Thank you so much, Neil, for kicking off this third week and bringing these important issues to our attention.
I want to emphasize that the Purdue case, while paradigmatic, is not unique, and share with all of you information about the Opioid Industry Documents Archive (OIDA), a relatively recent but invaluable tool for understanding the opioid epidemic in depth.
OIDA is a public digital repository, created in 2021 by the University of California, San Francisco and Johns Hopkins University, that brings together millions of internal opioid industry documents made public primarily through litigation in the United States.
- It contains millions of pages (over 16 million) from pharmaceutical companies, distributors, consulting firms, and pharmacies.
- It includes emails, internal reports, marketing strategies, court testimonies, and regulatory documents.
- It is open access and follows a similar tradition to the tobacco industry archives.
Its central objective is to preserve, organize, and make accessible primary evidence on the role of the opioid industry in the opioid epidemic.
You can access it at: https://www.industrydocuments.ucsf.edu/opioids/
What does OIDA contribute to our understanding of the opioid epidemic?
1. Direct evidence of the commercial drivers of the epidemic. One of OIDA's greatest contributions is that it allows us to study the crisis "from within" the industry.
2. Understanding systemic failures. The archive allows us to analyze how multiple systems failed simultaneously:
- Insufficient regulation
- Medical practices influenced by marketing
- Lack of adequate distribution control
- Lack of monitoring of suspicious orders
Taken together, these factors explain why the US has reached a point where overdose deaths exceed historical levels.
3. Global Relevance (Beyond the US). Although OIDA focuses on the US crisis, its importance is clearly global:
1. Anticipation of Epidemics in Other Countries
Many countries are in the early stages of increased opioid use. OIDA allows us to:
- Identify market expansion strategies
- Detect risks before similar epidemics take hold
2. Lessons for Public Policy
The archive offers concrete evidence for:
- Regulation of pharmaceutical marketing
- Prescription control
- Distribution monitoring systems
3. Conceptual Framework: Commercial Determinants of Health. OIDA contributes to consolidating the approach of:
- Commercial determinants of health, showing how corporate decisions directly influence the burden of disease
The documents show that:
- Aggressive and deceptive marketing strategies were implemented, minimizing [maximising - NPW] the risk of addiction.
- The widespread use of opioids was promoted for broad indications, beyond the evidence.
- Commercial incentives prioritized sales volume over safety. This transforms the narrative: the epidemic is not just a clinical or individual behavioral problem, but a phenomenon driven by commercial determinants of health.
Taken together, these factors could explain why the US has reached a point where overdose deaths exceed historical levels.
Regarding the pharmaceutical industry and opioid consumption in Latin America, while information exists, it is much more limited than in the United States.
As I have already stated, the available evidence does not (yet) show an equivalent epidemic, but it does show clear signs of market expansion strategies and emerging risks that are highly consistent with what has been documented in OIDA for the United States.
Some studies explicitly indicate that, following the opioid crisis in the United States, the industry has viewed Latin America as an emerging market.
It is documented that the pharmaceutical industry has used strategies similar to those in the US to promote opioids in the region, and that the region has been identified as a “potentially strong market” for opioid expansion.
As in the US (according to OIDA), in Latin America the influence is not always direct, but rather mediated by influencing medical education and clinical practices.
- Taking advantage of the lack of adequate training on opioids and pain management.
- Exerting influence through educational materials and clinical guidelines.
This creates an environment where the industry can influence: Prescription indications and the perception of addiction risk.
Referencias
· The Opioid Industry Documents Archive: A Living Digital Repository https://pmc.ncbi.nlm.nih.gov/articles/PMC9342819/
· World Opioid and Substance Use Epidemic: A Latin American Perspective
Psychiatr Res Clin Pract. 2019 Jan 24;1(1):32–38. doi: 10.1176/appi.prcp.20180009
https://pmc.ncbi.nlm.nih.gov/articles/PMC9175731/?utm_source=chatgpt.com
· Drugs, Violence, and Capitalism: The Expansion of Opioid Use in the Americas. Paulo José dos Reis Pereira https://journals.sagepub.com/doi/10.1177/0094582X20975007?utm_source=cha...
Kind regards,
Eduardo
Eduardo Bianco, MD, MSc, BIR
ATHP Director
Addiction Training for Health Professionals
Email: ebianco@nextgenu.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master's in Prevention and Treatment of Addictive Disorders. Bianco also has a degree in International Relations. Currently, he is Director of International Policy Education in Addictions of the Frank Foundation for International Health and Member of the Interim Policy Committee of the Global Alliance for Tobacco Control (GATC). He had a prominent role in promoting smoking cessation, tobacco control, WHO-FCTC implementation and NCD control in his country (Uruguay) as well as in Latin America for over 25 years. Bianco participated directly in most of the development process of the WHO-Framework Convention on Tobacco control and in the Sessions of the Conference of the Parties to this treaty. He was Director or Tobacco Control Program of InterAmerican Heart Foundation, Regional Coordinator for the Americas of the Framework Convention Alliance (FCA), Chair of the Tobacco Expert Group of the World Heart Federation and Technical Director of the MOH Center for International Cooperation for Tobacco as well as Founder and Former President of the Tobacco Epidemic Research Center (CIET) in Uruguay. Eduardo helps coordinate the HIFA working group on substance use disorders. https://www.hifa.org/support/members/eduardo