John R. Roby

Binghamton Press and Sun Bulletin, part of the USA TODAY Network

Proposed state policies intended to control the opioid abuse epidemic over the past decade have faced a $3.7 million roadblock — the amount of money spent by drug companies and related advocacy groups to influence New York lawmakers.

A joint investigation by The Associated Press and the Center for Public Integrity found members of the Pain Care Forum, composed of drugmakers and allied advocacy groups, spent more than $880 million on campaign contributions and lobbying over the past decade as they worked to influence state and federal policies.

The groups have an array of political interests that include opioid advocacy, and their spending was eight times that of the gun lobby during the same period. By comparison, groups advocating for limits on opioid prescribing spent about $4 million.

Of that total, $37 million was spent on contributions to state-level elected officials and party committees. And in that time period, less than one-quarter of the 800 bills introduced in state houses nationwide that would have imposed limits on opioid prescriptions have been approved.

In the mid-Hudson Valley, between 2006 and 2015, Assemblyman Kevin Cahill, D-Kingston, got $4,500; Sen. George Amedore, R-Rotterdam, Schenectady County, got $2,000; Sen. John Bonacic, R-Mount Hope, got $2,000 and Sen. William Larkin, R-Cornwall, got $500.

At the federal level, Sen. Kirsten Gillibrand led with $298,848 in donations. Sen. Charles Schumer followed with $179,550. In the House of Representatives, Rep. Sean Patrick Maloney, D-Cold Spring, received $46,899, while Rep. Chris Gibson, R-Kinderhook, got $25,650.

Among those no longer in office, Hillary Clinton received $36,520 while in the U.S. Senate; state Sen. Stephen Saland got $5,800; state Sen. Cecilia Tkaczyk got $2,000; state Sen. Greg Ball got $2,400; Rep. John Hall got $11,000; Rep. Nan Hayworth got $37,341; Rep. Sue Kelly got $24,000; and Rep. Maurice Hinchey got $7,000.

Drug companies "are spending a fortune, and there's nobody out there with deep pockets to fight them," said Andrew Kolodny, a medical doctor, research professor and executive director of Physicians for Responsible Opioid Prescribing. The group advocates for "cautious and responsible prescribing practices," and has been in frequent opposition to the Pain Care Forum on the federal level.

New York data analyzed by the USA Today Network finds:

The state had an average of 184 lobbyists hired annually by Pain Care Forum members between 2006 and 2015 — the most of any state and more than twice the total of the No. 2 state, Pennsylvania.

New York ranks fourth in the proportion of Pain Care Forum political contributions to overall political giving.

Top legislative beneficiaries of Pain Care Forum largesse include the state Senate Republican Campaign Committee, which collected $1.2 million from 2006 to 2015, and its Democratic counterpart, with $560,000.

Top individual legislators include Republican Kemp Hannon, of Nassau County ($53,000), former Senate Majority Leader Dean Skelos ($43,000), and Joe Morelle ($22,000), the Assembly's Democratic majority leader, of Rochester.

Some of the elected officials who received Pain Care Forum money have sponsored and supported legislation friendly to the opioid drug industry, and some of that legislation reflects language in similar bills passed in more than 20 other states in the past two years.

A spokesman for the senate's Democratic campaign committee declined multiple requests to comment for this article. A Republican spokesman referred questions to Hannon.

"I have consistently and successfully worked to cut the use and availability of opioids and enhance access to recovery from opioids," Hannon said. "No other legislator has anywhere near such an effective record."

As examples, Hannon pointed to legislation he has introduced in past sessions that limit initial opioid prescriptions and establish physician review committees to evaluate prescribing practices.

Those are among several New York laws signed in the past few years intended to curtail opioid abuse. In 2013, the state adopted the I-STOP prescription monitoring program, designed to prevent doctor-shopping. The Republican-led Senate created a task force that recommended 48 opioid-related policy changes this year, some of which made it into alegislative package signed by Gov. Andrew Cuomo this summer.

Yet other recent legislative efforts have aligned with the Pain Care Forum's priorities to expand access to certain kinds of opioid drugs.

The Albany numbers

Overall, the data show Pain Care Forum members have directly supported nearly 200 New York state legislators and party committees since 2006, to the tune of $3.7 million. That represents a full 10 percent of all such spending in the 50 state houses, and trails only California.

Democratic legislators took in $800,000 in contributions, while Republican members took in $506,000. Average contributions, though, were $9,200 for Republicans and $6,100 for Democrats, due to the imbalance of power in Albany.

Pharmaceutical Research and Manufacturers of America (PhRMA), a trade group representing drug companies and a member of the Pain Care Forum, was the top industry contributor to New York political committees. Its $1.8 million accounted for nearly 30 percent of spending, according to The Associated Press and Center for Public Integrity data.

PhRMA gave $949,000 to the Republican senate and assembly committees, and $810,000 to the legislative Democratic committees. The top individual contributions were to Republican Sen. Hannon ($6,500) and former Republican Sen. George Maziarz ($2,250), whose district went from Niagara Falls to Rochester. He now is a lobbyist.

Pfizer Inc., the world's largest drugmaker, was No. 2, contributing $770,500 to 170 state-level politicians and party committees over the past decade. Pfizer makes one opioid drug, Embeda, a mix of morphine and naltrexone.

Members of the Pain Care Forum advocate for issues beyond opioid prescriptions, so some fraction of their contributions were likely made in support of policies outside of access to pain medication.

Yet the data likely also under-report the amount of contributions to individual legislators. Some of the funds were distributed to candidates by the party committees, and thus were not recorded in a legislator's total.

Furthermore, the data do not include independent expenditures — spending on a politician's behalf by a party or trade group — or so-called "dark money," which is unlimited contributions to politically active nonprofits that can spend at will without reporting their donors.

Meanwhile, only Phoenix House, one of the handful of nonprofits identified by the Associated Press and Center for Public Integrity analysis as spending to advocate tighter restrictions on opioid drugs, has made contributions in New York. The funds, totaling only $6,800 over 10 years, went exclusively to members of Congress, not to state legislators.

New pill technology

A recent priority of many drugmakers and their allies — reflected by bills advanced in at least 20 state houses, including New York's — has been to expand access to so-called abuse-deterrent formulations for opioid prescriptions.

Abuse-deterrent formulations (ADFs) are opioid drugs chemically identical to the typical versions but with features that make them harder to pulverize, melt or dissolve. That is intended to reduce the chance for abuse by snorting or injecting, though swallowing the pills gives the expected effect.

Opponents have countered they are, in reality, a solution to a largely nonexistent problem.

"Our opioid crisis isn't a crisis of people crushing pills and sniffing them," said Kolodny, who is also a medical adviser to Phoenix House. "While some who are addicted sniff them or inject them, addiction almost always begins with swallowing pills whole."

To date, seven brand-name opioid drugs with abuse-deterrent qualities have won approval by the U.S Food and Drug Administration, starting with Purdue Pharma's OxyContin in 2010. The agency has issued guidelines for drug manufacturers that want to develop generic versions, but it is likely to be years before the first abuse-deterrent generic hits the market.

For that reason, the opioid pharmaceutical industry supports expansion of abuse-deterrent formulations. Purdue Pharma extols its virtues on a section of its website aimed at physicians and pharmacists. While noting the science behind abuse deterrence "is relatively new," it calls the availability of prescription opioids with abuse-deterrent properties "an important advancement toward the goal of providing responsible pain management for appropriate patients."

The State Pain Policy Advocacy Network, which describes its mission as working "to effect positive pain policy on the state level," maintains advocacy partnerships with numerous members of the Pain Care Forum, including the American Cancer Society Cancer Action Network, the American Chronic Pain Association and the U.S. Pain Foundation.

The network advocates for the development of abuse-deterrent formulations, and for restrictions on substituting non-ADF generics for brand-name ADF prescriptions. Its list of 2015 legislative priorities included tracking bills dealing with abuse-deterrent formulation drugs nationwide.

New York's legislation

One such piece of legislation passed the New York Senate and Assembly this past session and is awaiting delivery to Cuomo's desk. Senate Bill 6962 would require insurers to offer at least one abuse-deterrent formulation for every class of opioid drug they include on their formulary.

Hannon sponsored the bill.

He and the four co-sponsors have received $63,000 from Pain Care Forum members between them, according to the finance data. The Assembly version was sponsored by Democrat Michael Cusick, of Staten Island, and cosponsored by Republican Peter Lopez, of Schoharie, who together have received $5,400 in Pain Care Forum member contributions.

That legislation is one of at least 20 identified by the Associated Press and Center for Public Integrity analysis to reach state houses from coast to coast with nearly identical language.

For instance, bills passed or considered in Illinois, Kansas, Kentucky and West Virginia all identically state that insurance companies "shall provide coverage for abuse-deterrent opioid analgesic drugs as preferred drugs on their formulary, preferred drug list, or other lists of similar construct."

Whereas an insurer "shall provide coverage on its formulary, drug list or other lists of similar construct for at least one abuse-deterrent opioid analgesic drug product," according to the language in the New York bills.

"Like many other bills, the New York proposal was drafted off of model legislation used in other states," Hannon said. "With the opioid epidemic plaguing the nation, many states have looked to abuse-deterrent formulations to help."

In the 2012-13 session, Hannon sponsored a similar bill that passed the Senate but faltered in the Assembly. The sponsor memo said the bill's purpose was "to help prevent the abuse and diversion of opioid drugs by ensuring that opioid drugs which incorporate abuse-deterrent technologies are dispensed whenever possible."

Related bills last year — the Senate version was also sponsored by Hannon — would have prevented pharmacists from substituting a generic for a prescribed opioid with abuse-deterrent properties. That sort of legislation is also in line with the State Pain Policy Advocacy Network's stated priorities.

Cuomo vetoed the 2015 bills, writing in a veto memo that the research on abuse-deterrent drugs "is still in its infancy."

Developing abuse-deterrent formulation versions of existing opioids is also profitable for drugmakers. An abuse-deterrent formulation of an exiting generic or brand it owns allows a drugmaker to secure a new patent and extends protections from other generic competition.

By pushing the abuse-deterrent formulations, drugmakers are "trying to profiteer on our concern about the opioid crisis," Kolodny said. "They're trying to exploit the very problem they helped create."

Follow John R. Roby on Twitter @PSBJRoby.

More online

For more on the Poughkeepsie Journal’s extensive heroin coverage, go to pojonews.co/nyheroin.