Articles, Blog

Why America’s opioid epidemic is going global

December 17, 2019

This is a film about selling pain. It’s about big drug companies, and the sophisticated marketing playbook
that fueled an opioid epidemic. – An opioid epidemic has reached Australia. – An opioid crisis. – Codeine and tramadol. – Non-medical use of prescription drugs
has reached epidemic proportions. – So something has to be done. This story only starts in the United States. – We are facing the deadliest drug… – …crisis in American history… – …and unfortunately shows no signs of ending. Where one pharmaceutical company has
gotten a lot of the blame: the makers of OxyContin, Purdue Pharma. – Purdue Pharma! – Purdue Pharma! – Every single one of us was lied to about OxyContin! They even admitted it… sort of. – The maker of a hugely popular painkiller
has some pain of its own tonight. Back in 2007, as part of a huge settlement, Purdue
pleaded guilty to misleading doctors and patients. And that was just the beginning. – More than 1,600 lawsuits… – We the state of Oklahoma… – The state of Wisconsin has filed suit… – …against Purdue Pharma. – Drug manufacturer Purdue Pharma. – Misrepresentation… -The lies… – Knowing how addictive it was… – Companies gave doctors fraudulent marketing… – …so they could profit from pain. – For Purdue, it was all about the money. – Now, one of the largest suppliers
of the addictive painkiller OxyContin says it will no longer promote
the drug to doctors. Purdue even laid off their sales staff. End of story, right? But here’s the thing. They’re still doing tons of business, and not just in America. Purdue is the US part of a huge network
of pharmaceutical companies. Here’s how one company in the network explained it. – The Mundipharma group is known as
Purdue Pharma in the USA, NAPP in the UK, and Mundipharma
in the rest of the world. Members of the Sackler family own Purdue
and Mundipharma through trusts. And a lot of their billion-dollar profits
are now coming from overseas. So after all these lawsuits in America, somehow
Mundipharma and many other companies are finding ways to keep making
lots of money off opioids. What are they doing overseas that’s so different
from the stuff that got Purdue in trouble here? – We are Mundipharma. And we’re just getting started. – Mundipharma. We bring more to life. First, you’ve got to understand this whole marketing
playbook that Purdue used in the United States. This advertisement lays it out.
And it starts with a simple idea. The world is suffering from an
epidemic of chronic pain, like this guy is suffering. These pins… are his pain. And he doesn’t need to be suffering because
there is a safe, effective treatment: Opioids. The message is pretty clear. The companies spread these messages in ways that
are a lot more subtle than a single advertisement. We’ve pieced together big pharma’s
opioid marketing practices, what we’re calling their marketing playbook. And it’s got tons of parts, involving money, and medical journals, and conferences,
and doctors, and advertising, and patients. But it’s all part of a coherent strategy. It can be a little hard to see it
that way, so we hired Charles. He’s a voiceover artist who does a lot of ads. – Fa-fa-fae-fa-foo-fa-fae-fa-fa-fa Hi Charles! – Here’s how to sell drugs. Here’s how to sell drugs. But we’ll come back to him. Because we also need to explain what we
actually know about prescription opioids. – Opioids are fantastic medications
that are essential for health care. Meet Keith Humphreys. He was a senior adviser at the White House
Office of National Drug Control Policy. – And it might even be more important
for the opioid epidemic, which after all was started, not by criminal gangs,
it was started in the health care system. Now, he’s a professor at Stanford who
studies how to treat addiction. – Opioids are extremely good at dealing with
injury and other sort of acute harms. They’re essential for surgery. They’re also essential for palliative care, for
example, when people are dying of cancer. This is worth emphasizing. Opioids aren’t bad in and of themselves. They’re essential for short-term use, like after surgeries or for treating the pain
associated with cancer or a terminal illness. – Chronic use of opioids, which
is longer than three months, increases the risk of addiction
and also tolerance, meaning that the body builds up more and
more resistance to the medication, and you have to take more and more
of it to get the same effect. If you take opioids long term,
they become less effective, and you’re more likely
to become addicted. These estimates suggest about a quarter
of patients who are prescribed opioids for chronic pain misuse them,
and around 10% end up addicted. But drugs people take long term,
that’s where the money is. A patient who needs a drug for a couple weeks isn’t as
profitable as a patient who needs that drug every week. So in the 90s, Purdue began to aggressively
market opioids for chronic pain in the US. – No question that our best, strongest
pain medicines are the opioids. – Once you’ve found the right doctor, don’t
be afraid to take what they give you. And it was really successful. Between 1999 and 2002, Purdue
more than doubled their sales. The number of prescriptions for
OxyContin also doubled. And the rate for drug overdose deaths involving
prescription opioids almost doubled too. Purdue’s marketing is just one part of a complex
pharma machine that led to the crisis. There’s also loosening regulations,
incentives from insurance companies, lots of other opioid manufacturers and distributors,
and a burgeoning black and gray market. So let’s go back to Charles. – Addiction is concerning.
So ease the prescribers’ minds. – So the cure for pseudo-addiction,
you were trained, is more opioids. – A higher dose, yes. Carol Panara was a sales rep for Purdue Pharma for
five years, when OxyContin was their blockbuster drug. – The concern about addiction
would come up with the doctors. And they might say to you as a representative,
“Well, isn’t OxyContin addicting?” As a salesperson in general, you understand
that an objection is a “buying signal.” That means they’re interested. So, again, the objection might be, “Well,
everybody that takes that is an addict.” OK, so how do you handle that objection? – Here’s how to handle any objections
prescribers may have. Present facts like this one: The risk of addiction is less than 1%. – The rate of addiction amongst pain patients
who are treated by doctors is much less than 1%. – Less than 1% of patients taking
opioids actually become addicted. – Less than 1% sounds very safe. You know, people take 1% risks every day. It’s a great selling point. It’s not science. But it serves a corporate agenda. Chris Johnson is a doctor who
started noticing more and more opioid overdoses from chronic pain
patients in his emergency room. – I’m going to talk to you today
about the opioid epidemic, and I’m going to begin with an apology. On the behalf of the medical
industry, we failed you. Now, Johnson is also on the board of an organization
called Physicians for Responsible Opioid Prescribing. – When I started doing research into the literature
supporting increased use of opioids for chronic, non-cancer pain, I realized,
‘Oh my goodness what have we done?’ when the study that this doctor sent me
was a five-sentence letter to the editor. Doctors and medical journals were stating
that the risk of addiction was less than 1%. But that statistic came from a letter: five sentences written to the New England
Journal of Medicine in 1980 on rates of addiction for patients who took
at least one opioid while at the hospital. – But it said nothing about putting patients on
these medicines in pill form indefinitely. Nothing about that at all. Here’s one of the letter’s authors,
Hershel Jick, on that 1% number: – It was used by drug companies who
created these these new opioids and concluded that they were not addictive. But that’s not in any shape or form
what we suggested in our letter. – And how do how do you feel about that? – Well, to be honest, I’m mortified. In the 90s, after Purdue started
marketing opioids for chronic pain, that letter was referenced a
lot in medical literature. It was cited more than 600 times. Now, that statistic rarely appears in America. But something weird happens when
you look outside the US. – I think it’s about 1% of people who are on opioid
pain relievers who are dependent on the medication. Big pharma’s opioid marketing
playbook? It’s gone global. – And this brings us to the next
rule of opioid marketing: Find some experts. Hire medical leaders to educate doctors
about the value of opioids, like Willem Scholten. – People often think that if you use
opioid analgesics for pain, that you have a very high risk that
you will become dependent. But the risk is very low. – What I’m trying to say all the time is that
pain medication does not lead to dependence. Willem Scholten used to work for
the World Health Organization. He was team leader for access
to controlled medicines. Now, he consults for pharmaceutical
companies as well as NGOs. – There’s a lot of fear for opioids in the world,
and most of the time that’s not justified. Scholten cites two reviews as evidence. – According to the Noble study, the
risk of becoming dependent is .05%. This Noble review was published in 2008. It reviewed earlier studies on long-term
opioid use for chronic pain. – This study is a meta analysis, which means it
combines many studies that have been done over time. So it’s not a subjective truth. The decade-old review did find low rates of
addiction in the studies it included. But it also said the evidence was low quality,
making any conclusions unreliable. And the authors noted that most studies had screened
out patients at higher risk of addiction. – You can find case studies to prove witchcraft work. Case studies aren’t healthy because you could pick
and choose who you want to select in your criteria. – There is another study, which is
highly authoritative, by Miniozzi. Their final conclusion was that opioids
cannot be withheld to pain patients because of the risk of becoming dependent. The Minozzi review is from 2012. And the study’s authors also concluded that
the quality of evidence was very low and could not be considered conclusive. We showed the study to Johnson. – Nonsense review article comparing
multiple different types of studies? This is what you do when you don’t have good data. Long-term studies on the risk of addiction
are expensive and difficult to do, so good data is hard to find. But no independent experts we spoke to said the risk
was less than 1% or pointed us to these reviews. Most gave a range. The US National Institute on Drug
Abuse looks to a newer review, the one that estimated that about 10% of
patients taking opioids for chronic pain end up with opioid use disorder
(what’s commonly called addiction), and about a quarter misuse their medication. – I often talk with doctors. When I ask them, ‘How many of your pain
patients have have become dependent?’ They often couldn’t [remember] any patient.
That’s supportive for the conclusion. – That’s the best they got? Yeah that’s poor. They should know better. They do know better. – I think when you look at the literature,
there is no financial incentive. – Addiction when treating pain is distinctly uncommon. Russell Portenoy was a key opinion leader who
used to cite the less than 1% statistic when talking about the risk of addiction. He was named in several lawsuits
filed against Purdue Pharma. He testified against the industry in return
for being dropped from the suits. – I gave so many lecturers to primary-care audiences in which the Porter and Jick article was just
one piece of data that I would then cite, none of which represented real evidence. And yet, what I was trying to do
was to to create a narrative, so that the primary-care audience would
look at this information in total and feel more comfortable about opioids. And because the primary goal was to destigmatize,
we often left evidence behind. That’s not the only part of the American opioid
marketing playbook that’s started to travel worldwide. – Which brings us to the next rule: Give your experts a platform. Pay for medical journals, studies, and conferences
to educate doctors on the most important information. Consultants and key opinion leaders get paid
to speak at industry-funded conferences. – This is my declaration of interest as a consultant. I have many customers, so I also
work for many companies. – The reason you use a key opinion leader,
the reason you set up these speaker programs, is so that the attendees, the other doctors that go, hopefully, they’re going to feel more
comfortable prescribing your product, and when they go back to their practice,
they’re going to prescribe it more. – The prominence of the key opinion leader,
or thought leader, is such that, ‘Well, this person is the head of a major
pain center in New York or Boston. Who am I to question them?’ And yep, this is still happening around the world. – The role of the key opinion leader was to
convince the regular doctors like me that my reluctance and concerns for
patient safety were unfounded. Opioids were much safer than traditionally known
and could be used for much broader reasons. This is Tony O’Brien. In 2017, he received honoraria for lectures
and support for travel from Mundipharma. And this is O’Brien at a conference that same year
talking about opioid use for chronic pain. – In the general press, it’s all
about the opioid epidemic. And nobody’s talking about pain. There’s lots of misconceptions; that they’re
inherently dangerous, that they shorten life, that we’re going to see addiction as
being a problem—an exaggerated fear. The number of people in pain who are treated
with an opioid and who become addicted, that’s a very, very tiny percentage. Opioids are an essential tool. O’Brien’s main reference for his presentation
was a position paper he was lead author on. That paper was paid for by an organization
part-funded by three opioid manufacturers. It was published in a journal owned
by that industry-funded organization. And it was presented via a platform also
funded by an opioid manufacturer. – So that’s my, uh, disclosure. We reached out to Tony O’Brien,
who said the paper “best represents my views on the appropriate
use of opioids in chronic pain management.” But otherwise declined to comment on
his relationship to the industry. When we reached out to Mundipharma for this story,
the company said O’Brien’s paper was the best source on using opioids to treat chronic pain, saying it
reflected the conclusions of independent experts. And yet this is the conflicts of interest
disclosure for O’Brien and his co-authors. They received fees and grant
support, speaker’s fees, honoraria and consultancy fees
from all these companies: Archimedes, AstraZeneca, Cephalon, Grunenthal,
Roche, Janssen-Silag, Teva, GW Pharmaceuticals, Pfizer, Astellas…. Mundipharma. Nicholas Authier leads an observatory
tasked with watching for signs of the opioid crisis spreading to France. – You’re welcome. We went undercover to a pain conference in
France sponsored, in part, by Mundipharma, and we filmed with secret cameras. Tony O’Brien spoke at a
Mundipharma-hosted lunch there. – Thank you for your attendance.
It’s a great pleasure to be here. And my thanks to Mundipharma for
convening this important symposium. And we asked a speaker at the conference how she
felt about the pharmaceutical companies’ involvement. – The French Ministry of Health has a database
where I can look up any medical professional or medical organization and see if they have
any connection to any of these labs, including Mundipharma. Receiving financial support from the industry is
not an automatic indication of wrongdoing, but it’s happening a lot. In the past five years in France alone, we found 51,149
payments to health professionals from Mundipharma in exchange for attending medical
conferences, writing medical studies, giving scientific presentations, and more. Mundipharma told us it no longer directly promotes
opioids to health care professionals in Europe. Its companies do compensate some medical experts,
but only within industry guidelines, and do not write presentations for them. In Italy, the relationship between doctors and
pharma execs is under criminal investigation. Mundipharma Italy was accused of illegally paying
a well-known pain doctor for promoting opioids. Two executives accepted plea bargains
and lost their jobs. Mundipharma Italy was fined, along with another opioid
company, though all said they admitted no guilt. The doctor’s case is still ongoing. – Next, inform the patients. There is an epidemic of pain around the world. Patients don’t need to suffer. We’re here to help. If you have a lot of pain, you’re probably going
to ask Google what to do about it. So we did that. We found patient support groups and charitable
organizations with advice on how to treat pain. The thing is every one of the links we’re showing you
either is or gets money from an opioid manufacturer. We did this in different languages. Every one of these gets money
from an opioid manufacturer. – But 100 million people in Europe
who suffer from it shouldn’t be. It’s hard to find a chronic pain group that isn’t
financially connected to opioid manufacturers. Remember this ad? Supported by Mundipharma. These industry-funded groups published
materials with key talking points that sales reps like Panara would
hand out to prescribers. – These publications would have articles addressing concerns that doctors might have about opioids. So are your patients, you know, are they
experiencing a good quality of life? If not, you know, why not? As a representative, you want to work that
into the conversation with the doctor. You want the doctor to have that
conversation with the patient, and the end result is, hopefully, that leads
to more prescriptions to address it. That phrase, “quality of life,” appears a lot in
promotional material on chronic pain around the world. – When it’s your pain and your quality of life… – Your quality of life… – Treatment for chronic pain patients is
important to improve quality of life. To improve the quality of life… Improve the quality of life… Quality of life… Quality of life… – Thank you for giving me the opportunity to say something
about chronic pain from the patients’ perspective. So we met with the head of one
of these patient groups. Meet Joop Van Griensven, the president
of Pain Alliance Europe. – The crisis which you’re talking about is
mainly a crisis for the patients who need the opiates to get a better quality of life. If you deny them the opioids, they are
living in unbearable pain every day. Pain Alliance Europe describes itself
as a patient-led organization advocating for quality of life
for people with chronic pain. – Opiates are just a very good medication
for people with chronic pain. And if it’s done in the proper way, then
there’s no problem with opioids. Pain Alliance Europe includes 43
organizations in 19 countries. And Van Griensven says his organization
has received funding from multiple opioid manufacturers,
including Mundipharma. – The primary reason for pharmaceutical companies
to provide money to patient organizations, they want to do something on the
quality of life of the patients. And it most certainly is not
for selling products. – Unfortunately, it’s very
hard to find other funding. And governments don’t give huge
subsidies to patient organizations. – Yeah. Or you are invisible
and you don’t do anything, or you accept that you are working
with commercial funding. – There is an intentional blurring
of the lines by companies who want to sell product to say,
“We care about pain.” And of course we all care about pain. And then they say, “And the only way to solve
that is to buy a lot of the stuff we make.” And that is just not true. – Never see any advertising for
any products at all. – In our organization, and I only
speak for my organization of course, we don’t advertise for any kind of therapy. In the mid-1990s, an industry-funded patient
advocacy group called the American Pain Society recommended pain as the fifth vital sign. It made pain assessment as important a measure
of well-being as heart rate and breathing. – Vital signs include temperature, pulse,
respiration, blood pressure, and pain and are performed routinely in
every health care setting. It has since been cited as one of the drivers
that pushed doctors to prescribe more opioids. – There was a notion that pain
was the fifth vital sign, that you wanted to relieve pain,
that that was essential. You dosed until the pain was alleviated. – That, says Kessler, was a costly mistake. In 2016, the American Medical Association recommended
pain be eliminated from professional medical standards. And the American Pain Society filed
for bankruptcy over lawsuits accusing them of acting as a front
group for opioid manufacturers. Now, in the EU, the opioid manufacturer Grunenthal is
funding a Pain Alliance Europe-supported platform lobbying for ‘pain as a key indicator,’ as well
as chronic pain as a disease in its own right. – ICD11 is so important for the quality of life
of chronic pain patients across Europe. If you have chronic pain identified
as a disease in its own right, it will be more clear for politicians and policymakers
what the costs are for people to have chronic pain. Lobbying itself is… there’s nothing wrong with it. Because lobbying is trying to get things changed
in a way which gets improvement of what you want. – You are an industry spokesperson
if you are taking their money and that is supplying the funds
for your organization. You represent that industry then. Opioid manufacturers fund chronic
pain organizations across Europe.
00:26:56 ,420 –>00:27:01,769
– Unfortunately, the answer to
suffering hasn’t been opioids. I don’t want people with chronic pain to suffer.
I’m simply telling them the data is clear. These are not the answer. – And one of the most important
rules: keep your reputation clean. And remember it’s medicine, not drugs. – What’s going on? – I got two overdoses and
two babies in the back. – Purdue wanted to distance themselves from
what was going on as far as abuse. – She use? – Yeah. – Can you hear me? – Wake up on me! – Don’t fall asleep! – We were told if you’re going to refer
to OxyContin, refer to it as OxyContin. Never refer to it as oxy, because that’s
what it’s called on the street. So even in your call notes, if you’re trying
to type fast and you’re trying to abbreviate, if you say oxy, they’re going to flag it,
and you’re gonna get a phone call. – Abusers aren’t victims. They’re the victimizers. By the way, that’s a quote from
our very own Richard Sackler. – If there is an increase of overdose
deaths because of opiates, it’s about the abuse and the misuse of opiates. It has nothing to do with opiates being
available for people with chronic pain. – Multiple overdose deaths… There are allegations
of irresponsible prescribing practices. – The same risk you have to get
addicted to opioids is the risk you have in society to
get addicted to any drug. – The sales went up, the treatment admissions
went up, and the deaths went up. The slope of the curve was slightly different because
not everyone who takes opioids becomes dependent, and then another percentage becomes addicted,
so that the slope of the curve is different. But it went up proportionately and
exactly at the same time. – They’re totally different populations. People who are dependent are,
for the very large part, people who are using illicit substances
from the black market. – And remember: Drugs are bad. Medicine heals. This is an opioid drug factory in Pakistan.
00:30:05 ,340 –>00:30:09,538
They copy popular drugs in the legal pharmaceutical
world and produce cheaper alternatives. And then there’s the gray market, the intersection
of the legal market and the black market. – We are basically selling every popular medicine
which is available in the local pharmacies and more. Online markets like this company resell legitimate
prescription opioids around the world. – My job in this company is basically to
see which medicine is selling the most and to make sure that we have the availability. And if there is any new trend, we try our
best to cater to our customers’ needs. And the demand for opioid-based
medicine is going up drastically. – The legal opioid market and the illegal market are
a lot more closely connected than people realize. And when the legal market explodes,
it shows up in the illegal market. And a lot of those legal products
end up in the black market sold by people who got them legitimately. – I would strongly encourage anyone
viewing this problem as just like, “Oh it’s just the illicit stuff.
It’s not…” No. You view them as the same, OK? And that’s
because your brain views them as the same. They are intimately related. In the US, opioid prescriptions rose first, followed
by a rise in prescription opioid overdoses, an early sign of the crisis. Then, we saw an increase in overdoses from black
market drugs; first heroin, then fentanyl. Now the crisis is much bigger than
Purdue, OxyContin, and the US. Mundipharma is just one of many large,
international opioid manufacturers. And now opioids, both legal and illegal,
are seeding crises around the world. – Codeine is in large quantities.
Tramadol, you can buy cartons of it. – Where do they get it from? – Opioid-related deaths have
doubled in the last decade. – While millions of tablets are flooding the market,
the United Nations are now sounding the alarm. – The teen is one of the latest
victims of BC’s fentanyl crisis. It doesn’t have to be this way. More opioids
don’t automatically create a crisis. Take Germany, for example. They have one of the highest daily
doses of opioids in the world. And yet the country’s overdose rate is just
a tiny fraction of that in the US. One factor may be the way they treat chronic pain:
with a range of approaches, not just drugs. Germany also has strict anti-bribery laws which limit the monetary value of gifts big pharma
can give to health professionals each year. Regulations like that can be
a key line of defense. – You need to keep clear, blue water between corporate
industries who make their living by selling opioids, and the education of doctors, and the
conduct of the health care system. But monitors and regulators are also vulnerable. In Italy, the doctor accused of taking
kickbacks to promote opioids helped write one of the first laws in
Europe about chronic pain management, making it easier for doctors to prescribe opioids. A 30% spike in some opioid
prescriptions followed, and the Mundipharma executive accused
of corruption pushed for more. – I have no problem at all with the pharmaceutical
industry developing useful products. I’m glad they do. They save patients’ lives. But that does not mean that I have to condone,
as a public health professional or as a citizen, rampant pursuit of profit at
the expense of public health. – Now that you’re ready to go out and
make some sales, let’s recap: Create the demand. Present the solution. Handle objections. Close the deal. – That’s it. A core part of the industry playbook is to cite
a worldwide epidemic of untreated pain. And this part of the playbook
is actually true. There are plenty of countries in the world
where people in terrible pain need opioids. But the opioid the world needs more
of is cheap, generic morphine. Few companies are interested in promoting
it, because that’s not where the money is. The real money is in higher-cost
prescription medicine. So the pharmaceutical machine
is far from broken. Purdue’s total fines to date are just a small fraction
of their global network’s estimated annual revenue. And that network just keeps growing. – Mundipharma is actually now present globally. – It’s not only China, it’s emerging markets. – Expanding into new geographies… – Access to people in new markets… – Emerging markets, emerging markets,
emerging markets, emerging markets… – You can’t blame the drug company
for trying to sell the products. – Yes. – Actually, that’s what I’m saying. The economy in the country encourages companies
to advertise for their products. And whether you’re a gun company, or whether
you’re a pharmaceutical company, or whether you’re a car company,
you want to sell your product. And you’re actually forced to sell your
product because of the shareholders, because they want to make a profit. People should be aware that advertise
stuff is only used to sell the stuff. And it’s not to provide an honest and open view
on what the stuff is actually capable of doing.


  • Reply Why September 18, 2019 at 4:01 pm

    Uh oh

  • Reply 33Ddg209Ret7 September 18, 2019 at 4:06 pm

    Thanks China. This is warfare on the low income. Chinese fentanyl is the real monster in this war and responsible for the vast majority of these deaths. Some people with deadly diseases need these drugs and can't get them because of this bullshit. People should have to suffer a day in my life and then shoot down these drugs. I've been awake for five days from pain that drives 20% of the people to suicide with the disease I suffer. I hate junkies too but sick people are not criminals!

  • Reply 여행 유튜버 Rollin Joint September 18, 2019 at 4:08 pm

    I think im addicted to youtube. I’m a youtuber and one view and one like gives me high

  • Reply healingv1sion September 18, 2019 at 4:12 pm

    I don't think this drug should be illegal. It does help but only under certain circumstances. My mother was on fentanyl 4 days before her death. She didn't appear to be in pain and died unconscious and calmly. This medicine is not for long time use.

  • Reply Jarid Gaming September 18, 2019 at 4:25 pm

    Opioids shouldnt be illegal, but they shouldnt be handed out like candy either.

  • Reply A Zuri September 18, 2019 at 4:27 pm

    Hell it’s not half bad you should upload it as a podcast

  • Reply Dar Castro September 18, 2019 at 4:31 pm

    So you say that i can……….

    Sell drugs legally?!?

  • Reply Zeitgeist X September 18, 2019 at 4:47 pm

    Fake news, only we were stupid enough to allow broad use of opioids. In all other countries, Perdue tried but were never as successful as in the US and the international medical field was aware of the opioid holocaust in America and no where on this planet has perscription opioids taken hold like in the US. Literal fake news. 80% of perscription opioids globally goes to the US. In most of Western Europe its illegal for doctors to perscribe opiates for anyone but terminal cancer patients. So this is literally click bait journalism. The opioid crises hasnt gone global because in the rest of the developed world, doctors by law cannot perscribe opiates at all or only in narrowly defined circumstances. For example Japan, opiates are illegal for all circumstances except terminally ill patients. A US executive of a Japanese company was arrested for bringing her perscription opiates for her migraines into Japan. Quartz is dishonest and rather than make that clear and change their title. Opiates for migraines is illegal in nearly all developed countries. So will not be a global perscription opioid crises. That literally can only happen in America. The land of limited government. The rest of the developed world is too smart for that.

  • Reply The Greaten September 18, 2019 at 5:25 pm

    Danke für diese Dokumentation. Das ist wirklich erschreckend und andererseits überrascht es mich doch gar nicht. Traurig, dass es so viele Menschen gibt, die so geldgierig sind, dass sie auf das Leben so vieler Menschen einen Scheiß geben. Die können doch echt kein Gewissen haben… sonst würden sie daran zerbrechen wenn Ihnen klar werden würde, was sie da tun.

  • Reply zero September 18, 2019 at 5:27 pm

    There should be a documentary about antidepressant and anxiety "medicine" epidemic.

  • Reply Bryan Beck September 18, 2019 at 5:37 pm

    Based on what I have read and seen, many heroin addicts start using because they can no longer get opioids.

  • Reply omar oyt September 18, 2019 at 7:29 pm

    I don't think it will happen in Muslim countries lol

    I hope it doesn't our governments forgot our religion so it might as well happen

  • Reply Cyber Geek September 18, 2019 at 8:44 pm

    This is a ploy so when economys callapse people are desolate, people wont even know why, or when it happened, while they make money

  • Reply J L September 18, 2019 at 10:16 pm

    Force these opiod promoteurs to take it everyday for one yr, the survey if any of them addicted, and how many pecentage?

  • Reply Max Jensen September 18, 2019 at 11:17 pm

    Could the US Government revoke the US Patent for Opioids and regulate their disbursement and remove the profit incentive for their sale. Then they could just dissolve the company selling them.

  • Reply Marc James Levesque September 18, 2019 at 11:38 pm

    Opiates have been used effectively for hundreds if not thousands of years to treat pain. They're not going away, nor should they, unlike most prescription drugs which are noxious and should have never been manufactured in the first place. The cause of the so-called opioid epidemic lies not with the drugs themselves, but a social system that feeds on profits and opiate addiction.

  • Reply P B September 19, 2019 at 2:55 am

    This is such a well-made documentary. Kudos to you guys!

  • Reply ww3k September 19, 2019 at 3:09 am

    What an well researched and presented documentary!

  • Reply Drool Alot September 19, 2019 at 3:51 am


    I have my popcorn ? ready… I'll watch this from the sidelines…. Let me know when the drug dealers go to jail. Don't spend too much of my tax money on these sham rehab.

    Luckily those hillbillies will vote Trump in for another term…… Make sure you blame the Mexicans for your addiction and don't take responsibility for your actions ; you druggies.

    Stock tip though…. I've made a killing buying the stock of the company that makes narcan… Opiant (opnt)

  • Reply Abdul Malak September 19, 2019 at 8:36 am

    All the arguments the pharmaceutical industry uses can also be used for illegal drugs.

  • Reply Safasticated H September 19, 2019 at 10:18 am

    Lol the two treacherous Dutchmen, and here I thought the Dutch were people with integrity

  • Reply Lucas Zhu September 19, 2019 at 9:44 pm

    For some reason, morons in the comments. Disable the comments or try to moderate them.

  • Reply Sifiso Thwala September 20, 2019 at 7:29 am

    This was a good docie. Very informative…

  • Reply MrOhitsujiza September 20, 2019 at 11:58 am

    How America’s opioid epidemic is going global?

    Greedy subhuman scum and companies?
    Ooh thought so.

  • Reply E K September 21, 2019 at 10:42 am

    Incredible work y'all.

  • Reply E K September 21, 2019 at 10:42 am

    Incredible work y'all.

  • Reply Nigel Uchiha September 22, 2019 at 4:22 am

    Why should I care, I'm not hooked to opioids.

  • Reply Toby Royson September 22, 2019 at 12:41 pm

    whats with the comedy music at the start?

  • Reply MINSOO GONG September 22, 2019 at 2:24 pm

    Such a good video with a lot of work put in. It should be watched more

  • Reply Melchizedek Phuah Siow Jin September 26, 2019 at 12:02 pm

    This is a brilliant and timely documentary. Thank you very much.

  • Reply AssDust September 27, 2019 at 11:44 pm

    all about the money??

    ya, no shit.

  • Reply David van Dongen September 28, 2019 at 12:52 am

    weird that this video hasn't gained as much traction as it should have…

  • Reply Julia Lin September 29, 2019 at 2:05 pm

    28:39 what a heartbreaking scene

  • Reply potugadu October 6, 2019 at 11:02 am

    This is a good documentary about an important issue. That said, the frivolity (the doodles, Charles narrating the marketing playbook, etc.) was unnecessary and could've been left out of the documentary, in my opinion. Maybe they are supposed to provide some comic relief to the documentary on such a serious topic, but they just ended up looking out of place in the documentary —my 2 cents.

  • Reply Nik D October 9, 2019 at 10:35 pm

    They committed mass murders, but that's ok because they apologized! 7:50 … I wonder how many crosses his leather couch cost, and how many crosses his luxurious office!!
    Joop Van Griensven AND Willem Scholten MUST BE REMOVED ASAP !!! We don't want that shit in Europe !! enough is enough !

  • Reply Michael Ayeni October 23, 2019 at 1:56 am

    Highly underrated video.

  • Reply Vitas Zukowski October 23, 2019 at 3:13 pm

    Kudos for this well made piece, however I am still waiting for Quartz to cover the epidemic of benzodiapiene dependence and withdrawal, along with the corrupt practices behind peddling most psychiatric medications. For those drugs, adverse symptoms may include suicidal or homicidal ideation, not simply disabling addiction or withdrawal, and they are still being openly targeted towards the very populations (i.e. kids or patients with mania) the black box warnings mention.

  • Reply Bobby Howard October 27, 2019 at 5:22 am

    The problem is the illegal drugs on the streets.

  • Reply Cruzan October 28, 2019 at 1:50 am

    So now Big Pharma is turning outside of the USA to make huge profits. Greed knows no limits.

  • Reply Sandro D'assler October 29, 2019 at 11:15 am

    Legendas em português/ espanhol. ?

  • Reply Joel Levine December 12, 2019 at 6:01 pm

    You people abuse the pills thats why theres a problem. Stop blaming someone else

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