Opioid addiction rising in India as US drugmakers push painkillers

Here’s a development that must be characterized as entirely predictable: as U.S. prescription opioid sales decline, pharma firms look around for new markets to exploit – including overseas. That’s what Big Tobacco did as domestic sales fell, and it serves as the model for other industries facing similar problems at home.

This time the target is India. Easy to see why: a truly massive market ideal for exploitation. For instance, there’s no US-style credit system that would make purchases easy to track. Healthcare at the mid- and -lower levels of society is largely cash-driven. There may not be a record of how much money changed hands, or in exchange for  what services. Or, for that matter, into whose pocket the cash may ultimately have dropped.

It’s analogous to the situation in America during the boom years of the “pill mill”. That too was largely a cash economy. Purchasers would line up outside the clinic door at 7 a.m., money in hand, and after a brief visit with a prescriber, would head over to a cooperating pharmacy to complete their purchase. The very simplicity of it made the process almost impossible to monitor. It also made it easy to further divert opioids to the street for resale to a waiting public —  willing to pay a premium for anything that came in its original packaging.

They thought the packaging guaranteed safety.

Another disturbing similarity to our own experience: India’s once-strict opioid laws have been relaxed due to an aggressive advocacy campaign by pain patients and their physicians. At the time, legislators failed to realize how much of it backing came from Big Pharma. Some familiar tactics:

  • Cultivating panels of experts, mostly clinicians, to testify to a vast unmet need for more opioids to treat pain.
  • Articles in the media and medical journals, mostly anecdotes about treatment success.
  • Other articles that minimize risk of addiction or abuse. For instance, a big push for physicians to rely on Tramadol, another opioid, on the grounds that it’s a “weak” drug that won’t get someone high. “It will if you take enough of it,” joked one user.
  • Shifting responsibility to the patient. Advocates pushed the idea that taken as directed, opioids were quite safe. By inference, a patient who exceeded the recommended dose was really at fault for any adverse consequences that resulted. It’s a neat trick of logic that allows physician and drug company to shrug off blame as overdoses mount.
  • Reward programs for physicians and other prescribers — free trips to conferences in exotic resorts, for instance. Even cash awards.
  • And of course, free samples, so the can “try out” the opioid with patients.

The salesman’s goal, as always, is to make the sale. S/he doesn’t look farther into the future than a completed transaction. The longer-term outcome? That’s someone else’s problem.

And don’t forget, from a purely business perspective, someone who’s addicted to your product is the ideal return customer.

Let’s hope the powers that be in India will recognize the flaws in this approach more quickly than we did, here in America.