Drug Industry Wages Opioid Fight Using an Anti-Addiction Ally

As Minnesota lawmakers prepared to push a proposed tax on opioid sales in November, the pharmaceutical industry lobbyists who opposed the bill set up a meeting with its sponsors, and they brought an unusual guest: Jessica Hulsey Nickel, a prominent anti-addiction advocate in Washington.

Nickel told the lawmakers that she took no position on the tax and was simply offering her group’s resources to help fight the state’s drug epidemic. But her presence along with five representatives from the industry’s trade group raised eyebrows among the Minnesota lawmakers, who believed that drug companies needed to be held accountable for the prescription opioid crisis — not embraced as an ally.

“She was insisting that she was totally independent and they hadn’t put any strings on her,” said state Sen. Chris Eaton, one of the bill’s sponsors. “I wasn’t buying it.”

Two weeks later, Nickel’s ties to the industry grew even deeper when her advocacy group, the Addiction Policy Forum, announced in mid-December that it had accepted funding from the trade group, the Pharmaceutical Research and Manufacturers of America, known as PhRMA.

While she is open — and unapologetic — about accepting money from the pharmaceutical group, Nickel declined to disclose exactly how much PhRMA had donated to her group. “It is our preference to talk about the patients and the families and not focus on the numbers,” she said.

Stephen J. Ubl, the trade group’s chief executive, said in an interview that it was in the “tens of millions,” over multiple years, a heady influx of cash for a nonprofit group whose annual donations and grants totaled $4.7 million last year.

Nickel insisted that her group was not beholden to PhRMA in any way. The drug industry, she said, should be viewed as a partner in fighting addiction, not an adversary. She said the funding would help her group provide vital services like an online resource center for patients struggling with addiction and training for doctors treating overdoses.

Still, PhRMA’s donation to Nickel’s group is roiling the anti-addiction world — where there are varying approaches to the drug problem and a fight over scarce sources of funding.

“You cannot hold an organization accountable if they are paying your bills,” said Lexi Reed Holtum, executive director of the Steve Rummler HOPE Network, which advocates on addiction issues in Minnesota. Holtum said she respected Nickel’s intentions but worried about the risks of teaming up with an industry with a self-serving agenda.

The partnership with Nickel also sheds light on the industry’s efforts to shape the perception of its role in the nation’s burgeoning opioid epidemic, which President Donald Trump has called a “national health emergency.” By enlisting a prominent advocate as a partner, PhRMA is trying to position the industry on the right side of a health crisis that many blame it for creating. The drug industry is a formidable force in state and federal politics, investing hundreds of millions of dollars a year in lobbyists, campaign donations and public relations campaigns. In 2017, PhRMA spent close to $26 million on lobbying at the federal level, hiring 169 federal lobbyists to work on its behalf, according to the Center for Responsive Politics.

Its donation to the Addiction Policy Forum was the centerpiece of what PhRMA described in December as a “major commitment” to addressing the opioid crisis. It unveiled a set of policy proposals that include supporting seven-day limits on opioid prescriptions for acute pain, and announced a partnership with the federal government on initiatives to battle addiction.

“We feel very strongly about trying to do our part,” Ubl said.

At the same time, drugmakers are fighting to protect their profits in the face of measures such as the proposed tax in Minnesota. Gross sales of narcotic painkillers totaled $8.6 billion in 2016, according to IQVIA, a health care analytics company.

Activists and lawmakers, however, are stepping up their pressure on the industry. Last month, Gov. Andrew M. Cuomo proposed a similar tax in New York. At least six other states have considered an opioid tax over the past year, according to the National Conference of State Legislatures. Dozens of cities and counties have sued opioid manufacturers and distributors, mirroring the legal strategy that extracted billions from the tobacco companies to offset health-associated costs from smoking.

This week, Sen. Bernie Sanders, I-Vt., called for pharmaceutical executives to testify before Congress about what they knew of the addictive properties of prescription opioids.

The industry says much of the current problem is being driven by illicit use of street drugs like heroin, and not prescription drugs. Some advocates are skeptical of the industry’s motives.

“The industry is making investments, trying to influence policymakers that this is not a problem of overprescribing opioids,” said Dr. Andrew Kolodny, a co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. “They are investing in nonprofit groups that will do the same.'’ In Nickel, the pharmaceutical industry has found an advocate who combines firsthand knowledge about addiction with Beltway policy savvy.

Growing up in Southern California, Nickel was the child of parents who struggled with drug addiction, she said. She escaped that world, got into Princeton and then entered public service. She went to work with Barry McCaffrey, the director of the Office of National Drug Control Policy under President Bill Clinton, and later served as a legislative aide to Sen. Rob Portman, R-Ohio, while he was in the House.

Nickel also started her own lobbying firm, whose clients included nonprofit groups and Alkermes, a drug company that makes a medication that helps treat opioid addiction.

The impetus for her nonprofit group, which has about 30 employees, was to empower families that are losing loved ones to opioids, Nickel said.

Nickel said her $4.7 million in funding last year had come from a “diverse set of foundations, federal grants, corporate sponsors and individual donors,” including PhRMA and the Department of Health and Human Services. In 2016, the group’s funding totaled $573,000.

“No one has cured a disease by making an enemy of the white lab coats,” Nickel said in an interview. “Sometimes our resistance to working with new partners is an old way of thinking.”

Her group includes a network of thousands of families around the country. Doug Griffin, who lost his daughter to an overdose and now volunteers for the Addiction Policy Forum in New Hampshire, said he welcomed the donation from PhRMA.

“If someone asks me, ‘Are you mad at pharma for your daughter’s death?’ I tell them no,” Griffin said. “These kids had free rein of our medicine cabinets.”

In Minnesota, Eaton and a fellow state lawmaker, state Rep. Dave Baker, see things differently. Like Griffin, they each lost a child to fatal overdoses, but they want the industry to pay for what they view as its role in the addiction crisis.

Their tax proposal would have raised about $20 million for addiction programs in Minnesota, but the measure faced stiff opposition from the pharmaceutical industry. Some state legislators said they felt “bullied” by pharmaceutical lobbyists to oppose the bill, according to Sen. Tina Smith, the former Minnesota lieutenant governor who replaced Al Franken.

In late November, PhRMA set up the meeting with the bill’s sponsors as a sort of olive branch. But Eaton and Baker said they viewed Nickel’s presence as part of the industry’s effort to dissuade them.

Nickel said she had not read the bill and had no intention of killing it. “I walked into a meeting maybe I didn’t belong in not to talk about taxes but to talk about building resources for families in crisis in Minnesota,” she said.

Nickel said she had moved ahead with establishing programs in Minnesota, regardless of whether the two state lawmakers decide to join her efforts.

Baker described Nickel’s intentions as “true and honest and good,” but said PhRMA’s decision to highlight and support her work in Minnesota struck him as too much of a coincidence.

“Sure, I’ve got my guard up,” he said. “Why weren’t they here 10 years ago?”