Will Big Pharma Support a Non-Addictive Opioid?

By Kristance Harlow 10/02/16

With painkillers like OxyContin, the overdose reversal drug naloxone, and detox/maintenance medications like Suboxone, the pharmaceutical industry is making a profit off people addicted to opioids at every stage.

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Stacks of coins and pills.
Pile 'em high.

Opioids are highly addictive and sometimes, especially in combination with other drugs, deadly. There is, as of yet, no other kind of pain medication that matches the level of relief provided by opiates, nor is there any comparable high for people who are addicted to the drug. Thus, the epidemic grows and more people die. 

Some researchers are unwilling to give up on the search for a non-addictive opioid and they may be getting close to finding one. A report in the "Proceedings of the National Academy of Sciences" published findings on a new opioid only named BU08028. The drug was tested on monkeys and found to be as effective at managing pain as the most powerful opioids on the market today. The uniqueness of BU08028 lies in its lack of fatal side effects. It's non-habit forming, is believed not to bring on a euphoric high, and even at extremely high doses is not deadly. The science on this drug is still in the early phases, and some doctors have doubts over the kinds of pain it can manage and whether or not it is actually as benign as these initial tests have found.

There are many factors that play into developing an addiction. The chemical properties of a drug make up only one piece of the puzzle, but it is a piece that cannot be ignored. The human body easily becomes physically dependent on opioids in all of their current formulations. Even people who do not develop an addiction will experience a painful withdrawal syndrome if they have been taking opioids for an extended period of time. Addiction and opioids have always gone hand in hand. As more potent versions of the drug have made their way to pharmacies, more people have become addicted and more people have died.

The predisposition of opioids to being misused has been well documented over the last several thousand years. Opium, from which morphine is synthesized, was used in 1500 BCE and possibly as far back as 4200 BCE. Morphine was purified from opium in 1805 and ever since the hypodermic syringe was invented in 1853, opioids have become an increasingly deadly and widespread addiction. If we've known about these issues for so long, how did we let the problem get so bad?

In large part we can thank the pharmaceutical industry. Prior to 1990, opioids were only used to treat patients with severe pain, such as cancer patients. Aggressive marketing initiatives by Purdue Pharma in the 1990s advertised OxyContin as a non-addictive alternative. In reality, OxyContin is just a time release version of oxycodone, the dangers of which have been well documented since the 1960s. As a result of the “non-addictive” advertising campaigns, OxyContin flew off the shelves and Purdue Pharma counted the cash (in 2010 they raked in $3.1 billion on OxyContin sales alone). When it was discovered that Purdue Pharma was knowingly misleading the public they were forced to pay a fine of $635 million. The fine barely made a dent in their profit margin and it did not affect their OxyContin sales. The majority of the $3 billion that the company continues to generate annually come from that drug. The Sacklers, the family at the helm of Purdue Pharma, were added to the Forbes 2015 list of America’s richest families with a net worth of $14 billion.

Even if BU08028 turns out to be extremely safe and effective in humans, the likelihood of the pharmaceutical industry putting its weight behind such a development remains to be seen. If big pharma’s history of shadiness is indicative of the future, any attempt to transition to a non-addictive opioid will be met with strong opposition. Opioids are a cash cow for the drug companies; 90 percent of opioids used illicitly are produced legally for medical use. Companies like Purdue Pharma are not unaware of this.

Just this past spring, a law was passed that protects the pharmaceutical industry from legal repercussions for failing to report suspicious drug orders. Which is exactly what Purdue Pharma refused to do when a fake medical clinic was writing prescriptions for OxyContin from 2008 to 2010. The drug manufacturer knew what was happening and allowed the fraudulent activities to continue. When that recent legislation was signed into law it barely made a ripple in the news, even though it will make it easier for drugs to move through illicit networks by protecting the drug manufacturers. Ultimately, it makes it harder for the DEA to suspend companies that may pose an imminent threat to the public.

The pharmaceutical industry is making a profit off people addicted to opioid medication and spending money to protect its investments. An estimated 80 percent of all the opioids in the world are consumed in the US. Over the past decade, the industry has spent over $800 million to fight legislation that wants to put limits on the availability of opioids. Some of this money has been funneled through to cancer advocacy organizations who fear opioid limits will make it harder for people who live with chronic debilitating pain. The majority of patients who are lawfully prescribed opioids use them as directed and are not addicted. Yet, there are far more opioid prescriptions written than needed, such as the OxyContin scripts filled for the fraudulent medical clinic. According to data provided by the Center for Disease Control (CDC), 25 percent of patients who are given an opioid script for pain unrelated to cancer and have it refilled are struggling with addiction.

Prescription drugs can be expensive and difficult to obtain, which is why some turn to heroin. Heroin addiction and overdose death rates have risen more than 300 percent in the last six years. Heroin use has skyrocketed in tandem with the rising cost of prescription opioids because people are turning to cheaper street produced narcotics. A major danger with street drugs is how difficult it is to know the purity of the product.

Fentanyl, a fast-acting and extremely potent opioid, is a contributing factor to the unprecedented number of overdoses occurring currently. Fentanyl can be 50 times stronger than heroin. Increasingly, the two painkillers are being laced together. Much of the fentanyl is illegally produced but some of it comes from medical pharmaceuticals, although the CDC doesn’t know how much. It is a more difficult prescription to get filled, but that doesn’t make it impossible. An investigation by Fusion uncovered that companies have provided kickbacks to doctors for writing prescriptions and encouraged salespeople to push the drug. Fentanyl is all too easy to overdose on because it is so potent.

Big pharma is also making money on overdoses. There is a drug called naloxone (Narcan) that can bring people back from an opioid overdose. Naloxone has been around since the 1960s but rose in popularity after 1999 when the number of overdoses skyrocketed. The non-profit North Carolina Harm Reduction Coalition (NCHRC) has been keeping tabs on the number of drug overdose reversals since they began supplying overdose prevention kits on August 1, 2013. As of September 20, 2016 they had reversed 4,519 overdoses, just in North Carolina.

As demand for the lifesaving antidote rises, so does the price. The cost of branded versions naloxone have risen to shameful heights even though it is not an expensive drug to manufacture. One version went from less than a dollar to over $15 (a 1,500 percent increase) in less than ten years. Some of the sharpest price hikes have happened over the course of only a few months. In August 2016, an auto injector version of the drug called Evzio was priced at $2,250, which is a whopping 500 percent increase from its price of $375 less than a year ago in November 2015.

Politicians seem to believe the answer lies in treatment, not prevention. Obama passed legislation to make it easier for doctors to prescribe buprenorphine (Suboxone). Buprenorphine is used by people who are addicted to opioids to prevent withdrawal symptoms and as a maintenance medication to keep them from returning to active addiction. Users become physically dependent on buprenorphine because it is an opioid itself. Treating addicts is big business for big pharma.

It is impossible to ignore the connection between these profit threads. Big pharma misleads the public and pushes to increase prescriptions. People become addicted. Addicted people require more drugs and companies make money. Drug users overdose and need a drug to save them, big pharma makes more money. Then someone trying to recover takes a drug like Suboxone, big pharma makes even more money. If history tells us anything, it’s that the pharmaceutical industry is going to continue to push their addictive drugs even if a truly non-habit forming and safe opioid becomes a reality.

Kristance Harlow is a writer who is passionate about ending the stigma of mental illness and addiction. She hangs out on the internet and sometimes updates her blog Digging to Roam or celebrates awkward humor on her YouTube channel.

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Kristance Harlow is a freelance writer and mental illness advocate. She fights stigma and writes about uncomfortable experiences. She lives in a foreign land with her husband and rescue pupster. Find Kristance on Twitter, Instagram, LinkedIn, or her blog.

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