A tête-à-tête with a US Pharmacist and author Peter Barski
Kruti: You and I have both written about the opioid crisis in our novels. Being a US-based pharmacist and having seen the catastrophe up-close, why do you think the government of such a tightly regulated country was so blind-sided in detecting an oncoming drug disaster?
Peter: In my opinion the government really did not think there was an epidemic until it was too late. These drug companies (Purdue for example) were all abiding by government regulations and laws, so there was no pursuit by the DEA[1]or FBI in the early stages of the problem. They marketed their products to doctors who in turn began writing prescriptions for these opioids.
Once some unscrupulous doctors began noticing a niche market for these drugs and an abundant demand for them, they opened up what became known as "pill mills." In these "pain clinics" doctors would charge their clients $200 cash co-pays and then referred them to pharmacies that would fill their prescriptions without question. Some clinics even had their own pharmacies located within the doctor's offices. This snowballed into a vast number of people getting addicted to pain medications.
The increase in drug overdose deaths finally brought about the attention of several government agencies. Unfortunately, they began closing down these clinics and even implemented strict procedures for retail pharmacies to be able to dispense opioid medications. One of these was requiring retail pharmacies to adhere to a ratio of non-controlled drugs dispensed to controlled drugs. For example a pharmacy could only order a bottle of 100 oxycodone if they also ordered 1000 tablets of high blood pressure medication, thus creating a high ratio of non-controlled drugs to controlled drugs dispensed. This requirement prevented retail pharmacies from dispensing as many controlled drugs, which is what the DEA wanted, but it left millions of addicted people searching elsewhere to get opiates so they would not withdraw.
Enter heroin and fentanyl and the continuation of an epidemic. The government was not counting on this and was thus blind-sided. They should have put way more money and effort into drug addiction treatment and counseling, which may have helped prevent this crisis. Instead they are now playing "catch up."
Kruti: Do you think Big Pharma had a role to play in this? How likely is a fair reversal of the crisis?
Peter: I think "Big Pharma" had a huge role in starting this crisis, but to be fair, they were operating within the confines of the law. Big pharma, as like any other company, put profits ahead of anything else. Purdue, the maker of Oxycontin, has just been fined over $8 billion dollars, and though now in bankruptcy, a large portion of any future profits from the sale of Oxycontin will go to drug treatment options such as cheap Narcan for emergency aid workers. The problem is that many opiate medicines were or are now available in generic form, so multiple companies were making them. Drug wholesalers like McKesson and Cardinal Health should also be blamed as they dispersed these vast quantities of opiates to pharmacies nationwide and never sounded an "alarm" to the DEA or FBI. Given the number of already shattered families and exhausted front line providers such as EMTs,[2]I highly doubt there will ever be a fair reversal of this crisis. Just look at the past owners of Purdue Pharmaceuticals and the vast fortune they ran away with, or the CEOs of these large drug wholesalers; not one of them that I know of has been jailed or fined.
Kruti: What is your opinion, personal and professional, about PrEP (Pre Exposure Prophylaxis) as a frontline HIV treatment in the US? Do you see any drug abuse/party-drug phenomenon?
Peter: In my experience as a retail pharmacist, I have not seen any real effort by the government to provide affordable PrEP treatment to the poor. There is Medicaid and I have seen a large number of people receiving HIV medications, but only as treatment for an already acquired HIV infection, not as prophylaxis. Just look at the homeless population in California and their rampant use of heroin. I have not seen nor heard of any agencies providing PrEP to them.
Kruti: In ‘The Aquila Trials,’ India follows into the footsteps of the US in allowing direct-to-consumer advertising of prescription drugs. Do you think DTCA empowers consumers by educating them about their options, or does it lead to increased (and needless) drug consumption?
Peter: I believe it is the latter, which is shocking given my profession as a pharmacist. Studies have shown that if a patient asks a doctor about a drug they saw on television or heard about on the radio, that doctor is more inclined to write them a prescription for that med, even if it may not be needed. Of course, these companies are required to list possible side effects on every commercial made, but people do not tend to always listen to these very intently. I do not think there were any opiates, except perhaps Oxycontin, that were directly advertised to consumers, so a lack of television commercials for these drugs would not have prevented this crisis. But as for other drugs that treat other ailments, I feel that it is a bad practice to advertise them. It should be left to the decision of the health care provider whether or not a patient should be prescribed something.
Kruti: What is your opinion regarding pharmacovigilance in the US? What proportion of adverse drug reactions reach back to pharma companies?
Peter:I thinkthe FDA does a very thorough guideline and follow through with drug companies in regards to new drugs and their side effects. Some may argue that it is stricter than other countries, hence the reason why medications cost more in the US.
Kruti: In your novel ‘To steal from the dead,’ you have written about a pharmacist who attempts to manufacture the opioid drug fentanyl in his home. What gave you the idea for this story? Is it based on any true-life incidents?
Peter: I guess you could say the idea for Paul's character came from the show ‘Breaking Bad’ (Walter White's character). He is an intelligent person who starts to make some bad decisions. The difference is Paul is really a sociopath or even a narcissist who lets a failed relationship trigger him to make these bad decisions. He goes from bad to worse, and in the end, instead of learning from his near death experiences, jumps into another bad situation in Jamaica. That leads to a second book, which is in the works now.
You can say it is based on true-life events given the influx of fentanyl from clandestine labs throughout the country and it also being imported from China. Both of these scenarios are touched on in the book. It makes reference to SilkRoad, a website that once sold illegal drugs over the Internet. In regards to Lucy providing sex through Backpage.com, I have seen this taking place even today. Even though Backpage.com has been shut down, several other websites have taken its place. Younger women, even teenagers who are addicted to opiates, are selling themselves for sexual favors so that they can pay for their drugs. Sex trafficking is a big problem that has taken a "back seat" to the COVID-19 epidemic but is still a problem. Until more money is funneled into drug counseling, therapists and free treatment, it will remain an issue.
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About Peter Barski
Peter Barski was born and raised in Florida. He grew up with a passion for fishing and the beach and spent countless hours outdoors growing up there. In 1987, he joined the military and became a pharmacy technician, introducing him to the medical field. He served during the First Gulf War conflict and was awarded a combat medal. After almost seven years serving, he left the military to pursue a college education. This is where he developed a love for writing, entering several short story contests, winning third place for the story ‘A Ride On A Bus.’ In 2000, he graduated Nova Southeastern with a doctorate in pharmacy and began a career in retail pharmacy. Over the course of twenty years in this profession, he saw first-hand the effects the opioid epidemic had on his clients and the people of Florida. Upon retiring in 2020, he wanted to convey to the public some of the stories he encountered along the way and decided that writing was the best way to convey them. ‘To Steal from the Dead’ is Peter's first book.
[1]The Drug Enforcement Administration is a United States federal law enforcement agency under the United States Department of Justice, tasked with combating drug trafficking and distribution within the United States.
[2]An emergency medical technician, also known as an ambulance technician, is a health professional that provides emergency medical services.
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