Baltimore is a city filled with rich culture, history and innovation. The city was the birthplace of “The Star-Spangled Banner”; the American railroad system; and Hopkins, the U.S.’s first research university, which has been a hub for research and invention for more than a century.
But beyond its historical and intellectual contributions, Baltimore is also known for another, more troubling distinction: the opioid crisis. The city has one of the the highest drug overdose death rates. According to an overdose tracking tool created by the San Francisco Chronicle, Baltimore has just over 174 drug deaths per 100,000 residents, which is more than 50% higher than the next highest city, which reported just over 101 deaths per 100,000 people.
Baltimore’s drug crisis has pervaded the city, instigating negative stigmas that devastate the city’s reputation. While many assume that Baltimore’s drug crisis began on the streets, public health experts have estimated that more than 80% of Baltimore’s opioid addiction cases between 2010 and 2021 began with prescription opioids, which then caused citizens to turn to illicit drugs. The overwhelming number of cases stemming from medicinal use, highlight that the opioid crisis is driven more by systemic issues within healthcare prescription practices rather than illegal activity.
While the blame is often put on physicians, in reality, for the last 25 years, pharmaceutical companies, in pursuit of profits, have been tight-lipped about addiction potential in their attempt to promote prescription opioids. The corporate side of the drug industry has led to a significant increase in opioid use and overdoses. When a branded opioid is approved, the parent company, desperate for a return on the billions of dollars used for research and production, often has the underlying agenda to promote aggressive prescribing.
One company guilty of aggressive advertising was Purdue Pharma, which promoted the drug OxyContin, the trade name for oxycodone hydrochloride and a painkiller available in the U.S. only by prescription. By the early 2000s, Purdue had been targeting primary care physicians (PCPs) to prescribe the drug, and, by 2003 nearly half of all physicians prescribing OxyContin were PCPs. Some experts, however, expressed their concerns that PCPs did not have the proper training in pain management and addiction issues to properly prescribe the drug.
Oxycontin’s ubiquity was one of the key driver’s in its overuse and by 2004, OxyContin had become a leading drug correlated with abuse in the United States. A report by the Justice Department found that Purdue was aware early on in the crisis that its product was being used as recreational narcotic and not as a short-term therapeutic. These executives knew that the drug they were flooding into the market was addictive and community destroying and chose to ignore the crisis.
The City of Baltimore is well aware of the correlation between medicinal drug companies and the opioid crisis in the city, as they established their own Opioid Restitution Fund, which has received more than $600 million from lawsuits by the city against opioid distributors. Furthermore, in 2018, the Mayor and City Council filed a lawsuit against Purdue Pharma and other opioid distributors to litigate that opioid use had been detrimental to its citizens and disrupted communities.
The increase in demand for these pain-killing drugs also fueled the rise of the illegal drug market. For the last two decades, pharmaceutical companies have been sending out their addictive pain pills to pharmacies across the country. Around 2006, Baltimore, in particular, had been receiving around four hundred thousand opioid pills, such as oxycodone, each week, which resulted in some patients selling their prescribed pills and expanding the illegal drug market, according to the city health commissioner at the time.
Overall, the clear link between the legal and illegal drug markets has fueled the vicious cycle of addiction in Baltimore. The solution to the drug crisis does not solely lie in the sweeping of narcotics off of Baltimore streets or distributing products like Narcan. This is a systemic issue that should be addressed from a top-down approach, first at the highest level of regulatory oversight: the Food and Drug Administration (FDA).
The FDA is the primary regulatory body that oversees pharmaceutical approvals and is ultimately responsible for ensuring that prescription and over-the-counter drugs that enter the healthcare market are safe, effective and don’t act as gateways to addiction. One of the FDA’s largest mistakes was giving oxycodone a broad indication, which allowed Purdue to push physicians to prescribe opioids even more milder conditions where the use of opioids was often more dangerous than therapeutic.
The path to mitigating the opioid crisis in the nation’s hardest-hit city begins with a forceful call to action.The FDA must act by strengthening their independence from pharmaceutical companies. These companies view drugs as a product, something that is meant to generate revenue, rather than a vital part of the healthcare system and the unregulated structure that allows profits to supersede human welfare cannot be allowed to continue. The FDA’s priority should lie in the health and safety of America’s citizens. Increasing the distinction between these two parties and their agenda, will help limit conflicts of interest between regulators and drug companies, ensuring that public health prospers above corporate profit margins.
Arman Momeni is a freshman from Toronto, Canada, studying Neuroscience and Applied Mathematics and Statistics.
