Topics:

Fighting the Wrong War on Drugs

Fighting the Wrong War on Drugs

Since Richard Nixon was president, we have been fighting a drug war we can’t possibly win. Meanwhile, we have barely begun to fight a different drug war we couldn’t possibly lose.

The losing battle is against illegal drugs. Interdiction has been as big a bust as Prohibition of alcohol in the 1930s. Occasionally arresting a drug kingpin or confiscating a few million of dollars worth of contraband heroin or cocaine makes for a nice headline, but this doesn’t stop the flow.

The beneficiaries of our war on drugs have been the cartels and the narco-terrorists; the casualties are the failing states they can buy or bully. The Mexican government is fighting what amounts to an undeclared civil war against cartels armed to the teeth and flowing with money—both from north of the border. We have unwittingly created a terrific business model for the drug dealers and a disaster for the states where they deal.

That other drug war, which we couldn’t possibly lose, is against the excessive use of legal drugs that is promoted by our own pharmaceutical companies. Astounding fact: prescription drugs are now responsible for more accidental overdoses and deaths than street drugs.

Polypharmacy is rampant and uncontrolled with military personnel, the elderly, and children particularly vulnerable to its risks. Michael Jackson is just the most high–profile poster victim of this growing epidemic of legal drug abuse. The drug cocktails are sometimes prescribed by dangerous high-flying doctors, sometimes by multiple doctors who just aren’t aware of the other’s existence, and prescription drugs are also widely available for purchase on the street.

There is no one cause of this mess, and there won’t be one cure. Doctors, drug companies, patients, politicians, and our fragmented health care system are all to blame. But the elephant in the room is Big Pharma. It has hijacked the practice of medicine, using its enormous profits to unduly influence physicians, physician groups, academics, consumer advocacy groups, the Internet, the press, and the government. Misleading “disease mongering” promotional programs saturate the media with direct-to-consumer drug advertising that is illegal everywhere else in the world except New Zealand and the developing nations.

The result: a ridiculously high proportion of people have come to rely on antidepressants, antipsychotics, antianxiety agents, sleeping pills, and pain meds. Psychiatric meds are among the very top best sellers for the drug companies—over $16 billion for antipsychotics; almost $12 billion for antidepressants, and more than $7 billion for ADHD drugs. One in 5 Americans takes a psychiatric drug, 1 in 5 women is on an antidepressant.

Seventy percent of these pills are prescribed by primary care doctors with little training in their proper use, under intense pressure from drug salespeople and misled patients, after rushed 7-minute appointments and subject to no systematic auditing.

The free market in drug salesmanship has led to promiscuous drug use, needless side effects, and wasted resources—a kind of societal overdose. The government has unwittingly aided and abetted Pharma. The cash-strapped FDA is beholden to industry for funding.

And it gets worse. Big Pharma all too often also goes illegal to push even more product. The multi-billion dollar criminal and civil penalties recently levied on several different drug companies provide clear evidence of the pervasive extent of drug company wrongdoing—but have not been big enough to deter it. A billion dollars must seem like chump change—just the cost of doing business.

Pretty bleak. But if we ever had the political will to begin it, we couldn’t possibly lose a war to tame the dangerous use of legal drugs. The solutions are crystal clear and a cinch to implement—if we were really determined to solve the problem:

(1) Sharply restrict drug company marketing and lobbying. Pharma now spends almost twice as much money pushing drug sales as on research—we would have better medicines and less legal drug abuse if this were reversed.

(2) Make the punishments for marketing malfeasance much more of a deterrent to underhanded drug pushing. This could be done by levying much bigger megafines on the companies and also by holding the executives personally responsible and perhaps by reducing the period of product patent protection.

(3) Develop a computerized real-time national system to identify and prevent polypharmacy. Credit card companies can abort a suspicious $100 transaction before the fact. Why can’t we apply the same technology preemptively to prevent a patient from collecting potentially lethal pills?

(4) Closely monitor the prescribing habits of doctors to correct or eject the “Dr Feelgoods.”

(5) It would greatly improve the quality of our health care system and greatly reduce its costs if all doctors, professional associations, consumer groups, and politicians were prevented from accepting drug company funding. Do drug companies really need this much “free speech”? It makes no sense to have the FDA funded by drug companies.

What are the political prospects of my twin proposals—to begin the winable war against the overuse of legal drugs and to drop the losing war against illegal drugs?

You guessed it—zero and zero. The first will be doomed by Pharma’s political punch; the latter by the irrational victory of hope and ideology over experience.

I agree the televisions ads should stop. I do not agree that sales reps have restricted access to prescriptive providers as they provide much need information. Millions of prescriptions each year are written by PA's and NP's and they should be included in the conversation. A national database for prescriptions will be imperative in the coming years in order to stop the doctor shopping.

Melenie Meyers (not verified) @

According to NIMH, 25% of the adult population can benefit from some form of medical treatment for mental unhealth. With all do respect, several leaps were made which are not in logical progression.

1. I have not seen a drug of abuse, nor a controlled substance other then Lyrica advertised on television. Most of the medications which kill are opiod based and many are generic; they need nor have a rep.
2. The brain is an organ. In those affected, psychiatric problems are often chronic though not debilitating thus need recurrent Meds. Being dependant is not the same as addiction.
3. The number of people who gain remission of symptoms with one medication is 30%; what's left over is insomnia, daytime fatigue and pain out of proportion to tissue damage; poly pharmacy is required to get 70% symptom improvement.
4. The inference of legalizing heroin and cocaine is ridiculous; it wreaks havoc and is use often results from self
medication.

The medications associated with overdose are mostly narcotics and I have rarely seen a rep for those medications. Tying this in to add campaigns is a leap. Perhaps commercials have helped destigmitize depression. I have not seen data on impact.

If 1 in 5 women are on an antidepressant and there is a 25% prevelence of psychiatric issues, why is this not surprising? Suboxone is a game changer, it had to be developed.

I will agree about treating pain with primary opiods and avoiding that pathway in chronic pain until other Meds are tried; use as a top off for pain in long acting form is preferable.

We see a similar problem but it seems you infer medications for mental health into the slurry of poly pharmacy which is killing people. It is opiods, including heroin and cocaine which wreak the most havoc and these are not promoted. Certainly illegal drugs are a huge problem but the solution on making an attempt to catch cargo would simply allow more activity.

We have differing views and conclusions about opiod dependency and addiction. Less mental health treatment, however, will not affect overall use.

Most reps I see go through great pains to stay on course and not go off label;

Chevies Newman (not verified) @

Though I basically agree with this well written editorial (especially concerning the inappropriate use of antidepressants and anxiolytics by GP's and OB/GYN's), I have to differ on the 'Big Pharma's' influence on physicians. If a physician is swayed by a sales pitch to prescribe a drug, it's his incompetency, not the drug company......which is a private business....

Mark Pichler (not verified) @

Let me add another suggestion. Eliminate Powerpoint at CME and all medical education. It is a tool of propaganda, not of education. You won't get an aggressive Powerpoint lecture on MAOIs like you do with the newest SSRI because no one has a financial interest in making one. Bring back Socratic CME education in psychopharmacology.

Powerpoint caused a lot of problems at the Pentagon (including the open and shut case for the Iraq War) and was banned. If the Dept. of Defense can do it why not us?

Frankly, I don't get the TV ads from a PR perspective. Why would the average person want to even bother after they tell you the one benefit followed by twenty side effects?

James OBrien (not verified) @
Click here to close