By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.
I had hoped to welcome 2020 with an optimistic post.
Alas, the current news cycle has thrown up little cause for optimism.
Instead, what has caught my eye today: 2019 closes with release of a new study showing the FDA’s failure to police opioids manufacturers fueled the opioids crisis.
This is yet another example of a familiar theme: inadequate regulation kills people: e.g. think Boeing. Or, on a longer term, less immediate scale, consider the failure of the Environmental Protection Agency, in so many realms, including the failure to curb emissions so as to slow the pace of climate change.
In the opioids case, we’re talking about thousands and thousands of people.
On Monday, Jama Internal Medicine published research concerning the US Food and Drug Administration’s (FDA) program to reduce opioids abuse. The FDA launched its risk evaluation and mitigation strategy – REMS – in 2012. Researchers examined nearly 10,000 documents, released in response to a Freedom of Information ACT (FOA) request, to generate the conclusions published by JAMA.
As the Gray Lady tells the story in As Tens of Thousands Died, F.D.A. Failed to Police Opioids:
In 2011, the F.D.A. began asking the makers of OxyContin and other addictive long-acting opioids to pay for safety training for more than half the physicians prescribing the drugs, and to track the effectiveness of the training and other measures in reducing addiction, overdoses and deaths.
But the F.D.A. was never able to determine whether the program worked, researchers at the Johns Hopkins Bloomberg School of Public Health found in a new review, because the manufacturers did not gather the right kind of data. Although the agency’s approval of OxyContin in 1995 has long come under fire, its efforts to ensure the safe use of opioids since then have not been scrutinized nearly as much.
The documents show that even when deficiencies in these efforts became obvious through the F.D.A.’s own review process, the agency never insisted on improvements to the program, [called a REMS]. . .
The FDA’s regulatory failure had serious public health consequences, according to critics of US opioids policy, as reported by the NYT:
Dr. Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis, said the safety program was a missed opportunity. He is a leader of a group of physicians who had encouraged the F.D.A. to adopt stronger controls, and a frequent critic of the government’s response to the epidemic.
Dr. Kolodny, who was not involved in the study, called the program “a really good example of the way F.D.A. has failed to regulate opioid manufacturers. If F.D.A. had really been doing its job properly, I don’t believe we’d have an opioid crisis today.”
Now, as readers frequently emphasize in comments: pain management is a considerable problem – one I am all too well aware of, as I watched my father succumb to cancer. He ultimately passed away at my parents’ home.
That being said, as CNN tells the story in The FDA can’t prove its opioid strategy actually worked, study says:
Although these drugs “can be clinically useful among appropriately selected patients, they have also been widely oversupplied, are commonly used nonmedically, and account for a disproportionate number of fatal overdoses,” the authors write.
The FDA was unable, more than 5 years after it had instituted its study of the opioids program’s effectiveness, to determine whether it had met its objectives, and this may have been because prior assessments were not objective, according to CNN:
Prior analyses had largely been funded by drug companies, and a 2016 FDA advisory committee “noted methodological concerns regarding these studies,” according to the authors. An inspector general report also concluded in 2013 that the agency “lacks comprehensive data to determine whether risk evaluation and mitigation strategies improve drug safety.”
In addition to failing to evaluate the effective of the limited steps it had taken, the FDA neglected to take more aggressive steps that were within the ambit of its regulatory authority. According to CNN:
“FDA has tools that could mitigate opioid risks more effectively if the agency would be more assertive in using its power to control opioid prescribing, manufacturing, and distribution,” said retired FDA senior executive William K. Hubbard in an editorial that accompanied the study. “Instead of bold, effective action, the FDA has implemented the Risk Evaluation and Mitigation Strategy programs that … do not even meet the limited criteria set out by the FDA.”
One measure the FDA could have taken, according to Hubbard: putting restrictions on opioid distribution.
“Restricting opioid distribution would be a major decision for the FDA, but it is also likely to be the most effective policy for reducing the harm of opioids,” said Hubbard, who spent more than three decades at the agency and oversaw initiatives in areas such as regulation, policy and economic evaluation.
Opioids Crisis Nowhere Near Resolution
The Trump administration has made cleaning up the opioids crisis – which it inherited – a policy priority. To little seeming effect so far. although to be fair, this is not a simple problem to solve. And litigation to apportion various costs of the damages various prescription drugmakers, distributors, and doctors caused it far from over – despite some settlements, and judgements (see Federal Prosecutors Initiate Criminal Probe of Six Opioid Manufacturers and Distributors; Four Companies Settle Just Before Bellwether Opioids Trial Was to Begin Today in Ohio; Purdue Files for Bankruptcy, Agrees to Settle Some Pending Opioids Litigation: Sacklers on Hook for Billions? and Judge Issues $572 Million Verdict Against J & J in Oklahoma Opioids Trial: Settlements to Follow?)
Perhaps the Johns Hopkins study will spark moves to reform the broken FDA, so that it can once again serve as an effective regulator. This could perhaps be something we can look forward to achieving in 2020 (although I won’t hold my breath).
Or, perhaps if enacting comprehensive reform is too overwhelming, especially with a divided government, as a starting point: can we agree to stop allowing self-interested industries to finance studies meant to assess the effectiveness of programs to regulate that very same industry? Please?
This is a concern in so many areas, with such self-interested considerations shaping not only regulation, but distorting academic research (see Virginia Supreme Court Upholds Ruling that George Mason University Foundation Is Not Subject to State FOIA Statute, Leaving Koch Funding Details Undisclosed).