Like many Americans, I want to know how we got to the point that nearly 30,000 of our fellow countrymen and women died last year from overdosing on opioids. Answers, lots of answers, are to be found in a report written by staff working in the US Senate. But the senators overseeing the report have failed to release it.
In 2012, the chair and ranking member of the Senate Finance Committee, Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa), launched an investigation into financial ties between drug manufacturers and medical organizations that were setting guidelines for opioid use. When the investigation began, the federal government had already reported that opioid overdoses were killing more people each year than car accidents. Many staffers working for Baucus considered his home state of Montana to be ground zero for the epidemic of opioid addiction.
The committee focused on the American Pain Foundation, the Center for Practical Bioethics, and five other organizations. It also targeted three leading opioid makers: Purdue Pharma (OxyContin), Endo Pharmaceuticals (Percocet), and Johnson & Johnson (JNJ) (Duragesic). The committee demanded to see documents and get answers to its questions.
Over the course of many months, congressional investigators collected and analyzed a mountain of material. These documents, and the report that was drafted from them almost a year later, have never seen the light of day. Instead, they remain sealed in the Senate Finance Committee’s office.
As a former investigator who helped the Senate Finance Committee uncover corruption in science and medicine, I know firsthand the hard work that goes into these inquiries. Making information public can change policy, without needing to pass new laws. The public, the press, and lawmakers deserve to know what the committee learned about how the drug industry influenced opioid prescribing practices.
I also have personal reasons for wanting to see the report and learn more about the causes of the opioid epidemic. I have lost two cousins to opioids, and my father unwittingly became addicted to fentanyl. His personal physician had prescribed this painkiller for back pain without warning him that it is a powerful and addictive opioid. After a while, my father decided to stop taking the medication. That led to his being rushed to the emergency room in the middle of the night with severe abdominal pain and a feeling that fire was shooting up his arms and into his hands. The emergency doctors explained that he was experiencing opioid withdrawal, and put him on a morphine drip. Shocked that he was now a “junkie,” he restarted fentanyl the next day, and slowly tapered off the drug.
The American Pain Foundation was a nonprofit that described itself as America’s largest organization for pain patients. Yet its guidance on opioid use for patients and policymakers exaggerated the benefits of these drugs while downplaying the risks. At one point, pharmaceutical and medical device companies provided 90 percent of the foundation’s funding. Days after the Senate investigation began, ProPublica reported that the foundation had shut down “due to irreparable economic circumstances.” Senate investigators later combed through a treasure trove of the foundation’s documents, which helped explain how the foundation, affiliated physicians, and drug companies helped fuel prescriptions for opioids.
The Finance Committee also targeted the Center for Practical Bioethics, a nonprofit which bills itself as an independent national leader in helping policymakers and corporate leaders struggle with health care decisions. The Kansas City Star reported that Purdue Pharma had showered the center with funds, providing seed money to create the center’s $1.5 million chair in pain management, held by Myra Christopher, one of the center’s founders, and donating a sizable amount to the group’s annual dinner and symposium.
In 2008, Christopher coauthored a study to calm physicians’ fears that they might be criminally prosecuted or disciplined for inappropriately prescribing opioids. In 2011, as money from pharmaceutical companies continued to pour into the center, she wrote a commentary titled “It’s Time for Bioethics to See Chronic Pain as an Ethical Issue” for the American Journal of Bioethics, which was then housed at the Center for Practical Bioethics. The commentary failed to disclose that the center had received funding from the pharmaceutical industry and was one of many articles promoting opioid use the journal published. By the time the Senate launched its investigation, the journal had changed homes and sought to distance itself from the center.
Change of leadership further threatens the report
Baucus left the Senate in January 2014 to become the US ambassador to China. Grassley lost his leadership position with the Senate Finance Committee after becoming chairman of the Senate Judiciary Committee. They were succeeded by Senator Orrin Hatch (R-Utah), who now chairs the Senate Finance Committee, and Senator Ron Wyden (D-Ore.), its ranking Democrat. These new leaders are likely to do little to release the opioid report.
When Hatch took over the committee, he promised to lead aggressive investigations, just as Grassley had done. He has broken that promise. While Grassley zealously investigated nonprofits across the political spectrum, Hatch avoids rankling corporate America with aggressive investigations into corruption and, as I was told by one staffer, Hatch wants to keep his hands off nonprofits. Why? Hatch holds to an ideological conviction that government is bad and can be replaced by more efficient nonprofits. Releasing a report that hints at how corrupt some of these nonprofits can be would harm that ideology — even as it would help his home state. According to the Utah Department of Public Health, opioid poisoning kills about 30 people each month, more than die from firearms, falls, or auto accidents.
When Hatch took over the committee, he promised to lead aggressive investigations. … He has broken that promise.
Voters in Oregon, which has had the second highest rate of opioid abuse in the country, shouldn’t expect much better from Wyden. Like many Democrats, Wyden has no love for corporate corruption. But this is balanced by an aversion to the pain and drudgery required to hold wrongdoers accountable through congressional investigations. Instead of investigating and laboriously tinkering to improve the system we have, the senator seems to prefer writing new pieces of legislation onto which he can solder the Wyden nameplate.
Do the right thing
Last September, dozens of public health advocates pleaded with both senators to release the findings of the opioid prescribing report. They noted that many of the companies and groups targeted by the investigation “have continued to promote aggressive opioid use and continue to block federal and state interventions that could reduce overprescribing.” In response, Hatch said he would bring up the possibility of releasing the report with other senators. That hasn’t happened.
Every day, an estimated 78 Americans die from an opioid overdose and more than 1,000 are treated in emergency departments for misusing prescription opioids. Medical evidence tells us that these overdoses are “accidents.” A sense of justice tells us that they aren’t. Instead, they are preventable incidents tied to corporate profit. Those at fault should be named and held accountable.
Senators Hatch and Wyden have sponsored new legislation to control the societal impact of opioid addiction. These are Band-Aids that treat the symptoms of the opioid epidemic while ignoring the parasitic elements that caused the disease.
Release the report, senators. Americans deserve to know who created the national scourge of opioid addiction.
Paul D. Thacker, a former investigator on the United States Senate Finance Committee, is a writer living in Spain.
A previous version of this article incorrectly stated that opioid poisoning is Utah’s leading cause of death.