During my medical residency at Hennepin County Medical Center in 1995, drug salespeople would come into the hospital to pitch a new product. It was called OxyContin, and it was sold as a safe way to treat pain of all types. Because it was slow-release, it did not risk abuse or addiction. With this new tool, the salespeople defined pain as the “fifth vital sign,” and our goal as doctors was to get a pain score down to zero.

This pitch continued as evidence of the social devastation wreaked by opioid addiction mounted. Patients soon stopped asking me for prescriptions, as heroin and then more potent alternatives became abundant and affordable on the streets. These days, I see these patients mostly when they come in to the emergency department near death or dead. The state of Minnesota and our counties incur hundreds of millions of dollars in costs each year on hospital visits, foster-care expenses, addiction services and lost workforce capacity.

This clear history of misrepresentation is why the makers of opioids now are settling massive lawsuits in several states, and why bipartisan legislators at the State Capitol have agreed on bills that would attempt to recapture some of those costs from opioid manufacturers and distributors.

The only surprising thing is that the pharmaceutical industry continues to resist accountability and refuses to partner in creating solutions.

In a recent commentary (“In opioid fight, don’t drive off generic makers,” April 4), manufacturers of generic opioids wrote that the proposed fees would cost more than they would earn on these medications in the state of Minnesota and threatened to withdraw their business from our state if this legislation passes.

An open threat to inflict pain and suffering on patients rather than pay a modest and entirely absorbable fee should tell us all we need to know about the nature of these businesses. In the scope of their many products and enormous profits, the suggestion that an annual registration fee would lead them to take their ball and go home is brassy. Further, with the glut of pills available on our streets, a decreased number of companies distributing opioids in our state would likely have a positive public health effect. Not that there is any risk of that occurring: The threat to withdraw business from our state in response to this legislation is as empty as it is outrageous.

In the same commentary, the generic industry calls for blame to be shared by providers and supports legislation in other states requiring physicians to limit our prescribing of opioids, attend medical education and document our prescriptions in a state prescription monitoring program. These calls are valid, and that is why those exact provisions are included in the Senate Opioid Stewardship bill.

Physicians do not shrink from our role in this crisis. No matter what was said by a drug salesperson, the name at the bottom of a prescription pad is what counts. Physicians have been guilty of prescribing opioids for chronic osteoarthritis pain, a practice that has been proven no more effective than acetaminophen or ibuprofen; and prescribing long durations of opioids for transient events. We are committed to making this right. In addition to the legislative efforts described above, thousands of us signed on to Surgeon General Vivek Murthy’s pledge to educate ourselves on responsible prescribing habits.

The Opioid Stewardship bills advancing in the Minnesota House and Senate are a necessary step for our state. It’s time for manufacturers to stop resisting these efforts with threats and scare tactics aimed at patients.


Matt Klein, DFL-Mendota Heights, is a member of the Minnesota Senate.