In 2017, more people in the US died from overdoses involving opioids than from HIV- or AIDS-related illnesses at the peak of the AIDS epidemic. In 2019, 70,630 drug overdose deaths occurred in the country, 70.6 per cent of which involved opioids—mainly synthetic opioids (other than the heroin substitute methadone)—as reported by the Centers for Disease Control and Prevention (CDC). In 2020, opioids alone killed 74,000 Americans as overdoses almost doubled. While the opioid crisis in the US is officially recorded to have started in the late 90s—which is in fact the first time US politicians finally admitted the country had an alarming problem following the laid groundwork for the crisis in the 80s—it’s clear to see that the epidemic is still creeping its way across the nation, deadlier than ever. A sad reality that was blamed on the victims themselves, and not anyone else. Until now.
On Tuesday 23 November 2021, US drug store giants CVS, Walgreens, and Walmart were found liable by a federal jury in Cleveland for contributing to the US opioid epidemic by distributing millions of pain pills in two Ohio counties. It marks the very first time that pharmacy companies have faced legal consequences for their role in the public health crisis.
The jurors concluded that the pharmacy chains created a public nuisance by over-distributing painkillers in Trumbull and Lake counties in northeast Ohio, which in turn led to an oversupply of addictive pills that ended up on the black market. Two other pharmacy chains—Rite Aid and Giant Eagle—have already settled lawsuits with the counties.
The scale of compensation, to be paid to the two counties, will be decided at a future hearing. In the meantime, CVS and Walgreen have already said they will appeal against the judgement while Walmart, which also contested the cases, did not immediately comment.
“Local and state governments say the painkiller epidemic put huge strain on their resources as they tried to tackle it through social programmes and the legal system,” wrote the BBC when reporting on the news. “There are around 3,300 other cases being brought in an attempt to recoup some of those costs from firms that profited from the sales of the painkillers,” it continued.
While opioid addiction is not a new phenomenon in the US, it never had such a marked impact on the nation as a whole before. After pain increasingly became recognised as a problem that required adequate treatment, states began to pass intractable pain treatment acts, which removed the threat of prosecution for physicians who treated their patients’ pain aggressively with controlled substances.
That being said, at the time, opioids were prescribed mainly for short-term uses such as pain relief after surgery or for people with advanced cancer or other terminal conditions. Things truly started to go south for Americans once the idea that opioids might be safer and less addictive, than was previously thought, began to take root.
During the mid-90s, pharmaceutical companies introduced new opioid-based products—and, in particular, OxyContin, a sustained-release formulation of a decades-old medication called oxycodone, manufactured by Purdue Pharma—leading prescriptions to surge, and the use of opioids in treating chronic pain to become widespread.
Purdue Pharma, along with other pharmacy companies, promoted their opioid products heavily. “They lobbied lawmakers, sponsored continuing medical-education courses, funded professional and patient organizations and sent representatives to visit individual doctors. During all of these activities, they emphasized the safety, efficacy and low potential for addiction of prescription opioids,” reported the scientific journal Nature.
What’s worse is that we now know that opioids aren’t particularly effective for treating chronic pain—with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. As for the claim that OxyContin was less addictive than other opioid painkillers… You can guess how unfortunately untrue that was.
Of course, neither doctors nor patients were aware of any of that at the time. As if that wasn’t enough, the very structure of the healthcare system in the US also contributed to the overprescription of opioids. Because many doctors are in private practice, they can benefit financially by increasing the volume of patients that they see, as well as by ensuring patient satisfaction, therein lies the incentivisation problem of overprescribing pain medication. Oh, and prescription opioids are also cheap in the short term.
That’s why most European countries, where doctors aren’t motivated financially to make prescriptions, have so far been shielded from the opioid crisis. Last but not least, when initially marketing its OxyContin drug, Purdue Pharma focused on suburban and rural white communities—taking advantage of the prevailing image of a drug addict as an African-American or Hispanic person who lived in the inner city to head off potential concerns about addiction. The company targeted doctors who were “serving patients that were not thought to be at risk for addiction,” Helena Hansen, an anthropologist and psychiatrist at NYU Langone Health in New York City, told Nature. “There was a definite racial subtext to that.”
The hardest-hit communities can be found in the US states of West Virginia, Kentucky, New Hampshire and Ohio, which brings us back to the recent news surrounding drug stores. As reported by Quartz, attorneys for the counties cited government data which indicated that roughly 80 million painkillers were dispensed in Trumbull County between 2012 and 2016, equivalent to 400 per resident. In the same period, 61 million pills were distributed in Lake County.
“These pharmacy chains distributed mass amounts of opiates in these counties over the last 20 years,” Mark Lanier, CEO at Lanier Law Firm and an attorney for the counties, told the publication in an email. “They failed to follow the legal requirements of exercising a responsibility that corresponds under the law to that of prescribers,” and in turn caused the counties “needless deaths, irreparable injuries, and unnecessary suffering.”
Understandably, lawyers representing the pharmacies not only denied that the companies had much control over the flow of pills that was coming into these communities, but also said that the blame lay instead with other players including drug manufacturers, doctors, and regulators. A half fair point if you ask me.
Lawyers for the two Ohio counties said the costs are potentially $1 billion for each county, to cover social and legal expenses related to the impact of the opioid epidemic. Other cases around the country are relying on the ‘public nuisance’ argument to target the companies involved in making and distributing the opioid painkillers, meaning this upcoming verdict will set a precedent for future cases. While we remain hopeful that CVS, Walgreens, and Walmart will receive the verdict they deserve, earlier this month, courts in Oklahoma and California rejected that same argument as a legal argument in cases against drug makers.
Earlier this year, the European Union Agency for Criminal Justice Cooperation (Eurojust) released a report addressing the stark rise in the production of ‘synthetic drugs’ that poses legal challenges for prosecutors across Europe. Citing 562 cross-border drug trafficking cases handled by the agency alone, the report highlighted how synthetic and other designer drugs make up for almost one-third of the number. “This phenomenon has increased due to the COVID-19 pandemic, with organised crime groups (OCGs) adapting quickly to an online environment using secured communication channels, crypto-phones, cryptocurrencies and darknet markets,” the report continued.
In short, synthetic drugs are flooding the market even before governments can identify and outlaw them. With fatal overdoses from illicit tranquilisers jumping six-fold in the US over the pandemic, law enforcements around the world are presently on a quest to stay ahead of the curve and anticipate these drugs before they even hit the market. How? Enter AI in all of its harnessable glory, here to give cops a heads-up that could help shrink month-long drug investigations down to days.
Before we embark on the innovative road to faster and better drug discovery, however, let’s break down the concept of synthetic and designer drugs. Remember the time when people across the US were overdosing on bath salts in their hot tubs? Designer drugs refer to substances like bath salts and synthetic marijuana that are engineered in a laboratory to recreate the effects of traditional illicit drugs such as amphetamines, ecstasy, lysergic acid diethylamide (LSD), ketamine and more. Basically, if you peek behind the scenes of such drugs, you would see a bunch of underground chemists playing around with new molecules that emulate the psychoactive effects of conventional drugs.
This particular factor is what makes the substance practically undetectable by law authorities. “Because their chemical structures are different from the drugs they are intended to mimic, designer drugs frequently escape regulation, making them easier to obtain by users,” noted DrugAbuse.com, adding how they are often undetectable by screening tests at the same time. This not only fosters the concept of a ‘legal high’—where manufacturers technically can’t be prosecuted—but also opens up various possibilities for new synthetic drugs, presently limited only by our imagination.
Now, researchers at the University of British Columbia (UBC) are dedicated to tackling the issue head-on—with a little help from the space-age technology we currently call AI. In a study published in the online journal Nature Machine Intelligence, Doctor Michael Skinnider and his colleagues fed an AI model with a database of known psychoactive substances contributed by forensic laboratories around the world. With the aim of training the model on the structures of the drugs, the algorithm used was inspired by the structure and function of the human brain. Based on this training, the model then learned to predict 8.9 million potential designer drugs that could be developed and eventually hit the market.
Researchers then tested the AI against 196 new designer drugs that had emerged on the illicit market—while the model was being trained. We’re talking about drugs that the AI didn’t even know existed at the time. The result? The model had already predicted the emergence of more than 90 per cent of those drugs.
“The fact that we can predict what designer drugs are likely to emerge on the market before they actually appear is a bit like the 2002 sci-fi movie, Minority Report, where foreknowledge about criminal activities about to take place helped significantly reduce crime in a future world,” said senior author Doctor David Wishart, a professor of computing science at the University of Alberta. In a press release, he mentioned that the software essentially gives law enforcement agencies and public health programmes a head start on the “clandestine chemists” and lets them know what to be on the lookout for.
Now, one question remains. Is the model capable of identifying completely unknown substances from scratch, rather than predicting from a set of data? According to the researchers, the AI has also learned to predict the sort of molecules that are more likely to appear on the market. “We wondered whether we could use this probability to determine what an unknown drug is—based solely on its mass—which is easy for a chemist to measure for any pill or powder using mass spectrometry,” said Doctor Leonard Foster in the press release.
The researchers, hence, tested this hypothesis by leveraging the dataset of the 196 new synthetic drugs. Using only the mass, the model was able to list the chemical structures that landed in the top 10 most popular drugs with 72 per cent accuracy. Little tweaks and bits of chemical data further boosted this accuracy to 86 per cent. When it came to just one guess, the model could predict the correct structure 51 per cent of the time.
According to Doctor Skinnider, similar models could soon be used to discover all kinds of new molecules—from identifying new performance-enhancing drugs for athletic doping to previously unknown molecules in human blood and urine. “There is an entire world of chemical ‘dark matter’ just beyond our fingertips right now,” he concluded. “I think there is a huge opportunity for the right AI tools to shine a light on this unknown chemical world.”
With some authorities already expressing their interests in adopting and using the model as part of their investigation, one fact is out in the open: AI undoubtedly has the higher ground than governments across the world when it comes to keeping up with new drugs on the market. And the role of technology in drug discovery might just be starting to live up to its hype.