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The opioid epidemic that we’ve been living with for much of this decade often seems like a hurricane that’s come ashore, a calamity that is an act of a vengeful God and wholly out of our hands.

It’s been well understood by many observers, however, that the devastating toll prescription painkillers and heroin have exacted in recent years is a catastrophe that has its origins in old-fashioned avarice, folly and vanity. And that fact has been brought home by a study released earlier this month by the Journal of the American Medical Association.

It found that in the places where doctors were subjected to aggressive marketing by the pharmaceutical industry, which included free meals and trips, overdose deaths were 18 percent higher than in communities where the marketing push was less energetic. Some of the places highlighted in the report are not far from Southwest Pennsylvania, and include Cabell County, W.Va., in the southern part of the state, the Scranton area and Erie County, Ohio, home of the Cedar Point amusement park.

The authors of the study noted that they did not differentiate between opioids obtained legally or otherwise. But the lead author, Scott Hadland of Boston Medical Center, told The New York Times, “Even still, prescription opioids remain involved in one-third of all opioid overdose deaths, and are commonly the first medications that people encounter before transitioning to heroin or fentanyl. It is critical that we take measures now to prevent marketing from unnecessarily exposing new people to opioids they may not need.”

The forceful marketing of opioids, with an emphasis on the notion that they could wipe away pain and not cause addiction, goes back to at least the 1990s. A 2017 profile in The New Yorker of the Sackler family and their business, Purdue Pharma, which developed OxyContin, pointed out that Purdue wrote checks to doctors and pumped money into research to sell the idea that “concerns about addictions were overblown and that OxyContin could safely treat an ever-wider range of maladies.”

The profile went on to say, “Sales representatives marketed OxyContin as a product ‘to start with and to stay with.’”

And here we are two decades later, with thousands of people dead and hundreds of communities shattered.

Purdue Pharma has since announced that it would no longer market painkillers to doctors, and opioid prescription rates have been falling. Pennsylvania is among the 33 states that have placed limits on the amount of opioids that can be prescribed to each patient. It should also be noted that additional progress is being made on the state level – late last year, the American Medical Association hailed Pennsylvania’s approach to the problem, with its 45 Centers of Excellence that treat addicts, and the widespread distribution of the overdose reversal drug naloxone.

Still, there is much work that has to be done. Pharmaceutical companies and doctors must be part of the process.

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