The EconomistAugust 31st 2019 Leaders 131T
his weeksaw a landmark reckoning in court for a drugmaker
involved in America’s opioid disaster. A judge in Oklahoma
ordered Johnson & Johnson (j&j) to pay $572m to fund a state
plan to combat opioid addiction. Whatever the outcome ofj&j’s
legal appeal, this is a milestone in a public-health calamity that
cost 47,600 American lives in 2017 and could well claim a further
500,000 over the next decade (see Business section). Faced with
such devastation, states, counties and municipalities have
served firms with roughly 2,500 lawsuits.
The roots of the epidemic lie in the marketing of prescrip-
tions by pharma firms almost 25 years ago. Opioids have long
been known to be highly addictive and easy to overdose on. Al-
most one in five addicts dies within a decade. Yet newer versions
of the drugs were sold as having lower risks.
Firms also worked hard to promote the idea that
doctors were undertreating chronic pain.
Drugmakers involved in mis-selling opioids
could begin to make amends by shouldering
their share of the blame and settling quickly.
That way the money will arrive sooner, and less
of it will go to lawyers. There are encouraging
signs that Purdue Pharma, which lies at the ori-
gin of the epidemic, may settle a batch of lawsuits for up to
$12bn. Yet it is vital not to lose sight of why the opioid crisis
struck America so much harder than anywhere else. The blame
lies partly with the incentives woven into its health-care system.
For a start, many drug distributors and pharmacies, mesmer-
ised by growing sales, failed to take action, as they are obliged to,
when signs emerged that opioids were being diverted for illicit
use. Doctors and hospitals, eyeing the bottom line, also veered
towards incaution when handing out pills. The system put sales
and “customer” satisfaction before patients’ well-being. Medi-
cal-professional societies were at best supine, and in a few cases
complicit in encouraging overuse. Regulators fell short, too.
States could have limited prescription volumes, or set rules forhow opioids were to be prescribed. The Food and Drug Adminis-
tration (fda), the federal regulator, failed to take account of the
public-health impact of opioids when it deemed them safe. It has
since not done enough to reform its approval regime, and it has
still not properly reassessed the opioids already on the market to
determine whether they need to be removed from sale.
Keen to signal they mean business, some states have intro-
duced laws to tighten supply. Paradoxically, perhaps, they need
to be careful. Prescription opioids are no longer the main cause
of death from addiction. Efforts to cut off people who are addict-
ed risk sending them onto the black market for supplies. Regula-
tors need to focus instead on medically assisted treatment for
addicts, which has been scandalously neglected. This would
save thousands of lives a year.
The full cost of dealing with the crisis will
run to hundreds of billions of dollars, which is
why legal redress is needed—and why, unlike in
tobacco settlements, the damages from pharma
companies should go directly into alleviating
the harm from opioids rather than into general
government spending. Unfortunately, even
then, generous settlements with drug firms and
distributors will not foot the entire bill. Large sums will thus
have to come from taxpayers.
All this should be a warning to governments everywhere. In
most parts of the world there is a shortage of pain relief. But as
governments expand access to drugs, they should heed the les-
sons from America. Opioids need to be dispensed according to
properly enforced rules. Regulators have a role in supervising
how they are marketed. Doctors should be vigilant and inform
patients of the risks. None of this is to absolve the companies
that mis-sold drugs or looked the other way. Patients have a right
to expect high ethical standards from those who supply their
medicines. But making sure that opioids are a gift to humanity
and not a curse is a job for the entire health system. 7Avoidable pain
Opioid deaths
United States, ’01020301999 2005 10 15 17Methadone Prescription opioidsFentanyl and synthetic opioidsLegal settlements alone will not solve America’s opioid crisisOpioidsN
orth koreahas spent the past few weeks testing an appar-
ently new missile. It seems to have only a short range, so
does not much bother President Donald Trump, who says what
matters is stopping North Korea from developing missiles that
can reach America. But the governments of South Korea and Ja-
pan are naturally alarmed. The missile can manoeuvre in flight,
making it harder for anti-missile batteries to shoot it down. And
“short range” is relative: the weapon seems to have the capacity
to slam a nuclear warhead into Seoul or Tokyo.
How have South Korea and Japan reacted to this alarming
threat? Not, as you might expect, by putting their heads togetherto work out what North Korea’s device is capable of and how they
can best counter it, but the reverse. On August 22nd, two days be-
fore the latest missile launch, South Korea said it would let an in-
telligence-sharing pact with Japan lapse. A few days later it fur-
ther antagonised Japan by conducting big military exercises in
the sea between the two countries, around two rocky islands
which Japan claims, but which South Korea controls.
South Korea’s provocations are just the latest blows in a grow-
ing tit-for-tat dispute (see Asia section). They are a petulant reac-
tion to Japan’s abrupt decision to remove South Korea from a list
of trusted countries subject to minimal export controls and toSlight club
South Korea and Japan are letting a row about the past endanger their futureSecurity in Asia