In the 1970s Europe succumbed to a wave of heroin misuse. Heroin addiction had hitherto been viewed as an American problem, hence the term “American disease” became a colloquialism. Now as we approach 2020 Europe is confronting a second strain of the American disease: this time one in which big pharma produced synthetic opioids are the culprit.

As in the 1970s the roots of this second wave are found in the drugs epidemic that has been biting the North American continent over the last decade. Here it is imperative that we highlight the US crisis in a few lines in order to assess the potential impact of a European epidemic and in order to alert European policy makers to the scourge of addiction.

One of the starkest facts pertaining to the US epidemic is that more US citizens died of overdoses between 2000 and 2016 than died in world wars one and two combined and yet this does not take into account the hidden suffering of those who continue to live everyday with addiction. A second factor to consider is the symbiotic interrelationship between pharmaceutically produced opioids and heroin consumption. Here we discover that four out of five new heroin users started by abusing painkillers obtained under prescription. Consequentially between 2000 and 2013 the rate of US overdoses quadrupled.

A lot of the blame for this US public health crisis has been laid at the feet of multinational pharmaceutical companies. Indeed the illicit narcotics market in the States has grown exponentially as pharmaceutical opioids such as Hydrocodone, Oxycodone, Codeine and Tremadol found their way onto the streets. It’s a scenario both Purdue Pharma and Johnson and Johnsons exploited ruthlessly in order to obtain gargantuan profits, irrespective of the compensation settlements both multinationals eventually would be forced to pay (both firms paid out over a half a billion US dollars).

The modus operandi of the two pharmaceutical giants was the focus of
the attorney General at the recent Oklahoma vs Johnson & Johnson case, where Mike Hunter accused the multinational of playing a significant role in “the worst man made health crisis in the history of the country and the state” indicating that the large number of US addicts was not the mere result of iatrogenesis but the result of pushing drugs to those who did not require them. Hunter went on to describe how it was “greed” that drove the Pharmaceuticals agenda. Driven by a war chest of approximately $880 million a year the pharmaceutical industry campaigned and lobbied against state legislatures in order to facilitate the sales of their drugs.

It is this view of greed that drove the multinational sales strategies Keith Humphreys Jonathan P. Caulkins and Vanda Felbab-Brown in their article for Foreign Affairs magazine entitled “Opioids of the Masses: Stopping an American Epidemic From Going Global” give credence to. As the title suggests the authors are extremely disconcerted that the tactics employed by the drugs companies in the states are now being deployed across Europe and Asia. This is partly driven by a fear among the conglomerates that any tightening of the legal straight jacket in the US will effect profits and shareholder value, therefore the article argues the multinationals are seeking legal loopholes overseas in nation states unprepared for the challenge and thus provoking what could become a global “public health disaster of historic proportions”. These fears are not allayed when considering recent research conducted by the 2019 European drug Report. The report notes that since 2009 forty nine new synthetic opioids have entered the continental “street” market as indicated in the graphic below.

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The evidence is clear. Europe today much like in the 1970s could be confronting a new “American Disease”. This time the strain consists not of heroin, rather of new synthetic suppressants such as Fentanyl or Carfentanil. As Humprheys explains: “U.S. pharmaceutical companies are already working to expand foreign sales. The Sackler family, which owns Purdue Pharma, also controls Mundipharma, a worldwide network of pharmaceutical companies that is not constrained by the U.S. federal court decision against Purdue. Mundipharma is active in Australia, Brazil, China, Colombia, Egypt, Mexico, the Philippines, Singapore, South Korea, Italy and Spain and is using the same aggressive sales tactics that Purdue Pharma employed in the United States. These tactics consist of running training seminars in which representatives encourage doctors to overcome their “opiophobia”. It sponsors ad campaigns that promote pharmaceutical treatment for pain. It has hired consultants, local opinion leaders, and an army of sales representatives to promote its products”. Further these already dubious strategies seem to have been complimented by illicit payments to prominent doctors as a recent corruption case involving Mundipharma practices in Italy has indicated.

Central to the Italian case is one Dr Fanelli, a consultant in pain management who, it is alleged, has received money from a group commonly referred to as the “Pain-league”. In exchange for cash Fanelli effectively championed the pharmaceuticals opioid sales.
Reports claim that as far back as 2009 Dr Fanelli was meeting with representatives of Mundipharma. The year here is of significance, then Dr Fanelli is considered to be the driving force behind a 2010 law which he co-authored and which allowed for the easier proscribing of opioids. The legal loosening of safeguards against synthetic opioid abuse, however, appears only one of a myriad of strategies deployed by Dr Fanelli, who in addition organised conferences and wrote papers in support of the use of pharmaceutical opioids while downplaying the risk of addiction.

Andrew Kolodny, an executive director of an NGO which advocates for the responsible prescription of opioids, seems to confirm the above mentioned fears when stating that Mundipharma are “using the same play-book that worked in the United States despite knowing it led to a public health catastrophe”. Considering the prescription opioid crisis has lead to the death of 400,000 users in the States and simultaneously abetted the illicit heroin market, it is vital that governments take heed of the US experience and establish legal measures to protect themselves. The question therefore is: is Europe readying itself for the challenge?

The indices provided by the graphs above suggest not. Indeed a report from May of 2019 by the NGO “Corporate Europe Observatory” highlights the undue attention with which the European Commission interacts with the pharmaceutical industry. In fact pharma’s main lobbying group EFPIA sits on eight of the commissions advisory boards helping to create an environment conducive to profit maximisation, that is to the detriment of health concerns. As the report notes: “EU decision making on public health care and patient rights must be better protected from the influencing attempts by pharmaceutical companies and their lobby groups. Conflicts of interest rules and appropriate “firewalls” which guard against undue influencing of EU policy makers by pharma lobbyists would be important starting points”.

The NGO nonetheless is not resigned to defeat, and it places its hope in the newly adopted Euro parliaments and Commission. If the new Commission, unlike its predecessor, will manage to extrapolate itself from the pharmaceutical industries lobbying groups (who spend somewhere between 40-90 million euro a year targeting the EU) remains to be seen.

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