The opioid epidemic in America began in the late 1990s. Pharmaceutical companies convinced the medical community that the risk of developing an addiction to opioid pain relievers is minimal and healthcare providers started to prescribe them at higher rates. It has evolved into a massive threat to our society, taking over 70,000 lives in the U.S. last year. 

The government started cracking down on doctors and pharmacists who were over-prescribing opioid painkillers, including medical prescription falsification. Cities, counties and states started to bring federal lawsuits against producers of the prescription painkillers, wholesale distribution companies, and pharmacy chains that sell them. 

In their turn, inpatient drug rehab centers also work to reverse this epidemic. They offer treatment designed specifically for people with opioid addiction. According to AddictionResource, inpatient drug treatment includes counseling, therapy, and medical care. 

Opioid addiction is a chronic disease that can cause not only health but social and economic problems. This condition often requires long-term treatment and care. The goals are reducing dependence on illicit drugs, and decreasing its health and social consequences, which includes improvements in the well-being and social functioning of people affected. 

Though the government and inpatient rehab facilities take efforts to reduce the rates of opioid abuse and mortality, statistics remain sad. Approximately 21%-29% of patients prescribed opioids for chronic pain misuse them. From 8 to 12% develop an opioid use disorder. Between 4 to 6% of those who misuse prescription opioids switch to heroin. Every day, about 150 people in the U.S. die because of an opioid overdose. 

Can one imagine that this situation and these data can be the subject of jokes?  

Correspondence of drug companies' employees shows a real attitude to the opioid epidemic

In July 2019, attorneys for Summit and Cuyahoga counties sued companies that make, distribute and sell prescription opioids. The lawsuit reported "hundreds of millions" suspicious deliveries of prescription painkillers to these Ohio counties over two decades.  

Companies apparently knew about huge volumes of drug orders and the pernicious consequences they were causing. To prove that, the court filing cited private emails between two opioid distributors - Victor Borelli, a representative of Mallinckrodt Pharmaceuticals, a major player in opioid manufacturing in the country, and Steve Cochrane, a representative of KeySource Medical, a wholesale drug distributor based in Ohio.

In May 2008, Borelli wrote Cochrane to check his opioid stock and "[i]f you are low, order more.  If you are okay, order a little more, Capesce?"  

In January 2009, Borelli informed Cochrane about another big delivery of oxycodone pills. "Keep 'em comin'!" Cochrane replied. "Flyin' out of there.  It's like people are addicted to these things or something. Oh, wait, people are..."

Borelli made a sarcastic comparison, "Just like Doritos keep eating. We'll make more."  He also described his position responsibilities as "ship, ship, ship."

Journalists reached out to the authors of those emails and Mallinckrodt Pharmaceuticals for comment, to no avail. A spokesperson for Mallinckrodt tried to defend the reputation of the company. He called the emails "outrageously callous" and "antithetical" to Mallinckrodt's values. He added that the company had not employed Borelli for many years.

Mallinckrodt agreed to pay $24 million to Summit and Cuyahoga Counties and donate $6 million in pharmaceuticals, including addiction treatment drugs that are used in every inpatient drug rehab in these Ohio counties. This will help them avoid the federal trial.

The suspicious order system has to be improved

The Controlled Substances Act (CSA) characterizes "suspicious orders" as those having "unusual size", greatly exceed "a normal pattern", and are delivered with "unusual frequency". Drug companies have to report such orders to America's Drug Enforcement Administration (DEA) and not ship them until they can make sure the products are unlikely to get into the black market. 

In May 2019, Attorney Generals from 44 states filed a lawsuit accusing America's leading drug manufacturers of conspiring to artificially rise prices of more than 100 common medications by up to 1,000%. 

It's interesting that more than 400 defendants in the case failed to elaborate an effective "Suspicious Order Monitoring". The evidence includes text messages, telephone records, and testimony from former company insiders.

In January 2008, then-CEO of Cardinal Health, Kerry Clark wrote in an email to senior officials that their "results-oriented culture" led to "ill-advised or shortsighted decisions".

In January 2011, Kristine Atwell who managed the delivery of controlled substances for Walgreens' warehouse in Jupiter, Florida, expressed her concerns on the unjustified quantity of orders in an email she sent to corporate headquarters. Describing the quantity of orders to one store, she wrote: "I don't know how they can even house this many bottle[s] to be honest." 

The companies were well aware of the CSA's requirements. The DEA states that they have provided frequent guidance to the pharmaceutical industry, and regularly explained what makes a suspicious order. The correspondence between the representatives of the companies mentioned in the lawsuit demonstrates awareness. However, the companies didn't report suspicious orders to the DEA and kept shipping those that were or should have been flagged as suspicious. 

Drug companies justify themselves with different arguments. They blame the DEA for setting yearly production quota of pills. They emphasize on their investment in anti-diversion programs. They even blame physicians for overprescribing and dishonest doctors and pharmacists from "pill mills" on the opioid crisis. Finally, they say that only people who abuse drugs should hold responsibility for their actions.

Indeed, long-term use of prescription opioids, even if the dosage calculated by a doctor is followed, can cause a person to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to reach the same effects. Weak monitoring has enabled manufacturers, distributors, doctors, and patients to flood the market with prescription opioids. Addicted people should be enrolled in some inpatient rehab centers as opioid addiction is one of the most challenging addictions to overcome.