Today, we’re going talk about the Opioid Industrial Complex (not my term, but I like it)‚ and who’s prospering off America’s dependence on opioids like Vicodin and heroin.

There are dozens of examples why opioids, legal and illegal, are big business. I’ll never forget the first time I saw a commercial for Movantik, a drug to treat opiod-induced constipation. If you were watching the 2016 Super Bowl, you saw the ad, too.

I don't know which part was more surreal — America’s collective opioid-induced constipation (I mean, who knew?), or the obscene multi-million dollar marketing juggernaut rolling out this curious new product in such a high-profile way. I mean, damn. A Super Bowl ad?

Two quick points: First of all, the side effect of opioid worrying me is addiction. Not constipation.

And secondly, is America hooked on opiods so badly that we can’t even take a normal poop anymore? Well, apparently, yes we are. It’s so bad Big Pharma dropped $5 million on one 30-second ad promoting it’s new opioid-themed moneymaker.

Even the most casual sports fan knows that Super Bowl ads are big business. Big Pharma is big business. The illicit drug trade is big business, globally. Just ask your average Afghani farmer. In other words, there are people out there right now getting filthy rich off of our addiction: doctor, drug makers, shady halfway houses and rehab centers. It’s all very big business indeed.

Acknowledging that addiction is big business helps clear up what’s really driving New Jersey's opioid crisis.

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Who's getting rich

"Pharmaceutical companies make $24 billion a year just on pain pills. Just on opioids," Scott Rudder, president of the New Jersey CannaBusiness Association, told me.

He's the one who coined the term "Opioid-Addiction Industrial Complex," for an article on NJ Spotlight. I asked him about it:

"This is not something I intended to go after. This was not my original mission to go after the opiate epidemic, or to use cannabis as a method for being an off-ramp for addiction."

A quick history lesson: Back in 1961, then-President Eisenhower used the expression “Military Industrial Complex” in his farewell speech to urge all Americans to keep a careful eye on who profits from the ravages of war. You see the parallel.

The cycle of addiction is hard to break, harder still if someone’s getting rich off it. Hello Big Pharma!

More from Rudder:

"There (were) 300 million prescriptions last year for opioids and there's 330 million Americans. This epidemic was created by the corporations that were involved in it. You know, I get it, pharmaceutical companies are not all bad they produced a great amount of medicine that is really helpful for people and they do magnificent things.

"But for some reason on this subject, on this particular brand, this type of pill, they continue the process and they exploit addiction and they continue to make money off it."

Rudder told me about a dear friend whose son became a heroin addict. He'd been a college athlete — a wrestler — who sustained a significant injury. But the pressure on him to get better and perform was intense — so his doctors kept prescribing opioids.

"So he starts dealing with that and then he graduates from college, and now that constant supply of opioids is gone. What does he do? He turns to the street and gets addicted to heroin.

"The No. 1 reason people get addicted to heroin is from the prescription that was approved by the FDA and produced by a pharmaceutical company."

For Rudder, the line from A to B is obvious. Pharmaceutical companies know they make more treating you over time than in one shot. They know that a prescription you'll use over and over again is a gold mine.

That one individual that had that injury has now become a five-year customer. ... We consume 99 percent of the Oxycodone on the planet. That's outrageous.

It is outrageous. And it’s outrageous that our politicians are still dragging their feet on solutions.

Nov. 7 is Election Day in New Jersey. Whoever replaces a term-limited Gov. Chris Christie must contend with New Jersey's insatiable appetite for opioids like Heroin and Percocet — in a state that  houses 14 of the 20 largest pharmaceutical companies in the world.

Rudder knows those pharmaceutical companies are good for New Jersey economies. He knows they're huge employers. And that's great. But we need to challenge the methodology In which they're prescribing opioids, he says. There need to be alternatives to pain management.

Maybe rest. Or Massage. Or hey, a solution Rudder and I are both passionate about — medical cannabis.

Because when the pharmaceutical companies and the FDA together are saying their drugs are the way to go, and doctors keep prescribing them, and marketing companies keep pushing them — why wouldn't you try the opioids you put in front of you? We need to send another message.

From Rudder:

"When the tobacco companies were first brought before Congress, all the CEOs, all the executives denied that tobacco was addictive. They denied that they were adding things to the cigarette that would make that addiction more severe. They made all those denials and that it was proven that it wasn't (true), they all came back and said 'sorry.'

'And then we saw billions and billions and billions of dollars go out to the states and a settlement agreement with United States worked out with the tobacco companies. I think you're going to see the same thing. Tobacco has dropped off significantly in the United States. A lot of publication went with that, and a lot of that crackdown went as a result of the government cracking down. We need to see that happening with the opioid epidemic."

What we can do — and have

Each state has an attorney general whose duties include consumer protections. Those anti-tobacco lawsuits that came about in the mid-1990s when various state attorneys general successfully sued tobacco companies for marketing their product in a deceptive way, severely downplaying the addictive and deadly nature of the products? They made a difference.

Fortunately for us here in the Garden State, our attorney general, Christopher Porrino, is tackling New Jersey's heroin crisis with the sense of urgency it deserves.

He mentioned a stat cited in several studies — 8 out of 10 heroin addicts get their start with prescription painkillers. That's right — 8 out of 10 start on their pathway to addiction in the doctor's office. Porrino couldn't believe it at first, either. He had his staff dig deep to confirm it was true.

But earlier this year, Christie signed a law limiting how many opioid pills a patient can get on an initial prescription. It was a move celebrated by some activists, though fiercely opposed by doctors who said they were getting in the way of the relationship with patients.

Hear the governor defend the law on a recent episode of "Ask the Governor:"

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I asked Porrino about it:

"If 80 percent of the people who are addicted and who are dying from addiction started through the use of these pills, then if you’re going to focus on prevention. ... Then it’s a simple as reducing the number of pills available as well as providing education."

Porrino’s focus on prevention is refreshing. He’s smart enough to know that an ounce of cure is worth a pound of rehab.

"Once you’re getting Narcan, you’re already addicted. ... In all likelihood. And once you’re addicted, unless you’re fortunate enough to find yourself in a setting where you’re getting really good treatment, you’re going to die."

Let that sink in for a minute.

"I talk about this dirty, deadly trick – the reason eight out of 10 heroin addicts became heroin addicts through the use of opioid pain killers just because the barrier to entry. If you’re at a party, you’re hanging out with friends, my guess is that if someone walks in and they say they have a bag of heroin ... and offer to get high, most people are saying, 'Well, I’m not sure I want to go there.'

"Tell that same story. You’re at a party somewhere and someone walks over with a prescription bottle that came from a doctor, with pills in it that came from a pharmacy. You say, 'Well, okay. It’s not going to kill me at least.'"

Porrino said he's sure the number of pills on the street has dropped, though there aren't yet stats to back that up. But he said he's sure awareness is going way up. After all — those same doctors who objected to the new prescription rule certainly sat up and took notice.

But that alone won't do it.

More recently, Christie announced a new rule keeping doctors from accepting big perks like lavish meals and limitless compensation for speaking engagements from drug companies.  The rule outright bars cash, gift cards and several other sorts of gifts. It limits how often pharma companies can take doctors out to lunch — and puts a price tag of no more than $15 on those meals.

And even hiring the doctors for legitimate services is now capped at $10,000 a year.

That's nothing compared to what some doctors were making off of pharmaceutical companies.

According to the administration, two-thirds of the $69 million received by New Jersey’s doctors last year went to just 300 physicians — with 39 each having received at least $200,000.

In effect, Porrino said, it looks like some doctors were being paid to prescribe.

"So, the days of doctors or pharmaceutical reps coming into doctor’s offices with big lavish trays of food, and the trinket, and the gifts, and the electronics, and the trips, and the dinners, and the wine, and all of that. We said – bright line – no more.

"For a pharma rep to even come in with a $200 or $300 tray of food into a doctor’s office, that arguably impacts how the staff is going to behave in respect of that pharmaceutical company. And that has nothing to do with the efficacy of the medication and really should have nothing to do with whether they have an invitation to come in or not."

One doctor investigated by law enforcement, he said, was an "alleged drug dealing in a white coat."

"One bad doctor like that, can put an awful lot of opioid painkiller on the street. And so, they’re in the minority, but we have to be careful to make sure that the rules are clear, and that physicians understand what the rules or, and how they can avoid breaking them."

Don't expect things to turn around immediately, he warned. The problem is deep. It's going to take us a while to dig out.

What's next for New Jersey

I did not vote for Chris Christie either time he ran. But on the issue of New Jersey's opioid crisis, he’s very solid indeed. Porrino has been superb.

But the AG is a political appointment, and in a few short months we’ll have a new governor and, most likely a new attorney general. Whoever wins and becomes our new governor is well-served to ether keep Chris Porrino in place or two appoint someone just like him.

So my message is this: (Whatever you do, Phil Murphy or Kim Guadagno, do not make this a patronage appointment. As governor, there are dozens of plum job you get to pass out to your friends.

Don't you dare make the attorney general one of those plums.

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New episodes of Heroin Uncut are released every Saturday on and on the NJ 101.5 app.

Heroin Uncut is sponsored by Carrier Clinic, providing behavioral healthcare services in New Jersey since 1910.

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