Today (April 15, 2023) the FDA issued new prescribing guidelines to stem the opioid epidemic. This comes a year after a federal judge reignited the furor around the opioid problem. U.S. District Judge Charles Breyer upheld San Francisco city attorney's claim that Walgreens improperly oversaw dispensing of prescriptions and failed to report suspicious orders. 

In the verdict, the judge ruled that America's three largest pharmacy chains (Walgreens, CVS, and Walmart) must pay $650.5 million for helping fuel the painkiller crisis.

In 2019 pharmaceutical giant Johnson & Johnson was officially blamed for the opioid epidemic. In essence, J&J was labelled an opioid pusher. The J&J decision in 2019 was a long time coming. Some say, way too long.

On that day, families of opioid overdose tragedies finally received some measure of justice in the courtroom. That’s because mega-drug maker Johnson and Johnson was ordered to pay the state of Oklahoma $572 million. In other words, the biggest opioid pusher (J&J) was found guilty of fueling America’s national opioid epidemic.

In a 42 page ruling Cleveland County Judge Thad Balkman found Johnson and Johnson was guilty of “misleading marketing and promotion of opioids” and that they “created a public nuisance” among Americans. J&J's lawyers argued that they were just following the rules. But the Judge wouldn’t have it.

Personally, I’m hoping this high profile verdict and the new Walgreens announcement shines a light on a wider landscape of cunning, deceit, and conspiracy that goes on in modern medical practice. Such scheming is no longer confined to a few whispers among medical colleagues. It’s out in the open and widespread. And it represents a corruption that hospitals, regulators and even doctors are party to. Even if they just turn a blind eye they're still complicit in fueling the opioid epidemic.

The verdict is nearly identical to one handed down in 2017. Then, Oklahoma successfully sued J&J subsidiary Janssen Pharmaceuticals as well as Teva Pharmaceutical Industries and Purdue Pharma on similar grounds. Those were fraud, public nuisance, unjust enrichment and violating Oklahoma’s Medicaid laws.

Moreover, the state made the case that these companies pushed doctors to prescribe opioid painkillers. Just as criminal, at the same time they forced doctors to downplay the risks of addiction. Most experts say this is what started the current opioid epidemic we see today.

In the recent verdict, Oklahoma Attorney General Mike Hunter said in the end, it all came down to greed. He said J&J used pseudo-science and misleading data to “build its billion dollar brand out of greed, and on the backs of pain and suffering of innocent people.“

Attorney General Hunter also said, “What is truly unprecedented here is the conduct of these defendants on embarking on a cunning, cynical and deceitful scheme to create the need for opioids.”

Judge Balkman found the following:

• J&J was warned by their own experts about marketing potentially dangerous opioids, but ignored them.
• The company was warned that data they cited didn’t support their claims, and also ignored it.
• Several times, the FDA warned opioid pusher J&J that their message was misleading.
• J&J ignored experts who said their studies were unsound and they misrepresented the facts.
• The company misled and excessively influenced doctors.

More recently, in December 30, 2021, Teva Pharmaceuticals was also found liable for fueling the opioid epidemic. The company was responsible for every point of the prescription opioid supply chain. It ranged from the manufacturer to the pharmacy chains which filled the prescriptions.

Teva Pharmaceuticals was found guilty of harming the public. The penalty phase is pending, but will likely reach into the billions of dollars.

Exposing J&J, Walgreens, Teva and other opioid pushing companies is the first crack showing in corrupt system. But at the core of the problem is the doctor.

Today, we barely notice major drug issues, like a new report showing opioids are a leading cause of childhood poisoning deaths. Even the opioid crisis in general has waned in the public eye.

There was time when no company, no person, and no law stood above a doctor’s sacred oath to “do no harm”. There also was an unwritten rule that the patient’s welfare came first, no matter what. In other words, no amount of money could buy otherwise. Today, that sounds almost laughable in our profit-driven society.

Modern medicine (and healthcare in general) is a just another for-profit business. But it’s arguably the biggest money maker in America – after war. The beating heart of that engine is the ordinary doctor.

Modern doctors are just like anybody else. They go to school, work, have families, and pay bills. Doctors listen to what their “superiors” tell them. Then they carry on with their business.

Their superiors, of course, are drug companies, hospitals, insurance plans. They all contribute in regulating how doctors practice medicine – and how they get paid.

Now enter the poor, suffering patient… the money engine’s fuel. If patients were not sick, doctors would be out of work. And thousands of companies would be worthless. In a word, sick patients keep the machine humming.

Doctors know this. And they know there’s no money in a cure. That’s because a cured patient will never come back! Moreover, a cured patient won’t need drugs. Drug companies know this quite well, and it’s part of their business model.

Think about it: of the thousands of drugs available, how many can you name that cures a disease? There are none! Every single drug manufactured today is a treatment, not a cure.

The Judge stopped short of saying doctors were complicit in the J&J verdict. That would be almost impossible to prove. But Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative of Brandeis University (and the prosecution’s star witness) put it best.

He said, “There were so many doctors who recognized this practice was harming patients. But it was hard [for doctors] to speak out against it because it had become accepted.”

“Accepted” means condoned, forgiven or overlooked by the system. Overdosing patients had become accepted medical practice. Opioid maker J&J and Walgreens happily supplied the system with as much product as it could move. Thus, the opioid epidemic went unchecked for years.

The cases against opioid epidemic makers J&J and Walgreens is just the tip of the iceberg. Many corrupt standards of medical practice are widely “accepted” even though they’re immoral or illegal. But in almost every instance, corruption is simply too profitable to give up. 

American medical history is full of “money first” practices. For instance, runaway radical mastectomy surgeries nearly overwhelmed the system in the 1970’s and 1980’s. Around the same time, hysterectomies were all the rage among surgeons. Similarly, tonsillectomies were routine only a decade before.

Nowadays, the big money maker is carpal tunnel surgery. This is in spite of what the hand surgery regulators (the AAOS and NIH) clearly advise. They say 90% of people are successfully treated without surgery. And they recommend every patient be treated with non-surgical remedies first. But everybody (including hospitals and insurers) turn a blind eye to those recommendations. Surgery is just too big of a money maker.

Today, carpal tunnel surgery is this second most popular surgery in America. And it’s by far the most profitable, requiring only 30-45 minutes, yet costing thousands. It’s almost commonplace for patients to complain that doctors never even suggest non-surgical alternatives. Instead, carpal tunnel release surgery is most often a surgeon’s first recommendation. 

In fact, most surgeons don’t even bother to confirm the patient has carpal tunnel to begin with!

The rush to carpal tunnel surgery is the new medical epidemic and conspiracy, in spite of:

• It’s completely unnecessary in the vast majority of patients.
• There are great non-surgical options available that are far less costly than surgery.
• Carpal tunnel surgery is inherently risky.

But the engine of medicine hums along as long as patients are in pain. Family doctors turn a blind eye. Surgeons, hospitals and insurers conspire to be silent. All this status quo continues, even in spite of recent studies showing opioids alone are not enough to treat chronic pain. It's out of control. And everybody benefits…expect the poor patient.

The time has finally arrived to pay the piper for the opioid epidemic. An Oklahoma Judge ordered opioid supplier J&J to pay $572 million for its role in fueling the opioid drug crisis in America. Now Walgreens is facing a similar fate. But this is just the tip of a much bigger medical iceberg. Doctors, hospitals, and insurance companies all continue conspire to provide other therapies and perform procedures that are completely unnecessary – and even dangerous.