Good morning. This is David Ovalle, a health writer focusing on opioids and addiction. We teamed up with newsrooms in other countries to delve into Mundipharma, the group of international pharmaceutical companies that sell opioids and other drugs. But first, email tips to david.ovalle@washpost.com.
How some Sackler companies continue to profit off opioid sales abroad
At home in the United States, Purdue Pharma, the drugmaker accused of fueling the opioid crisis through its aggressive marketing of highly addictive pain pills, is bankrupt and facing thousands of lawsuits. Abroad, global counterparts are selling opioids — and still profiting.
Among the beneficiaries: some members of the Sackler family, who own Purdue and also sit atop a group of international companies known as Mundipharma, records show. The family faces a wave of litigation over Purdue’s alleged role in an opioid crisis that has claimed hundreds of thousands of lives and ruined countless more throughout the United States.
From 2020 to 2022, nine Mundipharma companies in Europe and Australia made profits of $531 million on sales and distribution of pharmaceutical and other products, according to a first-of-its-kind analysis conducted as part of an investigation by journalists in eight countries. Total profits are probably higher because the figure does not include amounts, if any, from Mundipharma companies in jurisdictions that do not require disclosure of financial data.
The analysis provides a glimpse into Mundipharma’s value to possible buyers as the Sacklers approach a Sept. 27 bankruptcy court deadline that could end the mediation meant to determine how much the family could have to pay to settle lawsuits related to the opioid crisis.
Why it matters: The Sacklers have previously pledged to sell their international companies to compensate U.S. cities, states, tribes, victims and others ravaged by the epidemic. Purdue, based in Stamford, Conn., still sells opioids such as oxycodone, though the company has been saddled with years of investigations, litigation and a massive bankruptcy reorganization.
The investigation found some of the same tactics used to persuade a generation of U.S. doctors that potent painkillers could be safely prescribed have been used abroad.
Mundipharma said “strong” opioids now make up a smaller share of the companies’ total sales as they have diversified into other treatments. It stressed that the companies strive to adhere to local laws and regulations and work with local authorities to monitor for drug diversion or abuse.
“We recognise that there are risks associated with the use of prescription opioid medications, so all employees, regardless of role, undertake mandatory opioid awareness training,” the company said.
Health effects overseas: In Europe and elsewhere, pharmaceutical marketing regulations and drug approval systems may guard against reaching the scale of America’s opioid crisis, experts say.
Pain afflicts millions globally, according to the World Health Organization, which says morphine and other opioids are essential for treating pain associated with surgeries, cancer and emergency care but are difficult to obtain in many low-income countries. Still, pharmaceutical industry practices are contributing to more overdoses and addiction, especially when doctors too aggressively prescribe opioids after surgeries or to patients with conditions such as long-term back pain or arthritis, critics say.
“There’s very little evidence that they’re actually useful” for chronic pain, said Kyla Thomas, a doctor and professor of public health medicine at the University of Bristol.
Read the full story here.
On the Hill
Senate Democrats mount another push on IVF
On tap today: Senate Majority Leader Chuck Schumer (D-N.Y.) will call another vote on a legislative package aimed at establishing a federal right to IVF and making it easier for people to access the popular fertility treatment.
The vote marks the latest Democratic attempt to pressure the GOP to take a stance on an issue that Donald Trump claimed to be a “leader” on during last week’s presidential debate. In June, Senate Republicans blocked the bill just days after all members signed a statement expressing “strong support” for IVF, dismissing the vote as political grandstanding.
A closer look: In August, Trump pledged that if he returns to the presidency, he would require the government or private insurance companies to cover all costs associated with IVF. The announcement was delivered with few details, prompting a mix of skepticism and opposition among his supporters.
In a “Dear Colleague” letter on Sunday, Schumer noted that Trump’s insurance proposal is a “key provision” included in Sen. Tammy Duckworth’s (D-Ill.) bill. Still, the legislation faces steep odds in today’s vote, with only two Republicans — Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) — supporting it earlier this year.
In other news from the upper chamber …
A group of more than 250 clinicians nationwide is urging lawmakers to cap the prices of next-generation diabetes and obesity treatments.
The letter sent to Senate health committee Chair Bernie Sanders (I-Vt.) and ranking member Bill Cassidy (R-La.) comes ahead of a hearing next week on the issue where Novo Nordisk CEO Lars Jørgensen is set to testify.
On our radar: Sanders will host a discussion this morning with experts on the cost of Ozempic and Wegovy in the United States, where he’s expected to share new details from his talks with drugmakers on pricing and production.
Meanwhile, across the Capitol …
The House is gearing up to vote on a slew of health-care bills under suspension of the rules.
Up for consideration: expanding access to treatments for kids with complex medical conditions, improving insurance coverage for chronic diseases and tackling language barriers in health care.
Also on the table are bills to reauthorize Alzheimer’s and traumatic brain injury programs, increase funding for Down syndrome research and fight fraud in Medicare and Medicaid.
Agency alert
Report: Inpatient sepsis hospital stays increased almost 40 percent over five years
The number of sepsis-related inpatient stays at non-federal acute-care hospitals in the United States jumped from 1.8 million in 2016 to 2.5 million in 2021, with a faster rate of increase after the emergence of covid-19, the Agency for Healthcare Research and Quality told Congress in a new report.
The financial impact: The total cost for inpatient stays because of sepsis increased from $31.2 billion to $52.1 billion over the five-year period, making it one of the most expensive conditions treated in U.S. hospitals. Medicare was expected to pay over half of those costs, and Medicaid almost 20 percent, the report said.
- Patients with sepsis also face a high risk of hospital readmission and, for those who survive, often require home health care, long-term care or skilled nursing because of lasting effects such as cognitive impairment and physical disability, the agency notes.
Next steps: To enhance care and outcomes, the report recommends updating international sepsis guidelines, care bundles and quality improvement initiatives. The agency also calls for more research on the burden of sepsis and its long-term effect on patients and health-care providers.
Data point
Superbug alert 🚨
More than 39 million people could die from antibiotic-resistant infections by 2050, The Post’s Lizette Ortega reports, citing a new study published in the Lancet.
Authors of the study forecast a nearly 70 percent spike in deaths from drug resistance from 2022 to 2050, with older people most at risk and driving the rise in fatalities. Long identified as a public health concern, antimicrobial resistance occurs when bacteria, fungi and other microbes evolve in a way that makes them harder to kill with existing medications.
State scan
Louisiana hospitals and pharmacists prep for new abortion pill rules
Louisiana providers are scrambling to prepare for a first-of-its-kind law, set to take effect in two weeks, that will classify two drugs used for abortions, incomplete miscarriages and postpartum hemorrhages as “controlled dangerous substances,” The Post’s Emily Wax-Thibodeaux reports.
A closer look: Staff in some hospitals are doing timed drills, sprinting from patient rooms and through halls to the locked medicine closets where mifepristone and misoprostol will have to be kept starting Oct. 1.
Pharmacists, meanwhile, are still trying to decipher guidance from state officials about the two drugs and the diagnosis codes that will be required before prescriptions for them can be filled. They and doctors are also speaking out about the extra layers of danger and difficulty expected because of the law, which some fear will cause recent improvements in the state’s dismal maternal mortality outcomes to falter.
The bigger picture: Abortion opponents believe that narrowing access to the drugs could be another path to restricting a patient’s ability to terminate a pregnancy, and hope Louisiana’s approach will be a template for others. The law, passed this spring despite significant opposition from doctors, threatens incarceration and fines if an individual possesses the pills without a valid prescription or outside of professional practice.
In other health news
- The Food and Drug Administration released draft guidance on how oncology companies can run multi-regional clinical trials to support U.S. cancer drug approval applications.
- The Advanced Research Projects Agency for Health launched an initiative to increase access to government funding for early career researchers and community health centers.
- On the move: Shawn Bishop will leave the Senate Finance Committee next month. The Democratic staffer played a major role in crafting key provisions of the Inflation Reduction Act and the Affordable Care Act, per Stat’s John Wilkerson and Rachel Cohrs Zhang.
Health reads
Sugar rush
@docschmidt Sometimes, doctors just don’t give helpful advice
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