In addition to direct lobbying of lawmakers, drug companies channel their message through front groups that present themselves as “objective.” The sleaziest kind of front group is the nonprofit, often no more than a tax-exempt ID number, a ream of letterhead, and a room in the office of a PR company. Invoking a distinguished membership, the group presents the “scientific” side of an issue to lawmakers and medical professionals — without disclosing that a drug company supplied both the medium and the message.
A less cynical type of front is the patient-advocacy group. After taking money from the drug companies, advocates become their unwitting mouthpieces.
For example, when US Representative Pete Stark (D-California) began drafting a bill for prescription accountability last year, he received calls from such advocates as the Anxiety Disorders Association, the California Cancer Pain Initiative, and the Oncology Nursing Society. They were concerned that Stark’s legislation would stop patients from getting the drugs they needed — a misconception promoted by lobbyists. Not coincidentally, each group is dependent on pharmaceutical largesse.
Several states already have a drug law known as triplicate prescription, or “trip scrip.” Every time a doctor writes a prescription for narcotics, amphetamines, or barbiturates, he or she has to file one copy with the state health agency. Variations exist: New York has added benzodiazepines — the class that includes Xanax — to its regulated pharmacopoeia. Under Oklahoma’s electronic system, pharmacists report prescriptions just as they report charges on a credit card. Stark’s proposal would take it one step further, requiring pharmacists nationwide to report all prescriptions. On April 1 of this year, the Massachusetts Department of Public Health began using a system similar to Oklahoma’s — but benzodiazepines are not among the drugs covered by the new regulations.
One goal of trip scrip is to monitor the black market. Truck drivers, for example, stay up with amphetamines, and crackheads come down with Xanax. In Washington, where Xanax is known on the street as “Double X,” street use is growing and dangerous. The drug can be lethal when mixed with alcohol, and abusers often land in the emergency room.
In addition to tracking “scrip doctors,” who knowingly prescribe to abusers, trip scrip identifies doctors with bad prescribing habits. According to recent estimates, careless doctors have put two million senior citizens in the United States at risk of becoming dependent on tranquilizers. No one knows how many of them are currently hooked.
New York’s monitoring of “benzos” is widely viewed as a success. The program has cut prescriptions, reduced street sales and overdoses, and saved the state Medicaid program $37 million in two years. “Nobody is saying benzodiazepines are bad drugs,” explains Arthur Levin, head of New York’s Center for Medical Consumers and a champion of trip scrip. “They’re drugs whose risks have been understated, and which are prescribed for longer than they should be.”
Attempts to control legal drug abuse and dependence have long been opposed by the pharmaceutical industry, which rightly fears such regulation will cut into profits. Trip scrip is no exception. After feeling the pinch in New York, leading benzo manufacturers Upjohn and Hoffman-La Roche joined forces to prevent the model from being copied elsewhere. The legerdemain in this one campaign shows just how sophisticated the industry’s covert operations can be.