Dilemmas continue in search of solutions to opioid crisis

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October 21 the headline read, “Four major drug firms reached a $260M settlement with two Ohio counties [for liability in the national opioid crisis].”

Public companies bear a duty to maximize the company’s profits, referred to as their fiduciary responsibility. No CEO could get away with intentionally-reducing sales or lowering the prices of profitable products. Individually, managers may believe they have a moral obligation to control excessive use of opioid drugs, but that belief is secondary to their responsibility to the shareholders. Although some might claim that they don’t care about the financial duty because they’re not shareholders, the fact remains that pharmaceutical stocks are some of the best-performing products in the market and are likely to be included in the investment portfolios of millions, including active investors and retirees. Everyone who derives benefit from the stock of a company that makes opioids is benefitting from the overuse of those products.

Although it might feel good to see a fine assessed on the so-called “the greedy drug companies”, we should clearly understand that those dollars will be quickly recovered from the drug makers’ customers. The businesses will not suffer a financial loss, regardless of the size of the fine, and none of the managers will be found guilty of any crime. Increased drug prices will cover the costs, and then some. The fines might, in fact, be a financial boom when the elevated prices remain after the expenses are recovered.

Rather than fining the manufacturers and distributors for doing their duty to their shareholders, who should be held responsible for pushing so many addictive opioids on the population? The users? Of course not. Regardless of how addiction gets started, intentionally maintaining it is immoral and illegal.

If it isn’t the manufacturers, the distributors, or the addicts, then who? How about directing attention at health professionals who are obligated by professional code and the law to control the distribution of dangerous drugs, including opioids, doctors, and pharmacists? When a user begs for more drugs the doctor is obligated to do no harm and do the best for the patient by preventing abuse, not feeding an addiction. Maybe the doctor is too busy. Too bad. Maybe the doctor is a coward. That’s sad. Maybe the doctor is greedy. That’s evil in a white coat.

The same can be said about pharmacists who dispense the toxic opioids while simultaneously knowing it’s wrong. Are they too busy, fearful, or greedy? Too bad. Feeding an addiction, in the absence of a terminal situation, shouldn’t be tolerated. Yet, that’s what’s happening. The blame is shifted away from the actual perpetrators, doctors, and pharmacists, and dumped on large companies that will pay the fines and raise their prices.

Perhaps law enforcement should look more closely at the situation, identify the real pushers in the system and devise methods for punishing those bad actors, and preventing more in the future. Should the guilty doctors and pharmacists be fined personally, have their licenses revoked, or put in prison? Before locking them up we ought to know what causes them to act the way they do. Of course, there are some who first react from their greedy human nature. However, could something else be driving the opioid prescribing frenzy, forcing the doctors to prescribe and the pharmacists to dispense?

It doesn’t take much mental work to conclude that the health system as a whole is flawed. Doctors and pharmacists are most commonly employed by large companies and are regularly forced to maximize the number of patients they see and the prescriptions they dispense in a day. Failure to meet imposed quotas from management will have a serious impact on salaries and continued employment.

Although it would be best if the professionals in the trenches would stand their ground and reject the demands placed on them, the pressure to perform is too great. How would they pay off their student debts and mortgages without jobs?

Until our national health system is changed for the better, we always will be plagued by problems such as the current opioid epidemic and, sadly, we will continue using wrong-headed approaches while believing we’re doing the best we can.

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