By Chris Adams

As the country tries to clamp down on the dramatic increases in opioid use and deaths, a range of players often have competing interests that can – and have – slowed efforts to do so.

Dr. G. Caleb Alexander, an associate professor at the Johns Hopkins Bloomberg School of Public Health, gave fellows at a National Press Foundation session an overview of who those stakeholders are.

“There are a lot of different people in the room,” he said. Among those who seek to influence how the government regulates prescription opioids are:

  • Health insurers, who set coverage and reimbursement rates;
  • Prescribing doctors, who value their autonomy;
  • Pharmacies, which also value their autonomy;
  • Wholesalers, which establish the supply chain for drugs;
  • Consumer groups, which want access to new therapies and know that pain has long been under-treated;
  • Manufacturers that make and market the drugs;
  • Public health agencies that want to crack down on abuse; and
  • Regulatory authorities such as the Food and Drug Administration that want to provide market access while not interfering with doctors’ practice of medicine

Alexander talked about the tension between drugmakers and the FDA, as well as the less-noticed tension among the other stakeholders.

He pointed reporters to resources to document such tensions, such as an FDA Science Board meeting from 2016 during which a drug-industry official didn’t even mention “addiction.”

He also pointed reporters to, which has information about the best uses of opioids. And to a report he and Hopkins produced on the range of potential solutions to the opioid epidemic.

Perhaps most importantly, he shared a video of the people who have died as a result of overdoses – photo after photo after photo of people who died in their teens, their 20s, or later. Those, he said, make the need to counter the epidemic all the more urgent.