美国国家公共电台 NPR A Drugmaker Tries To Cash In On The Opioid Epidemic, One State Law At A Time

 

AUDIE CORNISH, HOST:

For the millions of Americans addicted¹ to opioids like heroin² and prescription³ painkillers⁴, some of the most effective treatments are medications. But addiction⁵ treatment is also a business, and an investigation⁶ by NPR and Side Effects Public Media reveals that the manufacturer of one of those medications is trying to make it harder to access its competitors. And this is happening across the United States. Jake Harper of member station WFYI starts us out in Indianapolis.

ANGELA TURNER: These are the films. They also have the pill.

NATE TURNER: OK.

A. TURNER: And that's what it looks like.

JAKE HARPER, BYLINE⁷: Angela and Nate Turner were trying to quit heroin last year, so they saw a doctor, and he prescribed a drug called Suboxone. Angela said it helped her feel normal.

So you could function.

A. TURNER: Yeah, you can function, but you're not high.

HARPER: But she had to wait to get her prescription filled. It took three days for her insurance company to agree to pay for the medication. The wait put her into withdrawals⁸.

A. TURNER: Laying in bed, going through cold sweats, hot sweats...

N. TURNER: Diarrhea.

A. TURNER: ...Diarrhea.

HARPER: Angela had to take care of her daughter. She was tempted⁹ to go back and use.

A. TURNER: It's either that or lay there and not being able to get up and feed your kid and do what you're supposed to be doing, you know?

HARPER: For her husband, Nate, the wait was too much. He used heroin again. If the Turners had been prescribed another drug called Vivitrol, they wouldn't have faced the same delays. But that wasn't the medication their doctor thought they needed. The three FDA-approved addiction medicines work differently for different patients, and addiction experts say they all need to be available. But in many places, options are limited.

Alkermes, the company that makes Vivitrol, has lobbied in statehouses around the country and Congress to promote its drug. Its lobbyists are pushing for regulations that put other treatments at a disadvantage and also for laws that explicitly¹⁰ favor Vivitrol. The approach was blatant¹¹ at a hearing a couple years ago - February 4, 2015, the Indiana House Committee on Public Health.

(SOUNDBITE OF ARCHIVED RECORDING)

STEVE DAVISSON: OK, thank you, Mr. Chairman and members of the committee.

HARPER: Representative Steve Davisson introduced a bill to allow insurers to delay paying for drugs like Suboxone, like what happened to Angela and Nate. This is what's called prior authorization¹², and the bill would forbid those delays on another medication.

(SOUNDBITE OF ARCHIVED RECORDING)

DAVISSON: The drug that we're referring to here is Vivitrol.

HARPER: Davisson explained why.

(SOUNDBITE OF ARCHIVED RECORDING)

DAVISSON: What that does is it encourages folks to go with the nonaddictive medications as their first choice.

BASIA ANDRAKA-CHRISTOU: Wow, yeah, I saw that for the first time today.

HARPER: I showed the bill to Basia Andraka-Christou, a researcher at the Fairbanks School of Public Health.

ANDRAKA-CHRISTOU: So to have, you know, in legislation specifically stating that one medication needs prior authorization while another one doesn't, that is pretty explicitly saying that, we're going to hamper¹⁴ one medication more so than the other.

HARPER: She has a problem with the phrase nonaddictive medication, too. I'll come back to that. But Alkermes had a hand in this bill. Davisson said that one of Indiana's best-known advocates for addiction policy, a man named Steve McCaffrey, helped draft it. McCaffrey runs a nonprofit called Mental Health America of Indiana. And that day in February, he testified on the bill.

(SOUNDBITE OF ARCHIVED RECORDING)

STEPHEN MCCAFFREY: We need to move Indiana toward evidence-based treatment. This bill would do that.

HARPER: McCaffrey didn't mention that he's also a lobbyist for Alkermes, but state records show he is.

Do people in the statehouse that you work with - do they know about this Alkermes connection?

MCCAFFREY: I mean I imagine some do, and some don't.

HARPER: I asked several lawmakers who have worked with McCaffrey on addiction issues, and none of them knew he lobbied for the company. And McCaffrey's efforts helped Indiana become what Alkermes calls an up-and-coming state where the drug sales are set to rise.

Vivitrol is a shot of a drug called Naltrexone, and it could be a blockbuster for Alkermes. Sales could reach a billion dollars within the next few years. At an investor¹⁵ event in 2016, CEO Richard Pops said his company has a special mission.

(SOUNDBITE OF ARCHIVED RECORDING)

RICHARD POPS: We find ourselves really deeply dedicated¹⁶ to bringing new medicines to patients and profoundly affecting their lives.

HARPER: But to do that, they're using tactics that fuel misconceptions about addiction. There are only three drugs that can treat opioid addiction.

ANDREW CHAMBERS¹⁷: All these medications have their pros¹⁸ and cons¹⁹.

HARPER: Andy Chambers is a psychiatrist²⁰ in Indianapolis. It breaks down like this. Two of the drugs are actually opioids - methadone and buprenorphine, better known as Suboxone, the drug the Turners were taking. They reduce cravings and prevent withdrawals and help people get their lives together.

CHAMBERS: If the addiction is the monster, methadone and Suboxone cage the monster.

HARPER: There are decades of research to back this up. But Chambers says it's hard for some people to grasp using an opioid to treat opioid addiction.

CHAMBERS: I think that when you sit down with people and you explain it and you talk about the science, eventually most people can get it. But you know, there's some people that just can't accept it.

HARPER: Then there's Vivitrol, which he says avoids some of that stigma²¹.

CHAMBERS: Vivitrol is not an opioid. In fact it's an opioid blocker.

HARPER: For policymakers who are not experts in addiction medicine, that's really appealing. But Vivitrol is not a one-size-fits-all solution. It's expensive, and to use it, patients must first go through a painful detox. Policies favoring Vivitrol can hurt people who need the other drugs, people like Angela and Nate Turner. Indiana state code now has at least 11 instances of a phrase that describes Vivitrol in sections dealing²² with criminal justice and addiction treatment - that term again.

(SOUNDBITE OF ARCHIVED RECORDING)

DAVISSON: The nonaddictive medication.

HARPER: Andraka-Christou, a researcher, says that using that phrase again and again could feed into stigma.

ANDRAKA-CHRISTOU: Even using nonaddictive suggests that the other ones are super addictive¹³ even though for most people, they're helpful and not abused.

HARPER: To Corey Waller with the American Society of Addiction Medicine, promoting a brand-name drug in law is a problem.

COREY WALLER: I think anyone who's willing to put somebody's advertisement in legislation should be ashamed of themselves.

HARPER: And he says Alkermes is using the stigma surrounding the other addiction medicines to tilt²³ policy in its favor.

WALLER: It's a little bit beyond the pale when they start to lock things down. When they lock down access to evidence-based treatments via legislation and that's their goal, I have to say, it's just unethical.

HARPER: Alkermes is targeting other states, too. We found variations of that phrase that refers to Vivitrol in dozens of bills outside Indiana. And the company is supporting efforts that could hamper access to other treatments. State Senator John Eklund authored a bill in Ohio which adds regulations to buprenorphine prescribers. Critics say making it harder to prescribe medicines like Suboxone may make some doctors steer²⁴ clear entirely²⁵. But Alkermes...

JOHN EKLUND: Well, they applauded the bill. Their interest was in, is there anything that they can do because Suboxone had such a toehold here in the state of Ohio? And you know, they're looking to expand their business.

HARPER: Alkermes spent years lobbying at the federal level, too, spreading one-sided information about buprenorphine and pushing for tighter regulation of the drug. A Democratic congressional staffer told me it was one of the most intense, frustrating²⁶ lobbying efforts they had ever seen. After our initial interview, Steve McCaffrey, the lobbyist in Indiana, wouldn't talk further. He says he's in favor of all treatment options.

MCCAFFREY: I've always said that we need to use all the tools in the toolbox for treatment.

HARPER: But a list of bills McCaffrey has worked on shows a pattern of favoring Vivitrol and adding regulations to buprenorphine and methadone. Leaders at Alkermes wouldn't talk to us. In a written statement, the company echoed McCaffrey, saying doctors should determine what medication is prescribed.

But behind the scenes, Alkermes is trying to make that harder, and policies the company supports can hurt people like Angela and Nate Turner. They said having to wait days for their medication was wrong. Doctors easily got them hooked on opioid painkillers. It was difficult for a doctor to help them quit.

N. TURNER: You know, we're not trying to just get pain medication just get it. We're actually - need these things to help us back into...

A. TURNER: Society, right.

N. TURNER: ...Society and be productive.

HARPER: The people who treat addiction say that's the goal with every patient. And the millions of people suffering from the disease need access to all of the medications, not just one. For NPR News, I'm Jake Harper.

(SOUNDBITE OF GLASS ANIMALS SONG, "POOLS")

CORNISH: You can find more about this investigation at npr.org. This story was produced in collaboration²⁷ with Side Effects Public Media and WFYI.

(SOUNDBITE OF GLASS ANIMALS SONG, "POOLS")

1 addicted   

adj.沉溺于....的，对...上瘾的

参考例句：

• He was addicted to heroin at the age of 17.他17岁的时候对海洛因上了瘾。
• She's become addicted to love stories.她迷上了爱情小说。

2 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

3 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

4 painkillers   

n.止痛药( painkiller的名词复数 )

参考例句：

• The doctor gave him some painkillers to ease the pain. 医生给了他一些止疼片以减缓疼痛。 来自辞典例句
• The primary painkillers - opiates, like OxyContin - are widely feared, misunderstood and underused. 人们对主要的镇痛药——如鸦片剂奥施康定——存在广泛的恐惧、误解，因此没有充分利用。 来自时文部分

5 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

6 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

7 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

8 withdrawals   

n.收回，取回，撤回( withdrawal的名词复数 )；撤退，撤走；收回[取回，撤回，撤退，撤走]的实例；推出（组织），提走（存款），戒除毒瘾，对说过的话收回，孤僻

参考例句：

• He has made several withdrawals from his bank account. 他从银行账户上提了几次款。 来自《简明英汉词典》
• It is not the bank's policy to deduct interest on withdrawals. 提款需扣除利息这并非是本银行的政策。 来自辞典例句

9 tempted   

v.怂恿（某人）干不正当的事；冒…的险（tempt的过去分词）

参考例句：

• I was sorely tempted to complain, but I didn't. 我极想发牢骚，但还是没开口。
• I was tempted by the dessert menu. 甜食菜单馋得我垂涎欲滴。

10 explicitly   

ad.明确地，显然地

参考例句：

• The plan does not explicitly endorse the private ownership of land. 该计划没有明确地支持土地私有制。
• SARA amended section 113 to provide explicitly for a right to contribution. 《最高基金修正与再授权法案》修正了第123条，清楚地规定了分配权。 来自英汉非文学 - 环境法 - 环境法

11 blatant   

adj.厚颜无耻的；显眼的；炫耀的

参考例句：

• I cannot believe that so blatant a comedy can hoodwink anybody.我无法相信这么显眼的一出喜剧能够欺骗谁。
• His treatment of his secretary was a blatant example of managerial arrogance.他管理的傲慢作风在他对待秘书的态度上表露无遗。

12 authorization   

n.授权，委任状

参考例句：

• Anglers are required to obtain prior authorization from the park keeper.垂钓者必须事先得到公园管理者的许可。
• You cannot take a day off without authorization.未经批准你不得休假。

13 addictive   

adj.(吸毒等)使成瘾的，成为习惯的

参考例句：

• The problem with video game is that they're addictive.电子游戏机的问题在于它们会使人上瘾。
• Cigarettes are highly addictive.香烟很容易使人上瘾。

14 hamper   

vt.妨碍，束缚，限制；n.(有盖的)大篮子

参考例句：

• There are some apples in a picnic hamper.在野餐用的大篮子里有许多苹果。
• The emergence of such problems seriously hamper the development of enterprises.这些问题的出现严重阻碍了企业的发展。

15 investor   

n.投资者，投资人

参考例句：

• My nephew is a cautious investor.我侄子是个小心谨慎的投资者。
• The investor believes that his investment will pay off handsomely soon.这个投资者相信他的投资不久会有相当大的收益。

16 dedicated   

adj.一心一意的；献身的；热诚的

参考例句：

• He dedicated his life to the cause of education.他献身于教育事业。
• His whole energies are dedicated to improve the design.他的全部精力都放在改进这项设计上了。

17 chambers   

n.房间( chamber的名词复数 )；（议会的）议院；卧室；会议厅

参考例句：

• The body will be removed into one of the cold storage chambers. 尸体将被移到一个冷冻间里。 来自《简明英汉词典》
• Mr Chambers's readable book concentrates on the middle passage: the time Ransome spent in Russia. Chambers先生的这本值得一看的书重点在中间：Ransome在俄国的那几年。 来自互联网

18 pros   

abbr.prosecuting 起诉；prosecutor 起诉人；professionals 自由职业者；proscenium （舞台）前部n.赞成的意见( pro的名词复数 )；赞成的理由；抵偿物；交换物

参考例句：

• The pros and cons cancel out. 正反两种意见抵消。 来自《现代英汉综合大词典》
• We should hear all the pros and cons of the matter before we make a decision. 我们在对这事做出决定之前，应该先听取正反两方面的意见。 来自《简明英汉词典》

19 cons   

n.欺骗，骗局( con的名词复数 )v.诈骗，哄骗( con的第三人称单数 )

参考例句：

• The pros and cons cancel out. 正反两种意见抵消。 来自《现代英汉综合大词典》
• We should hear all the pros and cons of the matter before we make a decision. 我们在对这事做出决定之前，应该先听取正反两方面的意见。 来自《简明英汉词典》

20 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

21 stigma   

n.耻辱，污名；(花的)柱头

参考例句：

• Being an unmarried mother used to carry a social stigma.做未婚母亲在社会上曾是不光彩的事。
• The stigma of losing weighed heavily on the team.失败的耻辱让整个队伍压力沉重。

22 dealing   

n.经商方法，待人态度

参考例句：

• This store has an excellent reputation for fair dealing.该商店因买卖公道而享有极高的声誉。
• His fair dealing earned our confidence.他的诚实的行为获得我们的信任。

23 tilt   

v.(使)倾侧；(使)倾斜；n.倾侧；倾斜

参考例句：

• She wore her hat at a tilt over her left eye.她歪戴着帽子遮住左眼。
• The table is at a slight tilt.这张桌子没放平，有点儿歪.

24 steer   

vt.驾驶，为…操舵；引导；vi.驾驶

参考例句：

• If you push the car, I'll steer it.如果你来推车，我就来驾车。
• It's no use trying to steer the boy into a course of action that suits you.想说服这孩子按你的方式行事是徒劳的。

25 entirely   

ad.全部地，完整地；完全地，彻底地

参考例句：

• The fire was entirely caused by their neglect of duty. 那场火灾完全是由于他们失职而引起的。
• His life was entirely given up to the educational work. 他的一生统统献给了教育工作。

26 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

27 collaboration   

n.合作，协作；勾结

参考例句：

• The two companies are working in close collaboration each other.这两家公司密切合作。
• He was shot for collaboration with the enemy.他因通敌而被枪毙了。