The roots of the opioid crisis in the United States lie in a laboratory at the University of Frankfurt, where two German scientists in 1916 developed what they hoped would be a non-addictive alternative to heroin and morphine. They were successful in developing an alternative, oxycodone, but missed on the non-addictive aspect. The semi-synthetic compound is made from thebaine, an alkaloid found in the Persian poppy and the opium poppy, and it turned out to be just as addictive as other opioids.
Oxycodone – now an active ingredient in OxyContin, Percocet and other painkillers – was just one of the many innovations made by German drug companies in the late 19th and early 20th centuries, ranging from heroin to aspirin. How these potent drugs spread to the US and other corners of the globe is part of the checkered history of foreign subsidiaries, which thrived even as two world wars severed the connections to their parent companies in Germany.
Oxycodone, for instance, was first brought to market in Germany by Merck in 1917 under the brand name Eukodal. But that was the very year the US government nationalized Merck’s American subsidiary – and when the US entered into World War I and sauerkraut was renamed Liberty Cabbage. Another measure in the wake of the war was to expropriate the rights to market aspirin, which had been developed by the German drug and chemical giant Bayer in 1897.
The original Merck pioneered the use of morphine and cocaine.
For decades, Bayer aspirin in the US was marketed by Sterling Drug, until Bayer reacquired it in the 1990s. Everywhere else in the world, Bayer has reacquired the rights to its name and the iconic Bayer-Cross logo.
The US company Merck & Co. no longer has any relation to the German Merck, even though it was founded in 1891 as the US subsidiary and remained so until its nationalization in 1917 (it was reprivatized when George Merck, a scion of the founding family who came to the United States to run the subsidiary, bought back the shares from the government). Schering-Plough was another prominent US drugmaker that traced its origins to Schering in Germany. The German company has since been absorbed by Bayer, and the US company by the American Merck. Charles Pfizer, a German pharmacy apprentice who immigrated to the United States in 1848, founded the eponymous drug company the following year in Brooklyn.
Germany’s Merck operates in 70 countries and has exclusive rights to the Merck brand in every country except the United States and Canada, where it is known as EMD (for Emanuel Merck, Darmstadt). This Merck, which traces its origins to a pharmacy established in 1668 by Friedrich Jacob Merck in Darmstadt, now markets itself worldwide as “the real Merck” or “the original Merck.” (The American Merck is known as Merck, Sharp & Dohme, or MSD, abroad.)
This original Merck pioneered the use of morphine and cocaine (Merck cocaine, purer than street versions, was popular with Rolling Stones band members). All of these drugs capable of reducing pain and inducing euphoria quickly became the objects of abuse, and as their addictive and destructive qualities were discovered, they were banned or strictly controlled.
Other German efforts to develop pain relievers were more harmless. At the end of the 19th century, Bayer developed a synthetic form of willow bark extract well-known for its pain relieving qualities that was easier on the stomach, and then trademarked as Aspirin. Over the years, Bayer lost the rights to trademark the name in many countries and it has become generic in use, though it remains a registered trademark in Germany and more than 80 other countries.
Bayer and other big German chemical and drug companies like Hoechst (now part of Sanofi) and BASF grew along the Rhine River where they could deliver their feedstocks by barge. They famously created a monopoly trust in the 1930s under the name I.G. Farben, which became notorious for its role in World War II and was disbanded by the Allies after the war. (Swiss pharmaceutical giants Roche and Novartis are also located on the Rhine, in Basel, Switzerland.)
Long before our current era of globalization, these companies targeted a world market for their drugs. By 1913, before the outbreak of World War I, Bayer employed nearly 1,000 people in its foreign subsidiaries in France, Britain, Belgium, Russia and the United States. Merck already had its US operation up and running in 1891.
If German scientists provided the ingredients for an opioid crisis, it was homegrown US companies that paved the way for them to become a public health emergency. It was primarily the 1995 release of OxyContin by Purdue Pharma, a New York limited partnership specialized in pain relief medication, that led to the current crisis. Lax controls on the prescription and use of the addictive medication hooked millions. In 2007, Purdue paid a fine of $600 million after pleading guilty to misleading the public about the risk of addiction. That pales in comparison to the $35 billion in sales of the blockbuster drug by 2017.
Purdue also manufactures fentanyl, an even more potent opioid. Today OxyContin is something of a gateway drug to fentanyl, a synthetic opioid, as well as to heroin. Overdoses of these harder drugs have led to a sharp increase in deaths. The Center for Disease Control and Prevention, a government agency, says that overdose deaths from opioids, both prescription and heroin, have quadrupled since 1999. From 2000 to 2015, more than half a million people died from drug overdoses, the agency says, and 91 Americans die every day from an opioid overdose.
President Donald Trump declared the opioid crisis a public health emergency last month. Several studies over the past year have drawn attention to the sharp increase in drug overdose deaths, especially among white males, as well as a reversal in life expectancy. It is a constituency that Mr. Trump appealed to in his 2016 campaign for the White House.
Germany, meanwhile, which consumes the most opioids in Europe, prescribes pills at about half the rate as in the United States. The UN International Narcotics Control Board puts daily opioid use per 1 million people at 50,000 in the United States, and 25,000 in Germany. Stricter regulation and more reluctance by health insurance to cover opioids are among the reasons cited for the lower rate. Also, US doctors see patients by the stopwatch and the easiest and quickest thing to do is prescribe a painkiller, often far more than necessary.
Under the Controlled Substances Act of 1970, most opioids are listed as Schedule II controlled substances. They are accepted for medical treatment under restricted circumstances even though there is a high risk of physical or psychological addiction. Oxycodone, fentanyl and morphine are all listed here. Heroin is Schedule I, which means there is no accepted medical use; it is illegal.
Prescription drugs have always been a big business. EvaluatePharma data, hosted on Statistica, projects worldwide prescription drug sales at $774 billion this year and $811 billion next year, rising to more than $1 trillion by 2022.
Bayer, Merck and Pfizer, in their various incarnations, now incorporating biotechnology and genetic engineering into their search for remedies to health disorders, will continue to churn out pills and other medications. Startling innovations no doubt await discovery. Equally without doubt, though, is that in decades to come these new innovations will also be subject to abuse.
Darrell Delamaide is a writer and editor for Handelsblatt Global based in Washington, DC. To contact the author: firstname.lastname@example.org