the nation’s three biggest drug distributors.” The state “is seeking a ‘transformative’ payout of tens of billions of dollars from the companies to help undo the epidemic’s damage” statewide, which is described as including “more than 8,000 deaths from 2006 to 2017 and untold devastation to families.” Opioid sales in Washington were up over 500% between 1997 and 2011. The trial is expected to last about three months.
The role of primary care physicians’ opioid prescribing patterns is also under legal scrutiny. According to the Shore News Network, a Roanoke, Virginia, doctor was recently “sentenced to 36 months in prison, a fine of $10,000, and a forfeiture money judgment of $500,000” for illegally prescribing controlled substances to patients “outside the usual course of professional practice and not for a legitimate medical purpose.” High dosages of morphine, oxycodone and hydromorphone were among the controlled substances.
The prosecutor overseeing the case stated, “This significant sentence sends a strong message that our office will continue to investigate and prosecute any in the health care system who seek to illegally profit from the opioid crisis.”
Somewhat lost in the media coverage is the impact the current drug crisis is having on active military personnel and veterans. Little information seems to be currently available.
According to a 2019 report by Harvard University’s Shorenstein Center on Media, Politics and Public Policy, “programs aimed at reducing painkiller prescriptions to soldiers and veterans appear, so far, to be working.”
“Opioid prescriptions from Department of Veterans Affairs doctors fell more than 40% from 2012 to 2017,” according to the authors. “This coincides with the VA’s Opioid Safety Initiative, which began in 2013 and aims to educate healthcare providers on the benefits and risks of prescribing opioids,” reports Clark Merrefield.
“Despite fewer painkiller prescriptions, the opioid overdose death epidemic among veterans is still very real — and appears to be getting worse,” writes Merrefield. Citing data from the Veterans Administration, he goes on to say, “After troop surges in Afghanistan and Iraq in the late 2000s, opioid use disorders among veterans rose 55%.”
Recent research published in the American Journal of Preventive Medicine supports the belief that veterans remain especially vulnerable to addiction.
According to a November report posted on Filter, a news service focusing on drug use, policy and human rights, a recent study published in the journal Addiction shows that military veterans today “are increasingly vulnerable to stimulant-involved deaths.” Based on “a nationally representative database of medical data available from the Veterans Health Administration,” between 2012 and 2018, over 3,600 veteran deaths in the U.S. involved stimulants taken alone or with other drugs — a death toll that has tripled over the six-year period.
“The adulteration of synthetic opioids in the stimulant supply is likely contributing,” says study coauthor and University of Michigan psychiatry professor Lewei Allison.
Greg Gharst is a lieutenant colonel and a preventive medicine officer in the Medical Services Corps within the U.S. Army Reserve and currently serves in the Center for Strategic Learning at the U.S. Army War College. In a November posting on the Center’s “War Room,” he writes: “U.S. military leaders must both acknowledge the effects of the opioid epidemic on the military, and further, they must act to mitigate the disastrous effects of widespread opioid abuse and overdose deaths connected to the U.S. military and military veterans … the opioid crisis presents a military readiness problem, and should be addressed with a sense of urgency as is warranted.”