Drug makers' guilty pleas won't end the opioid crisis

DOJ officials announced in October that Purdue Pharma – maker of OxyContin, an opioid painkiller that has been a major factor in substance use disorders – pleaded guilty to federal charges related to its role in contributing to the opioid crisis. The charges include conspiracy to defraud the US and violations of anti-kickback laws.

The plea deal includes an agreement for Purdue Pharma to pay more than $8 billion in fines and to close down the company. The money collected in fines will be used for opioid treatment and abuse prevention programs.

The guilty pleas aren’t the end of all this. Criminal charges are still being considered for the Sackler family that ran Purdue. And of course, we still have a serious opioid crisis in our country and our state.

Like most companies, Purdue Pharma doesn’t actually have $8 billion to pay the fines the company now owes. So when the company is dissolved, its assets will be used to build a new government-controlled company that will work in the public interest, using its profits to fight the opioid problem.

That new company will still produce OxyContin and drugs designed to reverse opioid overdoses. There are, after all, legitimate uses for medications like OxyContin (PDF), which can be very effective in managing chronic pain when used appropriately.

On the other hand, the inappropriate use of prescription opioids has had devastating effects on individuals and families in recent years. North Carolina is not immune to the problem. In 2018 alone, 489 people in our state died from overdosing on prescription opioids. Encouragingly, that number was down from 659 in 2017.

Around 40 years ago, the medical field started to change its thinking about treating and managing pain. Traditional concerns about the addictive properties of opioid pain medicines were balanced by the benefits of pain relief to quality of life. At the time, there were no extensive historical or medical records about how many people were misusing opioids.

By the early 1990s, pain management began to emerge as a specialty. That’s when OxyContin entered the picture.

OxyContin, a brand-name version of oxycodone, was marketed to doctors as a long-lasting pain drug providing 12 hours of relief. The US Food and Drug Administration approved the 12-hour dosing, providing reassurance to prescribers. Purdue Pharma’s marketing of OxyContin downplayed the risks of addiction, giving the impression that there was little to worry about.

Today, we know differently, of course. And Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has been working to reduce the misuse of prescription opioids for several years. In 2018, we changed our prescription policies, limiting first-time prescription fills of short-acting opioids to a maximum of seven days. After the first prescription, customers can fill future prescriptions for larger supply if it is deemed appropriate by their physician. This limits the number of unused opioid pills that could end up being misused and reduces the risk of chronic opioid abuse.

This policy change aligns with nationally recognized Centers for Disease Control and Prevention guidelines on the appropriate use of opioids. The NC STOP Act also put limits on certain first-time prescriptions.

And we’re seeing progress. Since Blue Cross NC changed its opioid prescription policies in 2018, the number of annual opioid prescriptions per 1,000 people in North Carolina dropped from over 700 to a little more than 500.

There is still much more work to do. Still, the settlement with Purdue Pharma is an important step forward in managing the nation’s opioid crisis.