Lawyers and protesters

The record $ 8 billion payout will not turn back the U.S. opioid crisis

By Clare Wilson

In August 2019, lawyers walked past protesters against Purdue Pharma

Charles Krupa / AP / Shutterstock

A longstanding lawsuit against a drug company accused of fueling the U.S. opioid addiction crisis was settled this week when Purdue Pharma agreed to disbursement of $ 8.3 billion, the largest such settlement ever. The company admitted violating anti-kickback laws, conspiring to defraud the US, and facilitate the dispensing of drugs for no legitimate medical purpose.

While the size of the payout sounds like a huge win, it won't reverse the U.S. opioid addiction problems, nor will it be a sufficient deterrent to similar behavior by drug companies in the future, critics say. No individual in the company or any of the Sackler family owners were convicted as part of the settlement, but individuals are under criminal investigation.

"Criminal charges against companies don't work. Companies view them as a business expense," said Andrew Kolodny of Brandeis University in Massachusetts.


Doctors used to be very cautious about giving opioids, the most effective class of pain relievers, and reserving them for severe, short-lived pain such as surgery or for people with terminal cancer.

In the 1990s, U.S. doctors began prescribing them more generously, in part due to Purdue's commercialization of a new opioid, OxyContin, which the company claimed rarely caused addictions. The company heavily promoted the product to some doctors with free rides and paid lectures.

But OxyContin can be addictive, and some users have looked for ever higher doses. Over time, some people switched to using illegally purchased pills or injecting heroin.

Opioid overdose deaths rose from about 9,000 per year in 2000 to 47,000 per year in 2017, although such deaths may now plateau. The staggering number of fatal drug overdoses may even have reduced life expectancy in the United States.

Purdue has been persecuted in court by families of people who have died from overdoses, as well as state and national agencies trying to recoup the public health costs of the epidemic, such as funding addiction treatment and overdose response teams.

But that last record breaking deal may never get paid for in full as Purdue filed for bankruptcy last year. The U.S. Centers for Disease Control and Prevention has estimated that opioid abuse costs the country nearly $ 80 billion each year. "That $ 8.3 billion can't really solve the problem," says Joseph D & # 39; Orazio of Temple University in Pennsylvania.

Opioid prescriptions in the US have declined since around 2012 when their addictive potential was recognized, although they have not yet returned to the lower levels of the 1990s. The coronavirus pandemic may make things worse, as in many areas the rules for doctors to see patients face-to-face before prescribing opioids have been relaxed as social distancing is required.

While restricting prescriptions may reduce the number of new people who become dependent, some rely on prescription opioids to relieve their chronic pain.

"We have millions of patients who have been given opioids for conditions we would never use them today, such as back pain and headaches," says Kolodny. "Many of these patients may never walk now."

There are also people who have switched to illegal opioids. "We now usually see people who die of fentanyl overdoses in their forties and fifties and didn't start until late teens (on prescription opioids) in their late teens and twenties," says D & # 39; Orazio. "I would hope that if we continue to reduce opioid prescriptions, fewer people will die of overdose, but there will be a significant delay."

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