If there is one thing in the US upon which there is virtually universal agreement, it is that we are in the midst of an opioid epidemic. However, whom or what is to blame for this is not as clear and should be the subject of greater discussion. So far, most of the blame has been placed at the doorstep of illicit drug dealers and the pharmaceutical companies that manufacturer opioids. There is no doubt that both have contributed to it, but their share of the responsibility for the epidemic is overstated.
Drug dealers are obviously the source of illegal drugs such as heroin and various forms of fentanyl not available by prescription in the US. However, data from SAMHSA indicate that when it comes to prescription opioids, drug dealers play a limited role in the supply chain. Fewer than 10% are purchased from drug dealers or other strangers. Approximately 50% of non-medical users of prescription opioids get them from friends or relatives; 25% get them by prescription from physicians. Despite the often-cited problem of patients obtaining prescriptions from multiple prescribers, most receive the prescriptions from one doctor.1
Several state and local governments have instituted lawsuits against some of the pharmaceutical companies. The lawsuits claim that the companies purposely misled physicians about the addiction potential of their products; the Federal government is currently deciding whether to join these suits. The main target of these suits is Purdue Pharma, the manufacturer of the now infamous OxyContin, although other companies have also been included.
There is no doubt drug companies have aggressively marketed products that contributed to the epidemic. Although the tobacco companies’ accepting the responsibility for the health consequences of their products and the consequent settlements have been cited as a model for what should be required of opioid manufacturers, there is a marked difference between the two. Tobacco companies sold their products directly to consumers whereas patients legally obtain opioids from physicians and dentists who write the prescriptions.
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