Jay Kuten: Exploiters of the epidemic

Anti-addiction drugs: Suboxone (left) and Methadone.

The immediate human cost of the US opioid epidemic can be measured in the deaths from so-called overdose. In 2016, deaths from prescription opioids and their street cousins, opiates -- heroin, fentanyl -- (59,000), exceeded deaths from gun violence (including suicide by gunshot) (31,000) and car accidents (34,000).

Deaths from opioids is a measure of extent of usage because "overdose" is a misnomer. Opioids all act to suppress respiration in the brain's medullary centre, which controls breathing. It's closer to understanding to say that the action of opioids is that the brain "forgets" to signal the body's breathing. The higher the number of users, the greater the number of deaths.

In addition to the hazard of death or of infection -- hepatitis C, HIV, or other infection -- users face the criminal justice system. While addiction is not a crime but an illness according to the 1962 US Supreme Court decision (Robinson v California), it is generally treated by local authorities as a crime. Or addicts face jail for crimes (mostly theft) they commit to support their habit.

Enter the substance abuse treatment industry and return of Big Pharma. There are many good drug rehabilitation centres in the US, and their work must be acknowledged as difficult and often frustrating as patients leave and relapse. In this maelstrom, opportunistic profiteers have emerged, as the New York Times recently described the situation in Del Ray Beach, Florida, where some operators, paid by government insurance, simply churn the addicts through, knowing the drug pushers are waiting outside.

Theoretically, a free market system works to decrease prices as demand rises and economies of scale eventuate. As Moore's Law dictates, that $600 smart phone is more powerful than the 16 bit 75lb computer onboard Apollo 11 that cost $3.5 million.

The pharmaceutical industry is upending capitalist theory. As demand rises, so do prices in what is supposed to be a competitive marketplace.

Jay Kuten

Nalaxone can reverse an opioid "overdose". It can be administered together with Buprenorphine, a drug that helps control and treats withdrawal. Together, these two, called Suboxone, are effective in the treatment of addiction. A Harvard study (2011) found Suboxone as one of the most effective ways to reduce substance abuse. These two have been available for pennies for decades, as they're both out of patent.

Given the extent of use of opioids, the consequent high accidental death rate, and life-saving capacity of Nalaxone in particular, it's no surprise that first responders of all fields are being equipped with the drug.

Some major cities made it standard issue to police cruisers as first on scene. Large drugstore (chemist) chains have made Nalaxone available without prescription, over the counter.

Several pharmaceutical companies have bought out generic manufacturers and raised the prices to astronomic levels. Injectable Nalaxone, which cost $9 in 2005 became available for $220 in 2010, then $550 in $2014, and in 2016 for $3750 for a 20-pack or $750 per shot.

In 2011, the Alkermes pharmaceutical company brought out an injectable version of a suboxone-like compound, Naltrexone (Vivitrol), which would allow a single injection to provide maintenance of sobriety for a month. The company bypassed conventional US practice and tested the drug in Russia. While there is no great evidence that the injectable drug, Vivitrol, is more effective than oral Suboxone in helping addicts stay clean, the company has lobbied law enforcement, the drug courts, to use Vivitrol exclusively. Suboxone costs $30/month. Vivitrol $1731.

The pharmaceutical companies made billions in fostering the opioid epidemic. And, as part of the substance abuse treatment industry (including law enforcement), they stand to make an estimated $12.4 billion per annum by 2024.

The losers here are the patients/addicts, the collateral damage in the war on drugs. And the taxpayers, whose money provides the government funds for all of it.

Einstein said insanity is repeating the same mistake, expecting a different result. The opioid disaster is what madness looks like. It doesn't have to be this way.

Next week: Sensible alternatives and final thoughts.