(USA Today)--The makers of prescription painkillers have adopted a 50-state strategy that includes hundreds of lobbyists and millions of dollars in campaign contributions to help kill or weaken measures aimed at stemming the tide of prescription opioids, the drugs at the heart of a crisis that has cost 165,000 American lives and pushed countless more to crippling addiction.
The drug makers vow they’re combatting the addiction epidemic, but the Associated Press and the Center for Public Integrity found that they often employ a statehouse playbook of delay and defend that includes funding advocacy groups that use the veneer of independence to fight limits on drugs such as OxyContin, Vicodin and fentanyl.
Between 2006 and 2015, drug makers spent more than $880 million nationwide on lobbying and campaign contributions — more than 200 times what those advocating for stricter policies spent. For comparison, it’s also more than eight times what the formidable gun lobby recorded for advancing its agenda through similar activities during that same period.
Those figures include a number of other legislative interests beyond opioids. The pharmaceutical companies and allied groups are a steady presence in state capitals, poised to jump in quickly on any debate that affects them.
Collectively, the AP and the Center for Public Integrity found, the drugmakers and allied advocacy groups employed an annual average of 1,350 lobbyists in legislative hubs from 2006 through 2015, when opioids’ addictive nature came under increasing scrutiny.
“The opioid lobby has been doing everything it can to preserve the status quo of aggressive prescribing,” said Dr. Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and an outspoken advocate for opioid reform. “They are reaping enormous profits from aggressive prescribing.”
The industry and its allies have not been alone in fighting restrictions on opioids. Powerful doctors’ groups are part of the fight in several states, arguing that lawmakers should not tell them how to practice medicine.
While drug regulation is usually handled at the federal level — where the makers of painkillers also have pushed back against attempts to impose restrictions — ordinary citizens struggling with the opioid crisis in their neighborhoods have looked to their state capitals for solutions.
Hundreds of opioid-related bills have been introduced at the state level just in the last several years. The few groups pleading for tighter prescription restrictions are mostly fledgling mom-and-pop organizations formed by families of young people killed by opioids. Together, they spent about $4 million nationwide at the state and federal level on political contributions and lobbying from 2006 through 2015 and employed an average of eight state lobbyists each year.
Boom in sales, deaths
Prescription opioids are the synthetic cousins of heroin and morphine, prescribed to relieve pain. Sales of the drugs have boomed — quadrupling from 1999 to 2010 — and overdose deaths rose just as fast, totaling 165,000 this millennium. Last year, 227 million opioid prescriptions were doled out in the U.S., enough to hand a bottle of pills to nine out of every 10 American adults.
The drugmakers’ revenues are robust, too: Purdue Pharma, the maker of OxyContin and one of the largest opioid producers by sales, pulled in an estimated $2.4 billion from opioids last year alone, according to estimates from health care information company IMS Health.
Opioids can be dangerous even for people who follow doctors’ orders, though they also help millions of people manage pain associated with cancer, injuries, surgeries and end-of-life care.
The industry group Pharmaceutical Research and Manufacturers of America issued a statement saying, “We and our members stand with patients, providers, law enforcement, policymakers and others in calling for and supporting national policies and action to address opioid abuse.”
One of the chief solutions the drug makers actively promote now are new formulations that make their products harder to crush or dissolve, thwarting abusers who want to snort or inject painkillers. But the new versions also extend the life of their profits with fresh patents, and some experts question their overall effectiveness.
A sizable slice of the drug makers’ battles are carried out by pharma-funded advocates spreading opioid-friendly narratives — with their links to drug companies going unmentioned — or by persuading pharma-friendly lawmakers to introduce legislation drafted by the industry.
Many patients vouch that opioids have given them a better quality of life.
“There’s such a hysteria going on” about those who have died from overdoses, said Barby Ingle, president of the International Pain Foundation, which receives pharmaceutical company funding. “There are millions who are living a better life who are on the medications long term.”
That’s contrary to what researchers are increasingly saying, however. Studies have shown weak or no evidence that opioids are effective ways to treat routine chronic pain. And one 2015 study from a hospital system in Pennsylvania found about 40% of chronic non-cancer pain patients receiving opioids had some signs of addiction and 4% had serious problems.
“You can create an awful lot of harm with seven days of opioid therapy,” said Dr. David Juurlink, a toxicology expert at the University of Toronto. “You can send people down the pathway to addiction when they never would have been sent there otherwise.”
A surprising opponent
Letting advocacy groups do the talking can be an especially effective tactic in state legislatures, where many lawmakers serve only part time and juggle complicated issues.
“A lot of times, those legislators, they don’t have the ability to really thoroughly look into who these organizations are and who’s funding them,” said Edward Walker of the University of California Los Angeles, who studies grassroots groups.
Nonprofit advocacy groups led the counter charge in Tennessee in 2014 when Republican state Rep. Ryan Williams began work to stanch the flow of prescription painkillers, alarmed by a rapidly rising number of drug-addicted babies who suffer from withdrawal in their first weeks of life and complications long after they leave the hospital.
More than 900 babies had been born addicted in Tennessee the year before, many of them hooked on the prescription opioids their mothers had taken. That number had climbed steadily since 2001, when there were fewer than 100.
Whitney Moore and her husband adopted two girls born addicted to prescription opioids and other drugs in eastern Tennessee, and she still remembers her older daughter’s cries in the hospital, “the most high-pitched scream you’ve ever heard in your life” — a common symptom in babies in the throes of withdrawal.
Doctors gave Moore’s infant daughter morphine to ease her seizures, vomiting and diarrhea, and she stayed in a neonatal intensive care unit more than a month. Now 3 years old, she still suffers from gastrointestinal problems and remains sensitive to loud noises.
When Williams was mulling potential legislation, doctors told him that part of Tennessee’s problem was a 2001 law — similar to measures on the books in more than a dozen states — that made it difficult to discipline doctors for dispensing opioids and allowed clinicians to refuse to prescribe powerful narcotics only if they steered patients to an opioid-friendly doctor.
The result, according to the experts Williams worked with, was a rash of prescribing, even for pregnant women. In 2014, Tennessee ranked third in the country for per-capita opioid prescriptions, with roughly 1.3 prescriptions doled out for every person in the state, according to an analysis of prescription data from IMS Health.
Williams’ mission to repeal the law failed that year, and he was shocked by the group that came out in opposition — the American Cancer Society Cancer Action Network, the advocacy arm of one of the country’s biggest and best-known charities.
Two Cancer Society lobbyists worked against the bill, even though prescribing painkillers for cancer patients is a widely accepted medical practice that would have remained legal.
The Cancer Action Network listed four major opioid makers that provided funding of at least $100,000 in 2015, in addition to five that contributed at least $25,000. Companies that donate such sums get one-on-one meetings with the group’s leaders and other chances to discuss policy.
The network said only 6% of its funding last year came from drug makers and that its ties to drug companies do not influence the positions it takes. The network said it advocates for certain measures despite exemptions for cancer because some patients continue to experience pain even after their cancer is gone.
It teamed up with another group to defend the Tennessee painkiller law — the Academy of Integrative Pain Management, an association of doctors, chiropractors, acupuncturists and others who treat pain. Seven of the academy’s nine corporate council members listed online are opioid makers. The other two are Astrazeneca, which has invested heavily in a drug to treat opioid-induced constipation, and Medtronic, which makes implantable devices that deliver pain medicine.
Both the academy and the cancer group have been active across the country, making the case that lawmakers should balance efforts to address the opioid crisis with the needs of chronic pain patients.
Purdue, which gives to both the academy and the cancer network, said it contributes to a range of advocacy groups, including some with differing views on opioid policy.
As for Williams, he tried again last year to repeal Tennessee’s intractable pain law — and won unanimous approval in both houses. The extra year had given Williams and his co-sponsor time to help educate their fellow lawmakers, he said, even though the Cancer Society still opposed the repeal.