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This past week, my wife and I viewed a docudrama on Netflix entitled "Painkiller". It starred Matthew Broderick as Richard Sackler, chief in all ways of Purdue Pharma, maker of Oxycontin. In quite stereotyped fashion, Broderick/Sackler was portrayed as an evildoer who directed a virtual army of attractive young, partygoing female drug reps whose job it was to seduce gullible and vulnerable physicians into prescribing more and more milligrams of oxycontin to their patients in pain, invariably leading them into a downward spiral of addiction, broken lives and even death by overdose. An important part of the companies' message about Oxycontin was that it was safer than other narcotics, in part because it was absorbed over twelve hours and therefore was a more acceptable alternative to existing drugs like morphine or vicodin. With a blatant disregard for what was actually taking place in the country, Purdue Pharma defended itself and its drug of choice through patient testimonials, supportive speeches by prescribing doctors and well-funded political lobbying. In the end, the evil drug manufacturer was forced into bankruptcy in the face of thousands of lawsuits from individual patients and from States alleging that the company engaged in deceptive practices. Mind you, the company was being held responsible for the prescription and use of the drug because they promoted it, even though a physician had to order it, a pharmacy had to fill it and the patient had to take it. Score one for government oversight and protection, a little on the late side but, nevertheless, a win.

Alcohol is a dangerous and highly addicting drug. Worse on every measure than oxycontin. Enter Peyton Manning. Not as sexy to most of us as the Purdue Pharma nymphets, but very funny and likeable, a perfect pitchman for Bud Light. Stepping up to the crowded bar, Peyton orders the beer and then has an idea, buy a round for the house! Apparently, everyone in the bar was fixated on Peyton because the entire place erupts with glee when he gestures to the barmaid that he is buying a can for everyone. In a very realistic scene, Peyton and Emmitt Smith throw full cans of Bud Light all over the room with no drops. What fun. But wait a minute, Peyton. Do you really want to buy a beer for Shirley who is five months pregnant and has already had three? Whatever the concentration of alcohol in her blood, that same concentration is in the babies' blood. Can you say Fetal Alcohol Syndrome. Or what about Ed, the guy with the big stomach. Except his big stomach in not just fat, it is fluid that is collecting in his abdomen due to end stage liver disease, earned over years and years of hard drinking. Or Mean Joe, as he's known, when he's had a few. His kids pray that they'll escape the 1:00am lineup where the true meaning of corporal punishment is defined. And that is not a fleet of Ubers in the parking lot. Those are the cars that a large number of inebriated patrons will drive onto the highways at closing. And since most of them are not related to Andy Reid, they may have to face the consequences of drunk driving, unlike Andy's son Britt, a multiple offender since he was a teenager, who destroyed the lives of a five year old girl and her family by causing a horrific crash that left the little girl with irreparable brain damage. Having entered into a sweetheart plea deal that sentenced him to three years instead of ten, Britt's sentence was commuted by the Missouri governor for an unspecified reason. But don't worry, the same state officials that commuted his sentence will monitor his compliance with the conditions of his release which include not drinking. Go Chiefs.

So what differentiates Purdue Pharma from Anheuser Busch? Well, several things actually. Both drugs are addicting and both can cause myriad human misery and destruction. The case against oxycontin was based on the effects of its use and its sanctions were aimed at restricting and controlling patient's access to it. Access to alcohol on the other hand is only controlled by statute, age. A pregnant woman, an ascitic man can belly up to any bar and order a drink. There are dram laws on the books that hold the seller or provider of alcohol potentially responsible for the consequences of serving a clearly intoxicated person but they are rarely enforced. Although strictly speaking, alcohol is in the category of drugs that are labeled controlled substances, the extent of government oversight is limited to ensuring that appropriate taxes are paid to governing authorities. This is because alcohol is regulated by the ATF (Alcohol, Tobacco and Firearms), an arm of the IRS and not by the FDA (Food and Drug Administration). We treat them as though they are an apple and a garden hose rather than substances that share much in common. Purdue Pharma was forced into bankruptcy because it tried to influence physicians into prescribing their drug. Anheuser Busch can use Peyton Manning on a television commercial to promote the use of Bud Light without any reference at all to the serious negative effects of its use including cancer, cardiac disease, liver disease, ulcers, diabetes, etc. etc. not to mention drunk driving, career ending behavior, violence and relationship trouble.

So where do we go from here? It seems clear to me that we have to start seeing the way that drugs are similar rather than focusing only on the ways in which they are different. If you agree with the treatment of Purdue Pharma, why do you let Anheuser Busch off the hook, if you do? I am mystified that the same legal rationale that underlies the prosecution of Purdue Pharma, or the 1998 tobacco settlement with the States, is not applied to the brewers and distillers. We need consistency in my view across the entire spectrum of substance use if we are ever to solve what is arguably our biggest and worst national threat.

As always, what do you think?

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