Las Vegas Sun

October 16, 2019

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U.S. exporting its opioid crisis

An American-made phenomenon is on the cusp of gripping the world, but this one is nothing to be proud of.

It’s the prescription opioid crisis, and the Brookings Institution’s Vanda Felbab-Brown says in a new essay that it’s begun spreading well beyond North America. As a result, she says, the world is facing “a public health disaster of epic proportions.”

Felbab-Brown, who visited UNLV this past week, teamed with drug policy experts Keith Humphreys of Stanford University and Jonathan P. Caulkins of Heinz College at Carnegie Mellon University to produce a sweeping examination of the growing crisis.

As outlined in a 4,000-word story for Foreign Affairs Magazine, Felbab-Brown and her fellow researchers describe how American pharmaceutical companies have begun to turn to international markets as a response to increased governmental regulations on prescription painkillers in the U.S. and Canada.

The authors say the companies are using many of the same tactics that fueled the epidemic in the U.S. — hiring huge teams to promote and lobby for their products, and understating the addiction risks posed by opioid medications (including by holding seminars urging doctors to overcome their “opiophobia.”)

“It’s the same thing that happened with tobacco,” Felbab-Brown said in an interview with the Sun at UNLV. “When Big Tobacco in the U.S. started having restrictions and taxes and was facing lawsuits, etc., its big push became to expand markets abroad. Big Pharma is acting in identical ways.”

That’s reprehensible, because the implications of a global opioid epidemic are staggering. In the U.S., overdoses killed 50,000 people in 2016 alone. From 2000 to 2016, the number of Americans who died from opioid abuse exceeded the nation’s death toll from World War I and World War II combined.

“There was a statistic that came out recently that one in every eight Americans know someone or have a relative who has either suffered a fatal overdose or a nonfatal overdose,” Felbab-Brown said. “And of course the people who overdose and die is a small fraction of the people who are addicted or who abuse the drug. So the numbers are just extraordinary.”

In their article, Felbab-Brown and her collaborators sound an alarm to foreign governments about the spread of opioids and urge them not to emulate the U.S. government’s response to the crisis, which they describe as complacent.

“Governments and international organizations urgently need to learn the lessons of the North American crisis,” they write. “The first and most important of those is that the more opioids flood the market, the bigger the problem will be — and so governments must couple efforts to treat addicted individuals with efforts to curb supply. That will require them to crack down on pharmaceutical companies that abuse their positions and to take aggressive steps to regulate the sale and marketing of opioids.”

Their specific recommendations to foreign governments include:

•  A new approach to fining companies that break the law. One-off penalties like the $600 million fine imposed on Purdue Pharma in the U.S. for deceiving doctors and patients about the addiction risks of OxyContin are inadequate considering that the company earned an estimated $35 billion in sales of the drug, Felbab-Brown said. If fines were made contingent on outcomes — say, $1 million for every patient proven to have overdosed on a painkiller — there would be more disincentive for companies to break the law.

•  Banning for-profit companies from selling opioids for home use, and instead putting those sales in the hands of government organizations or nonprofits.

•  Barring advertising of opioids.

•  Beefing up organizations that investigate and prosecute corporate crimes and oversee licensure of health care providers.

Although the researchers’ recommendations are mostly aimed at foreign governments, they also involve curtailing the pharmaceutical companies’ predatory practices at home. For instance, the article calls for a repeal of legislation passed by Congress in 2016 to curtail the Drug Enforcement Agency’s ability to investigate corporate malfeasances.

Felbab-Brown, an organized crime and international security expert who has done extensive study of drug cartels, said her interest in the opioid epidemic sprang from her research into the illicit drug trade. She said she was motivated to report on the spread of opioids partly because the Trump administration’s drug policy has largely focused on traffickers of illegal narcotics “and very much underplays, if not altogether ignores” Big Pharma.

The article from Felbab-Brown, Humphreys and Caulkins appears in the May/June issue of Foreign Affairs and can be found at

It should be required reading for federal lawmakers and regulators overseeing American pharmaceutical companies, as well as leaders of foreign governments. After seeing the damage caused by the opioid epidemic in the U.S., it would be unforgivable for the world’s leaders not to try to contain the problem.