Free Market Solutions to the Opioid Epidemic

As the epidemic of opioid misuse worsens, laws and government force aren't proper solutions

Prior to covid-19, it was the opioid epidemic that worried U.S. officials, with reports showing that the abuse of opioids nationwide was contributing to increased healthcare costs and overdose deaths. In 2020, however, things changed. With covid came lockdowns, and with the lockdowns came unemployment, isolation, and depression.

By early 2021, the Centers for Disease Control and Prevention (CDC) had announced that officials estimate that over 81,000 people died of drug overdoses in 2020, a record-breaking number. To some experts like Brendan Saloner, a professor of Health Policy at the Johns Hopkins School of Public Health, this record increase was directly associated with the pandemic and the isolation the ensuing lockdowns imposed on countless Americans.

“The pandemic itself [created] a lot of stress in people’s lives, a lot of social isolation,” Saloner told the Commonwealth Fund’s Shanoor Seervai. “We know from the mental health data that depression went through the roof during the pandemic, that a lot of people were just feeling a lot of loneliness. And so, I think those conditions caused a lot of people to use drugs more frequently and to use them in more harmful ways.” 

The Centers for Disease Control and Prevention (CDC) also highlighted the link between the covid-led lockdowns and the increase in drug overdoses in its website recently.

“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” CDC Director Robert Redfield, M.D. said.

“As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”

But despite this clear connection, the media still seems hesitant to cover the covid-led lockdowns and their impact on the mental health of Americans. Instead, we enter yet another news cycle of fear-induced reports pushing increasingly intrusive government programs that include vaccine mandates among government workers and even door-to-door vaccination drives.

Regardless of what is driving this increasingly tyrannical approach to covid mitigation, it is important to highlight the fact that the opioid epidemic isn’t going anywhere.

Incentives Matter

The drug war has been one of the biggest reasons behind the increase in opioid abuse in America, but not the only one.

As described by Austrian economist Mark Thornthon in this 2017 essay, the cozy relationship between big pharmaceutical companies and the government led to an affair that is hurting Americans.

In the 1970s, opioid drugs such as oxycodone and hydrocodone were mainly marketed for the relief of acute and cancer pain. By the 1980s, a movement started brewing, pressuring U.S. states to pass intractable pain treatment acts that removed the threat of prosecution for physicians who treated patients suffering from pain with controlled substances. By the mid-1990s, the American Pain Society, an organization that was later accused of acting as a “front” for pharmaceutical companies, had launched a successful campaign that urged the medical class to treat pain as a “fifth vital sign” that should be monitored and managed such as the heart rate or blood pressure.

Following the publication of a letter to the New England Journal of Medicine editor claiming that opioids were not addictive, a study involving only 38 people that concluded opioids should be used in the treatment of pain that is unrelated to cancer was published. But despite critics suggesting that the study’s conclusions had been overstated, opioid prescriptions increased dramatically.

But while opioids’ popularity grew then, the use of such drugs became widespread only in the mid-1990s when pharmaceuticals introduced new products such as OxyContin, a then-new formulation of the well-known drug oxycodone manufactured and marketed exclusively by Purdue Pharma.

What did Purdue and others do differently that helped boost physicians’ acceptance of their drugs? Simply put, they lobbied lawmakers, sponsored doctors, and patient organizations, offered cost-free medical education courses for doctors, and started knocking on physicians’ doors to tout the incredible efficacy of their newly patented wonder drug.

Considering that all the perks involved with pushing opioids also include financial gains for doctors who prescribed particularly large amounts of the drugs, it is easy to see how incentives may have played an important role in the current crisis. In addition, the protection the Food and Drug Administration (FDA) extends to such companies by granting them exclusivity rights insulates pharmaceutical manufacturers from the competition. With virtual monopolies on such drugs and the power to squelch anyone who tries to take a slice from their market share thanks to the FDA’s backing, these firms have more influence over doctors than they would have otherwise.

A Free Market Solution 

When crony capitalism is the established economic system of a nation, what we have is a system that incentivizes businesses to act in a predatory manner. Purdue and other large pharmaceutical companies seek and defend their patents, fight for FDA’s exclusive approval, and support politicians who are more likely to stand by them when times get tough because the government grants them that privilege, not because of lack of competition in the healthcare market encourages innovation.

To truly help change this situation, we would have to rethink our approach to both patent laws and the role the FDA plays in drug approvals.

As Senior Policy Analyst for the Reason Foundation Marc Joffe explained in this article, it is time to get the government to do less.

“[A more fundamental reform] would be to allow multiple organizations to approve drugs, providing competition to the FDA. A private drug adjudication industry would have to be carefully structured and regulated to ensure that approving organizations do not have perverse incentives.”

Additionally, he stated, we could allow drug companies to come up with their own drugs and formulas, giving them the permission to produce and sell them openly as long as they can be held responsible in court for any negative outcome.

By putting responsibility back in the market, drug companies would have to think twice before marketing a new treatment that fails to do what it promises. Unfortunately, the government now serves as a buffering force around large businesses. In this state of affairs, patients shouldn’t expect any accountability.

This piece originally appeared on The Beacon under the title As the Opioid Epidemic Worsens, We Must Look at Free Market Solutions