People take opiates. Politicians can't let people get high, especially black/brown people. Pharmaceutical companies invent a more dangerous, more addictive version of opiates and inadvertently (or purposefully) set off a "national opioid crisis." Pharmaceutical companies then invent an ineffective drug to treat people ensnared in said opioid crisis. Doctors don't prescribe it because there are already better treatment drugs on the market (buprenorphine, methadone, etc).
So the pharmaceutical company pulls an end-around and heavily markets its ineffective, questionably-tested (as in the FDA approved it based on a flawed study of 250 participants in Russia (Russia!)) "addiction cure" directly to law enforcement and drug courts.
The Food and Drug Administration approved Vivitrol in 2006 for alcoholism and expanded its approved use to opioid addiction treatment in 2010, based on the Russian study.
Sales of the drug initially were so tepid that market analysts urged the company to drop it. Instead, Alkermes adopted what Mr. Pops described to potential investors last fall as a “new commercial model for pharma.”
Rather than appeal to doctors’ offices or medical associations, the company has primarily pitched Vivitrol to law enforcement officials and lawmakers, who have relied heavily on government grants and the Affordable Care Act’s expansion of Medicaid to pay for the drug. Medicaid pays about $500 per shot, while private insurers pay $1,000, according to Alkermes. Suboxone, produced by Indivior, tends to cost a third to half as much, and methadone much less.
Alkermes assigns sales representatives to judges who oversee drug courts, where addicts arrested on minor drug charges go through supervised treatment programs. It also provides free shots to inmates preparing to leave jails and prisons, where Medicaid usually does not pay for medical care. Once the inmates are released, Medicaid often picks up the cost for them to continue shots of Vivitrol in re-entry or treatment programs.
Alkermes also relies on a “speakers’ bureau” of doctors who are paid to promote Vivitrol to other doctors and nurses across the country, and sends “outreach kits” with information about the drug to leaders of local grass-roots organizations.
The company and its political action committee have spent heavily to get its product before policy makers: $19 million in federal lobbying since the drug was approved in 2010, according to the Center for Responsive Politics. It made $222,521 in political contributions to Congress last year and has purchased high-level sponsorships of associations of drug court professionals and addiction treatment professionals, as well as organizations researching addiction treatment.
Suboxone still has a far bigger share of the market, despite its critics in the criminal justice system. It has come under more scrutiny lately, from 42 state attorneys general who have sued its maker on charges that it blocked generic alternatives.
And Alkermes’s strategy of appealing to law enforcement has paid off: Sales of Vivitrol reached $58.5 million in the first quarter of 2017, up 33 percent from the same period last year, with about half of that from Medicaid. In 2012, there were 15 programs using Vivitrol in nine states. By this April, there were 450 programs in 39 states.
In Massachusetts, where Vivitrol first took off, the company hired a lobbying firm led by Thomas P. O’Neill III, a former lieutenant governor. Company executives began attending fund-raisers and making contributions to lawmakers and political committees of both parties.
In 2012, one Republican, State Representative Randy Hunt, suggested a pilot program to the sheriff at the Barnstable County jail on Cape Cod, which has since become a showcase for Vivitrol. Other county jails then began offering the drug to inmates, and sheriffs from across the state have spoken on its behalf, including at a White House forum last year.
The drug courts often place offenders in treatment facilities or sober housing that allow only Vivitrol. “That’s where we’re handcuffed to Vivitrol,” said Judge David Matia, who leads the drug court in Cuyahoga County, Ohio.
Phillip K. Dick's estate should be suing them for royalties...
"Guilty as charged. Go ahead and ban me from the mall." - Ellie