Farhan Khokhar and Fazal Masood Malik, Canada
Human tendency to seek simple explanations for complex issues often falls short, particularly when faced with wider societal crises. Simple explanations fail to capture the complex web of historical, economic, and political factors that shape public health catastrophes. The opioid crisis serves as a stark illustration of this complexity, revealing how greed, misguided policies, and historical parallels have coalesced into a devastating epidemic.
The opioid crisis has become a public health calamity, claiming countless lives and shattering communities across the world. In the United States alone, opioids have been responsible for over 500,000 deaths since the late 1990s, with an additional 109,000 deaths worldwide annually, underscoring the devastating human toll of this epidemic. While pharmaceutical giants and drug traffickers have undoubtedly played a pivotal role in fueling this epidemic, misguided policies have also intensified the problem. At the core of this crisis lies greed, an age-old human affliction. (“What led to the Opioid crisis—and how to fix it”, www.hsph.harvard.edu/news/features)
The parallels between the current opioid epidemic and the Opium Wars of the 19th century are striking. In the early 1800s, Britain went to war with China to force open markets for the opium trade, despite the devastating impact on Chinese society. The roots of this conflict lay in Britain’s insatiable desire for Chinese tea and silk, which created a significant trade deficit. To redress the imbalance, Britain turned to opium cultivation in its Indian colonies and pushed the narcotic into Chinese markets. When China tried to stem the influx of opium that was ravaging its population, Britain launched the First Opium War in 1839, eventually compelling China to cede territory and open ports to the opium trade. Just as Britain disregarded the human toll to secure economic interests, modern pharmaceutical companies like Purdue Pharma have aggressively pushed highly addictive opioids, prioritising profits over public well-being. (“A New Trade War with an Opium Component: Can the U.S. Opioids Crisis Be Solved by Banning Fentanyl in China?”, www.ncbi.nlm.nih.gov)
Purdue Pharma, owned by the billionaire Sackler family, launched an aggressive marketing campaign for OxyContin in the 1990s, downplaying addiction risks and lobbying against restrictions. As OxyContin sales soared, reaching $1 billion by 2000, the Sacklers amassed immense wealth. However, this success came at a devastating human cost, as opioid addiction and overdoses skyrocketed. Purdue Pharma had earlier made its fortune with the production of Valium, an insanely common drug.
While Purdue Pharma has become the face of the opioid pandemic, other pharmaceutical companies have also played significant roles in fueling this crisis. Companies like Johnson & Johnson, Teva Pharmaceuticals, and Endo International have faced lawsuits and scrutiny for their part in the widespread distribution and promotion of opioids. This highlights that Purdue’s actions are part of a broader pattern of corporate malfeasance within the pharmaceutical industry.
When the dangers of overprescription became undeniable, Purdue reformulated OxyContin to make it harder to abuse. Unfortunately, this drove many users to even more dangerous substances like heroin and fentanyl. What is shocking is that despite knowledge of excessive addiction, Purdue continued selling the original formulation in Canada, revealing a brazen disregard for public health in favour of corporate profits. (“Empire of Pain: The billionaire Sackler family’s role in the opioid crisis”, www.macleans.ca)
Misguided policies have further compounded the crisis. Efforts to restrict opioid prescribing without providing adequate addiction treatment have backfired, pushing users toward illicit and often more potent opioids. Simplistic supply reduction strategies have proved futile—cutting off prescription opioids nearly tripled the risk of overdose death among chronic pain patients. While the Sackler family and Purdue now face lawsuits and public condemnation, the damage has already been done.
The legal battles surrounding Purdue Pharma and the Sackler family have taken a dramatic turn. In a recent development (June 2024), the U.S. Supreme Court has overturned a proposed settlement between Purdue Pharma and various stakeholders impacted by the opioid crisis. This $8 billion settlement included provisions to shield the Sackler family from future opioid-related lawsuits. The Court’s 5-4 ruling, with Justice Neil Gorsuch writing the majority opinion, argued that the Sacklers lacked the legal grounds for such protections as they had not filed for bankruptcy themselves nor placed all their assets for creditor distribution. (www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf)
This decision comes after years of legal manoeuvring. Before Purdue Pharma’s 2019 bankruptcy filing, the Sackler family had moved about $11 billion in profits into personal accounts. The proposed settlement included a $6 billion payment from the Sacklers in exchange for immunity from future lawsuits. However, the Supreme Court found that granting such immunity to non-bankrupt individuals was beyond the scope of the bankruptcy code. (“US opioid activists argue against Sackler family immunity in Purdue Pharma deal”, www.theguardian.com)
The ruling has elicited mixed reactions. Relatives of overdose victims and some advocacy groups have praised the decision, seeing it as a step toward holding the Sacklers personally accountable. Conversely, others, including Justice Brett Kavanaugh in his dissenting opinion, have called the decision “devastating” for victims and their families, who might now face prolonged delays in receiving settlement funds. Purdue Pharma has indicated its intent to negotiate a new settlement, while advocacy groups are urging swift negotiations to ensure victims receive necessary funds for addiction treatment and other related services.
This legal setback highlights the complexity of addressing the opioid crisis through judicial means. It highlights the tension between seeking accountability and providing timely relief to affected communities. The ruling emphasises the need for a revised agreement that aligns with legal precedents while effectively addressing the needs of opioid victims and affected communities. (“Families of those lost in opioid crisis ‘devastated’ by Supreme Court’s decision to reject Purdue settlement”, www.nbcnews.com)
We must hold the perpetrators accountable and learn from historical patterns to emerge from this crisis. As experts suggest, only evidence-based policies that acknowledge the structural determinants of health will effectively address this crisis. These include harm-reduction strategies, which aim to minimise the negative consequences of drug use without necessarily reducing consumption, and demand-reduction policies, which focus on preventing drug use and treating addiction.
Circling back to the core of the argument, it would be correct to note that the opioid epidemic is an issue involving overprescription, insufficient regulation, addiction, socioeconomic factors, and the rise of potent synthetics. Greed, from the 1800s to today, has been a driving force behind the reckless push of addictive substances. To solve this crisis, we must reorient our priorities from profits to public well-being, guided by ethics. Only then can we hope to heal the deep wounds inflicted by the opioid scourge.