Who profits?

The US is unusual among developed countries in that its life expectancy has gone down in the last few years.

In most high-income countries, life expectancy has been increasing, gradually but steadily, for decades. The last time that life expectancy in the United States showed a similar decline was in 1915–18, as a result of military deaths in the First World War and the 1918 influenza pandemic.

This time, the culprit has been a surge of drug overdoses and suicides, both linked to the use of opioid drugs. The death rate from drug overdoses more than tripled between 1999 and 2017, and that from opioid overdoses increased almost sixfold during the same period.

This crisis is often referred to as the opioid epidemic and, just like an infectious-disease epidemic, it has a distinct natural history. In the United States, the country most severely affected, it arose through a confluence of well-intentioned efforts to improve pain management by doctors and aggressive — even fraudulent — marketing by pharmaceutical manufacturers.

Managing pain is obviously desirable. Marketing drugs, not so much.

Prescriptions for opioids increased gradually throughout the 1980s and early 1990s. But it wasn’t until the mid-1990s, when pharmaceutical companies introduced new opioid-based products — and, in particular, OxyContin, a sustained-release formulation of a decades-old medication called oxycodone, manufactured by Purdue Pharma in Stamford, Connecticut — that such prescriptions surged and the use of opioids to treat chronic pain became widespread.

Purdue Pharma and other companies promoted their opioid products heavily. They lobbied lawmakers, sponsored continuing medical-education courses, funded professional and patient organizations and sent representatives to visit individual doctors. During all of these activities, they emphasized the safety, efficacy and low potential for addiction of prescription opioids.

And they did all this not as disinterested medical experts but as people flogging a product for profit.

In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. And the claim that OxyContin was less addictive than other opioid painkillers was untrue — Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a US$635 million fine for the company. But doctors and patients were unaware of that at the time.

Painkillers are not the only drugs that get marketed heavily.

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