CVS, Walmart and Walgreens corporations have agreed to pay $13.1 billion to settle numerous Federal and State lawsuits accusing them of furthering the opioid epidemic by failing to appropriately monitor opioid prescribing practices. These drug distributors will easily absorb this loss, especially since these settlements will be paid over the course of several years. It is unlikely their practices will change substantially since they acknowledged no wrongdoing. These corporations and others sued in recent years argued that they were filling valid prescriptions from authorized physicians or otherwise authorized entities. Several of the judges and juries hearing these lawsuits did not consider this a valid defense in light of the massive quantities of addicting drugs, such as Oxycodone, handed out by pharmacies controlled by these corporations. Obviously, the acquisition of addicting or otherwise dangerous drugs by dubious but largely legal channels is a relatively small part of America’s drug problem. Suing pharmacies may satisfy voters that somebody is doing something to stop the ever expanding impact of opioids and other abused drugs in America, but this legal maneuvering will change nothing of consequence.
In most states, physicians need to apply for and receive a license from the Drug Enforcement Agency to dispense what are classified as “controlled substances.” The drugs listed as controlled substances include derivatives or chemical relatives of morphine. These are referred to as opioids because of their historical or structural connections to opium. They are generally highly addicting. Excessive doses of opioids, such as morphine, heroin, and fentanyl, sedatives, such as barbiturates (downers) and propofol, and stimulants, such as cocaine, crack, and amphetamines (speed), are likely to be fatal.
Physicians and non-physicians have long been fascinated by opioids because of their pain-relieving properties, as well as a variety of other psychological effects attributed to them. The legendary Sigmund Freud wrote about the pharmacologic effects of cocaine and self-administered a variety of opioids as part of his “scientific investigations. Those cigars he chain-smoked led to cancer of his palate, and his familiarity with the potential lethality of opioids led him to use morphine to escape from the horrific pain that his cancer caused. He committed suicide by self-injecting 100 mg of morphine.
Most people taking opioids for reasons other than pain relief are not trying to kill themselves, but death by drug overdose has become a common occurrence in the United States. From May, 2020, to the end of April, 2021, more than 100,000 Americans died from drug overdoses. This exceeded deaths from motor vehicle accidents (about 50,000) and from firearms (about 47,000) during the same period. Unlike firearm deaths, more than half of which were apparent suicides, deaths from illicit drug use were rarely intentional.
The deaths and addictions attributed to controlled substances led President Richard Nixon to order a “War on Drugs” in 1971. This war involved more discussion than action until President Ronald Reagan stepped up drug interdiction and urged legislation that assigned mandatory minimum jail time for illicit drug possession or distribution. The number of individuals incarcerated for drug-related offenses ballooned with this initiative. Many of the individuals jailed were nonviolent offenders and a disproportionate number of the drug-related felony convictions involved African-American men. In retrospect it is apparent that illicit substances, such as crack cocaine, which were more inexpensively acquired and widely distributed in African-American communities, drew much more severe penalties than more expensive drugs, such as cocaine powder, that were widely used and distributed in more affluent and white communities. The minimum jail time for possession of five grams of crack cocaine was five-years. Individuals holding powder cocaine were subject to that much jail time only if they had more than 500 grams. The War on Drugs proved to be much more oppressive in poor and minority communities than it was in affluent suburbs and college campuses.
After 51 years of effort, any reasonable person would conclude that we lost the war on drugs. Addictions and overdose deaths continue to climb. The cost of this failed war has been prohibitive, not just in terms of the billions of dollars spent but also in terms of the collateral damage it has done to our country.
By trying to create barriers to the acquisition and distribution of opioids and a variety of other controlled substances, we have succeeded in making drug trafficking a fabulously lucrative activity. The profits from drug trafficking have helped finance criminal activities in innumerable countries, including Colombia, Mexico, Afghanistan, Pakistan, and India. The terror wrought by these criminal organizations in Latin America has led to massive waves of refugees seeking shelter in the United States. As Americans bemoan the influx of these people forced out of their homes by competing gangs and various other drug-money financed hoodlums, we continue to finance the terror by purchasing the fentanyl and heroin and cocaine sent to the United States by these criminal operations. Simply put, Latin America and more remote nations are not the cause of the opioid epidemic and the failure of the war on drugs: We are.
We cannot hope to stop this epidemic until we acknowledge the basis for this plague: our national thirst for opioids, stimulants, and other psychoactive agents. We cannot begin to heal the collateral damage being caused by this epidemic until we stop the flow of billions of dollars to criminal organizations happy to satisfy our demand for drugs. Jailing every American caught possessing or distributing illicit drugs will not limit the recruitment of more people to replace those incarcerated. The financial rewards of drug trafficking are too great to dissuade people from risking their freedom. We went down this road nearly a century ago with the Volstead Act and Prohibition and ended up in a situation disturbingly similar to that which we have reached with our decades-old war on drugs.
We are inclined to view ourselves, Americans, as more clever than people in other countries. This has interfered with our adopting strategies that have worked to humanely and equitably limit drug abuse and the profitability of drug trafficking in other parts of the world. It is time to change tactics and recognize that we are culpable. We are not the victims in this national tragedy: We are the enablers.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.
