The Drug Cascade

A boom in prescription painkillers drove the opioid crisis. Now there are pills to solve it.

When it comes to killing pain these days, a prescription for a high-powered opioid is no longer enough. Once you’re taking, say, OxyContin or hydrocodone on a regular basis, you’ll probably get pills for the side effects: pills to control the nausea, pills to regulate your testosterone production, and pills to help you use the bathroom when the drugs numb the receptors in your intestines that are supposed to help move things along.

If you become addicted to painkillers, there are pills to help you stop taking the pills, by reducing the symptoms of withdrawal. And if you take too many pills, there’s a pill for that too. Or, rather, there’s a nasal spray, or an injection, or a nifty $4,100 auto-injector that announces, through a tiny speaker, how to use it to reverse the effects of an overdose.

In the medical world, this phenomenon is known as a drug cascade, and with hundreds of millions of opioid prescriptions flooding American homes, the opioid cascade has become, over the past five years, a multibillion-dollar business.

In some cases, government initiatives have been the force behind more demand for drugs that treat addiction and overdose. With 33,000 Americans dying of opioid overdoses in 2015 alone, state and federal guidelines have encouraged doctors to co-prescribe opioids with a drug that reverses an overdose–just in case.

In other cases, drugmakers and their investors have marketed a whole new class of follow-on pills, because they know a growth industry when they see one.

Analysts estimate that the follow-on opioid market is worth at least $3 billion a year. Given current trends, some project that it will top $6 billion by 2022.

Putting an end to that cycle is complicated by the fact that many of the pills that have been developed to address the explosion in opioid use and abuse are beneficial and much needed. Many save lives.

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