Last week, in an overwhelming and bipartisan decision, the House approved spending $9 million to help the state cope with what has become the catastrophic abuse of opioid drugs. The extra money will help. In 2014 the U.S. Department of Health and Human Services found that New Hampshire did less than all but one other state to provide substance abuse treatment to all who need it.
In our state, many do need treatment.
Between 2013 and 2014 New Hampshire had the highest rate of increase in opioid overdose deaths of any state at 73.5 percent. It is one of three states with the biggest opioid abuse problem.
According to a host of news studies that include most recently, this month’s release of a long analysis of the internal documents of Purdue Pharma, one drug more than any other, Purdue’s oxycontin, is responsible for the opioid crisis. Oxycontin started life as a cancer drug but, with Purdue’s help, became the go-to drug for serious pain of all sorts.
The drug made Purdue’s owners, the family of three founding Sackler brothers, one of the wealthiest in America. Their success was based in good measure on their pioneering effort to form close relationships with the doctors who would dispense their drug and an aggressive advertising campaign.
In 2007, 27 states and the District of Columbia sued Purdue Pharma, claiming that its campaign, which asserted that oxycontin provided pain relief for 12 hours and thus was safer and less addictive than rival opioid pain relievers, was false. The states prevailed. Three Purdue executives were found guilty of false advertising and the company settled for a whopping $600 million. New Hampshire, for reasons that could not be determined on deadline, was, under then-Attorney General Kelly Ayotte, the only New England state not to participate in the suit.
The fact is – a fact disputed by Purdue – oxycontin does not provide 12-hour relief from serious pain for many sufferers. Some physicians began prescribing it every 8 hours, which brought relief but increase the drug’s addiction risk. Purdue fought to discourage the practice and said instead that the 12-hour schedule should be maintained but the dosage increased. With approval from the Federal Food and Drug Administration oxycontin’s dosages were increased to include first 80 milligram pills and then a 160mg version. Those also increased the addiction risk. Oxycontin, when injected, chewed, or crushed and snorted by abusers, can be deadly. Though other drugs bear a higher risk of overdose, oxycontin, because it has become so common, is responsible for more deaths than any other prescription opioid.
Purdue has taken steps to make its pills harder to crush and to become an uninjectable gel when dissolved but users haven’t been defeated. States, including New Hampshire, have established prescription registries to identify patients who get drugs from more than one source and doctors who are casual in dispensing drugs. But still the death toll mounts.
Because virtually everything Purdue did to increase oxycontin dosages and promote its use had FDA approval despite refutations of the 12-hour relief claim, that gave it a marketing advantage over its rivals. That raises the question of whether the FDA has become a captive agency, too heavily influenced by those it regulates to do so effectively. That’s a matter for Congress.
If the contentions made by the Los Angeles Times in its lengthy story are accurate, it’s also time for the states, including New Hampshire, to band together to determine whether it’s legal and appropriate to look to Purdue to cover some of the enormous price of the damage that its drug, when it turns pain suffers into addicts, costs society.