汇丰银行美股医疗保健行业美国阿片类流行病调查2018534页

Disclaimer&Disclosures:ThisreportmustbereadwiththedisclosuresandtheanalystcertificationsintheDisclosureappendix,andwiththeDisclaimer,whichformspartofit–whichcouldpotentiallyresultinbillionsinpenaltiesOpioidover-prescription(66.5scripsper100Americans)atcrisislevel,butmillionswithchronicpainseekalternativesESGGLOBALMay2018By:TessiePetion,Wai-ShinChan,andAshimPaun1ESG●GLOBALMay2018WhythisisimportantLaborforceparticipationrateeffects:LinksbetweendecliningUSlaborforceparticipationandtheopioidcrisis.Legalrisk:Historically,finesrelatedtoillegalmarketingorproductsafetyhaveonlytemporarilyaffectedpharmaceuticalcompanies’valuations.Finesandpenaltiespeakedin2012,andeventhentheyhadminimaleffects.However,themulti-districtlitigationagainstseveraldrugmakersanddistributorsispatternedafterthelawsuitsfacedbythetobaccoindustry,whichpaidmorethanUSD200mtosettlelitigationinthe1990s.Non-addictivealternatives:Onein10Americansexperiencechronicpain(USNationalInstitutesofHealth).AtthesametimethatopioidsareoverprescribedintheUS,therearecountriesthatareunabletoaccessmorphineforpalliativecare.Forthosemarkets,genericdrugcompaniesarewell-placedtosupplyproduct.Fordevelopedmarkets,researchisfocusedondevelopinganon-addictiveopioid(oranon-opioid)withminimalsideeffects.Cannabisresearch:Drugmakersareincreasinglyinvestigatingcannabis-basedpainkillers,nowthatmarijuanaisavailablelegallyin29statesandtheDistrictofColumbiaintheUS.Studieshavefoundthathospitalizationratesforopioiddependenceandabusedropped,onaverage,instateswheremarijuanawaslegalized.ThisapproachfacesrestrictionsatthefederallevelsoR&DoutsidetheUSmaybethepathforward.Antagonist/antidotesalescontinuetoincrease:Thoughprescriptionopioidsmayhavepeaked,addictionratesremainhighandmanyaddictshavetransitionedtoheroinandnon-prescriptionsyntheticopioidslikefentanyl.Thesaleofopioidantagonistsandantidotescontinuestoincreasebutefficacyhasbeenquestioned.Betterantagonistsareindevelopment.Taxes:Opioidtaxbillsarecirculatinginseveralstates.Thesehaveyettobecomelegislationbuttheyareaclearexpressionofattemptsbymunicipalitiesdeterminedtorecoupsomeofthecostsoftheepidemic.RiskstoUSmodel/disintermediation:AsHSBCanalystsSteveMcGarryandJulieMeadnotedintheirreport,UShealthcare:disruptionpossibilitiesabound(1February2018),thepharmasectoralreadyfacesmultipleheadwinds.Theprolongedopioidepidemiccouldincentivizeregulatorstorestrictmarketing.USD2.2trncoalitionofinstitutionalinvestors:InvestorsforOpioidAccountabilityisacoalitionofinstitutionalinvestorsaskingpharmacompaniestoinvestigatebusinessrisksrelatedtoopioids.SustainableDevelopmentGoals(SDGs):TheUNSDGsGoal3includesthepreventionandtreatmentofsubstanceabuse,includingnarcoticdrugabuse.Increasingly,investorshavepromisedtoallocatecapitaltoinvestmentswhichsupporttheSDGs.Couldotherprescriptiondrugsbenext?Amongprescriptiondrugs,amphetaminesandprescriptionstimulantsaresecondtoopioidswith37musersin2015.1Likeoxycodoneandfentanyl,prescriptionstimulants(Adderall,etc)areclassifiedasdrugswithahighpotentialforabuse(ScheduleII)bytheUSDrugEnforcementAgencyandhavebeenaccusedofbeingoverprescribed.2______________________________________1UNODCWorldDrugReport20172DEA.gov-DrugschedulingESG●GLOBALMay20182Abargainstruck:TheUShasacceptedthehighestdrugpricesintheworldinexchangeforinnovation.Thattranslatestowidespreadaccesstonewdrugs–andtheirexternalities.Fewanticipatedthatanewvariationofaveryolddrugwouldhavebroadsocietalandeconomicconsequences.Theresultingopioidepidemichighlightsthewaysthatenvironmental,social,andgovernancefactorscanhavematerialimpactsonthefinancialconditionoroperatingperformanceofcompanies.Butthechallengeliesinquantifyingandmeasuringtheseimpacts.Inthisreport,wetakemetricsfromthepharmasectortoexaminetheoverlookedcostsoftheopioidepidemic.TheopioidepidemicMoreprescriptions:Inthelate1990s,opioidpainkillersbegantobeprescribedwithgreaterfrequencyafterpharmaceuticalcompaniesassuredmedicalprofessionalsthatpatientswouldnotbecomeaddicted.Theincreasedprescriptionsledtowidespreadmisuseofbothprescriptionandnon-prescriptionopioids.In2017,theUSDepartmentofHealthandHumanServicesdeclaredapublichealthemergency.31.2016USfatalitiesSource:CentersforDiseaseControl,BureauofLaborStatisticsMorecosts:TheeconomiccostoftheopioidepidemicintheUSin2015wasUSD504bn(2.8%ofGDP)4.USlifeexpectancyhasdroppedfortwoconsecutiveyears–achangedrivenbyarisingdeathrateamongyoungerAmericans.Fewerworkingagemenareparticipatinginthelaborforceandmanyofthosemenoutsidethelaborforcearetakingprescriptionpainmedication.Broadlyspeaking,theUSopioidcrisishascoincidedwithadecreaseinlaborforceparticipation.______________________________________3USDepartmentofHealthandHumanServices4TheCouncilofEconomicAdvisers,November2017:TheUnderestimatedCostoftheOpioidCrisis05000100001500020000250003