The surge of opioids overdose deaths may be partly attributed to McKinsey & Company’s working with pharmaceutical companies to fuel opioid epidemic. The Opioid Industry Documents Archive, a project of Johns Hopkins University and the University of California, San Francisco revealed on June 30 this year, demonstrated how McKinsey, one of the “Big Three” management consulting firms, advised opioid makers Purdue Pharma, Endo Pharmaceuticals, Johnson & Johnson, and Mallinckrodt to drive sales, despite the growing public outcry over the opioid epidemic. The new documents supplemented McKinsey’s more than 15 years of emails responding to news about increased restrictions on opioids, letters from regulatory agencies in response to new drug applications from opioid manufacturers, slide presentations prepared for internal discussion and for clients (including Purdue Pharma and Endo Pharmaceuticals), spreadsheets outlining project staffing, preparation materials for regulatory advisory committee meetings, opioid-related transition documents for state and federal agencies, proposals, invoices and other documents. According to the JHU Hub, the documents came from the company’s files between 2004 and 2019 and were being released under the terms of the $573 million settlement that McKinsey reached with attorneys in 47 states, five U.S. territories, and the District of Columbia in February 2021. According to the analysis from the New York Times, “McKinsey’s extensive work with Purdue included advising it to focus on selling lucrative high-dose pills, the records show, even after the drugmaker pleaded guilty in 2007 to federal criminal charges that it had misled doctors and regulators about OxyContin’s risks.” OxyContin is typically used as painkiller that belongs to the class of Commonly Prescribed Opioids. But McKinsey’s most malicious suggestion was about the “bonus” given to the Purdue Pharma distributors if OxyContin they sold caused the buyer to become addicted. For each incident of drug addiction, the distributor might gain rebate of approximately $14,810. Early in November, 2020, the New York Times reported that in 2019, 2,484 people bought opioids from CVS (one of the distributors of Purdue) and became addicted, meaning that Purdue would pay CVS $36.8 million that year according to the “incentive principle”. However, both of Purdue’s two major distributors, including CVS, denied receiving the rebate. Back to this year, McKinsey also told Purdue that “it could ‘band together’ with other opioid makers to head off ‘strict treatment’ by the Food and Drug Administration.” McKinsey’s aggressive suggestions regardless of social responsibility and its dealing with regulators to secure the approbation of the opioids products, welded part of the pharmaceutical industry and claimed innocent lives of millions of Americans.

Not merely the consulting company, the pharmaceutical firms themselves, the inexperienced physicians and the vulnerable system should be responsible for the crisis.

However, the more recent upsurge in overdose deaths, especially those that are relevant to Other Synthetic Opioids, such as Fentanyl and its analogues that are 50 to 100 times more potent than Morphine, might result from other factors. According to the World Drug Report 2021, in 2019, Other Synthetic Opioids (Fentanyls and Tramadol) accounted for nearly 70% of opioid overdose deaths in the US. In contrast to the demand-driven Tramadol emerging in West, Central and North Africa, Fentanyl and its analogues (fentanyls) are supply-driven and are of great concern in North America. Its introduction into the illicit drug market has led to an unprecedented increase in opioid overdoses in the US. Some experts mentioned that Mexico is becoming the origin of Fentanyl and its analogues, and plays a vital role in the distribution in the US. “While seemingly dominated by two large criminal groups in Mexico, the fentanyl trade requires vast networks of smaller subcontractors who specialize in importing, producing, and transporting synthetic drugs.” Besides, both large and small organizations appear to be capitalizing on the surge in popularity of all types of drug, covertly lacing Fentanyl into prescribed pills such as Oxycodone and other substances such as cocaine, methamphetamine, and marijuana—very often without the end-user knowing it. As for the production of Fentanyl, according to “Covid-19 and Drug Supply Chain” reported by UNODC, though chemicals and some other materials are imported mainly from east Asia, “in general, traffickers are able to produce large quantities of synthetic drugs at relatively low cost and ship large amounts within and across regions. Without geographic constraints such as the need for access to suitable land and a climate conducive

to drug cultivation, clandestine manufacturing facilities can generally be set up anywhere and operated with relatively little in the way of logistics and workforce requirements,” which hinders drug regulation to some extent.