2012年，美國阿片類藥物危機造成的死亡人數不斷升級，當年制藥公司的強效成癮性止疼藥的出貨量足夠讓全美國的每一個人（包括孩子）吃上20天。

在一些縣——主要集中在阿巴拉契亞，當地的止疼藥夠吃100多天。

在針對該行業的訴訟中公布了一些關于藥物供應的數據，美聯社對上述數據的分析發現，直到這十年之初，阿片類藥物的藥片數量盡管開始下降，藥效總量卻仍然在上升。

原因是：醫生開的藥方藥效更強，制藥業供應的藥片藥效也更強。

“這表明，增加的不僅僅是藥片的供應量。阿片類藥物的實際處方量和消耗量都上升了。”斯坦福大學的教授安娜·蘭姆克說，她是阿片類藥物研究專家，在訴訟中為原告擔任有償專家證人。

“我們知道，即便是因為疼痛按照處方合法服用阿片類藥物，藥物劑量越高，服用時間越長，就越容易上癮。”

美聯社發現，從2006年到2012年，運往藥店、醫療機構和醫院的阿片類藥物總劑量增加了55%。在此期間，藥片的數量也顯著增加，但增幅略低，約為44%。（藥物劑量是通過一種叫做嗎啡毫克當量的標準來計算的。）

2006年和2007年，接收阿片類藥物最多的縣都分布在美國東部，到2012年，它們都在阿巴拉契亞地區。數量也急劇上升。

例如，2006年，田納西州漢布倫縣的人均阿片類藥物使用量居全國之首——大約相當于當地全部人口70天的常規處方用量。到2012年，弗吉尼亞州諾頓縣排名第一，數量相當于134天的處方用量，令人咂舌。

在計算用藥天數時，美聯社使用50嗎啡毫克當量作為每日劑量。這是美國疾病控制和預防中心（Centers for Disease Control and Prevention）設定的使用上限，醫生需謹慎使用。

這些數據來自于美國聯邦緝毒署（Drug Enforcement Administration）從制藥公司收集的信息，這些信息主要包括受控物質是如何流通到藥店、醫生和醫院的。這是2000多個州、地方和部族政府就阿片類藥物危機起訴該行業的關鍵內容。

俄亥俄州凱霍加縣和薩米特縣是最先提起聯邦訴訟的，計劃于10月開庭。

7月中旬，一名法官同意公布2006年至2012年的數據。在此期間，美國阿片類藥物服用過量導致的死亡人數從每年18000人增加到23000多人。此后，這個數字已經翻了一番，阿片類藥物已經超過了汽車事故，成為該國意外死亡的頭號原因。

在這十年的大部分時間里，海洛因和芬太尼等更強的毒品推動了危機的增長。研究發現，大多數海洛因新增吸食者的吸毒之路都始于服用開給他們或別人的處方藥。

原告在訴訟中聲稱，制藥商夸大了阿片類藥物的好處，淡化了它們的成癮性，勸說醫生增加劑量，向更多的病人提供此類藥物。

阿片類藥物危機的起源在很大程度上可以追溯到20世紀90年代中期，當時普渡制藥公司（Purdue Pharma）推出了奧施康定（OxyContin）。在此之前，阿片類藥物一般只用于外科手術或極度疼痛的癌癥患者。

政府部門在訴訟中還稱，這些公司違反了美國緝毒署的政策，因為即使他們認為某些訂單“可疑”——因為遠遠大于正常用量，卻仍然正常發貨。

例如，奧施康定的制造商普度制藥公司的電子郵件顯示，2009年10月27日下午4點15分，一名員工在藥品分銷商卡地納健康公司（Cardinal Health）的一份訂單上打了個標記，因為這張訂單的數量幾乎是該客戶往常12周訂單劑量的兩倍。該訂單價值近29.3萬美元。

郵件顯示，該訂單于下午4點16分得到了批準。

這封電子郵件是7月末公布的一批行業文件的一部分。這些文件還包括今年早些時候的一份證詞，美國最大的藥品經銷商之一卡地納健康公司的一名高管在該證詞中說，該公司在分銷阿片類藥物時沒有義務對公眾負責。

卡地納健康公司的法律顧問詹妮弗·諾里斯被一位律師問及，該公司是否想“確保盡其所能地防止公眾受到傷害？”

她回答說：“我不知道卡地納健康公司在這方面對公眾負有責任。”

她接著說：“卡地納健康公司有義務根據法律、法規、規章和指南履行其職責。”

卡地納健康公司的一位發言人說，該回應僅用于法律語境。（財富中文網）

譯者：Agatha

In 2012, as the death toll from the nation’s opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply.

In some counties, mostly in Appalachia, it was well over 100 days.

An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip.

The reason: Doctors were prescribing—and the industry was supplying—stronger pills.

“It shows it wasn’t just the number of pills being shipped that increased. The actual amount of opioids being prescribed and consumed went up,” said Anna Lembke, a Stanford University professor who researches opioids and is serving as a paid expert witness for plaintiffs in the litigation.

“We know that the higher the dose of prescribed opioids, and the longer patients are on them, even for a legitimate pain condition, the more likely they are to get addicted.”

The AP found that the overall amount of opioid medication shipped to pharmacies, medical providers, and hospitals increased 55% from 2006 through 2012. The number of pills rose significantly over that period, too—but that increase was lower, about 44%. (The amount of medication was calculated using a standard measure of potency known as a morphine milligram equivalent, or MME.)

In 2006 and 2007, the counties at the very top of the list of those receiving the most opioids were scattered about the eastern half of the U.S. By 2012, they were all in the Appalachian region. And the numbers were up dramatically.

For instance, in 2006, Tennessee’s Hamblen County received the most opioid medication per person in the country—about 70 days’ worth of a typical prescription for every man, woman, and child. By 2012, the top county was Norton, Va., and the number of days’ worth of opioids was a staggering 134.

In calculating days of medication, the AP used 50 MMEs as a daily dosage. That is the upper limit beyond which the Centers for Disease Control and Prevention urges doctors to use caution.

The data comes from the federal Drug Enforcement Administration’s collection of information from pharmaceutical companies about how controlled substances were distributed down to pharmacies, doctors, and hospitals. It’s a key part of the case for some 2,000 state, local, and tribal governments suing the industry over the opioid crisis.

The first of the federal trials, involving claims from Ohio’s Cuyahoga and Summit counties, is scheduled to start in October.

In Mid-July, a judge agreed to make public the data covering 2006 through 2012. During that period, opioid overdose-related deaths in the U.S. increased from about 18,000 a year to more than 23,000. Since then, the number has doubled, and opioids have overtaken automobile accidents as the top cause of accidental death in the country.

Heroin and even stronger illicit drugs such as fentanyl drove the increase for most of this decade. Studies have found that most new heroin users started with prescription drugs that had been prescribed to them or to someone else.

Plaintiffs in the lawsuits claim drugmakers overstated the benefits of opioids and downplayed their addictiveness, persuading doctors to offer the drugs to more patients and in higher amounts.

The origins of the opioid crisis are largely traced to the mid-1990s, when Purdue Pharma introduced OxyContin. Up until then, opioids were generally reserved for surgery or cancer patients in extreme pain.

The government lawsuits also say the companies violated DEA policy by shipping orders even when they believed them to be “suspicious” because they were far larger than normal.

For example, an email chain from Purdue Pharma, the maker of OxyContin, showed an employee flagging an order at 4:15 p.m. on Oct. 27, 2009, from drug distributor Cardinal Health because it was nearly twice as big as the customer's usual 12-week order of a certain dosage. The order was worth close to $293,000.

It was approved at 4:16 p.m., the emails show.

The email was part of a new trove of industry documents made public in the end of July. They also include a transcript of a testy deposition earlier this year in which an executive at Cardinal Health—one of the nation’s largest drug distributors—said the company has no obligation to the public when it comes to the opioids it ships.

Cardinal Health counsel Jennifer Norris was asked by a lawyer whether the company wants to “ensure that it does what it can to prevent the public from harm?”

She answered: “I don’t know that Cardinal owes a duty to the public regarding that.”

She went on to say, “Cardinal Health has an obligation to perform its duties in accordance with the law, the statute, regulations, and guidance.”

A Cardinal spokeswoman said the comment was made only in a legal context.