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（在线收听）

AUDIE CORNISH, HOST:

For the millions of Americans addicted to opioids like heroin and prescription painkillers, some of the most effective treatments are medications. But addiction treatment is also a business, and an investigation 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, BYLINE: 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 withdrawals.

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 tempted 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 explicitly favor Vivitrol. The approach was blatant at a hearing a couple years ago - February 4, 2015, the Indiana House Committee on Public Health.

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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 authorization, and the bill would forbid those delays on another medication.

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

HARPER: Davisson explained why.

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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 hamper 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.

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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 investor event in 2016, CEO Richard Pops said his company has a special mission.

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RICHARD POPS: We find ourselves really deeply dedicated 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 CHAMBERS: All these medications have their pros and cons.

HARPER: Andy Chambers is a psychiatrist 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 stigma.

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 dealing with criminal justice and addiction treatment - that term again.

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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 addictive 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 tilt 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 steer clear entirely. 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, frustrating 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.

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

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