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The Opioid Crisis: Big Pharma, Pain and the Addiction Blame Game 

There’s no doubt that the crisis of opioid addiction and fatal overdoses in the United States is a complex and complicated issue.

A recent Harvard study – The Opioid Epidemic: Fixing a Broken Pharmaceutical Market – walks back the origins of a predicament the National Institute on Drug Abuse (NIDA) estimates effects more 2.5 million Americans.

“In this article, we argue that non-rigorous patenting standards and ineffectual policing of both fraudulent marketing and anticompetitive actions played an important role in launching and prolonging the opioid epidemic. We further show that these regulatory issues are not unique to prescription opioids but rather are reflective of the wider pharmaceutical market.”

“Purdue was able to patent extended-release oxycodone in the United States despite the fact that its constituent elements—the active ingredient oxycodone and the controlled-release system Contin—had been developed decades earlier…Oxycodone was used in clinical practice in Germany as early as 1917, and was first introduced in the United States in 1939.”

“Between 1996 and 2000, the company more than doubled its U.S. marketing team…In 2001, Purdue paid forty million dollars in bonuses tied to extended-release oxycodone…Purdue also invested heavily in analytics, developing a database to identify high-volume prescribers and pharmacies to help focus their marketing resources…Patients were offered starter coupons for a free initial supply of extended-release oxycodone, 34,000 of which were redeemed by 2001…Finally, Purdue hosted forty all-expenses-paid pain management and speaker training conferences at lavish resorts. Over five thousand clinicians attended, receiving toys, fishing hats, and compact discs while listening to sales representatives tout the alleged benefits of extended-release oxycodone…Purdue elevated the stakes, spending an estimated six to twelve times more promoting extended-release oxycodone than its competitor Janssen spent marketing a rival opioid…Purdue’s efforts paid off. Between 1996 and 2001, extended-release oxycodone generated $2.8 billion in sales. From 2008 to 2014, annual sales exceeded $2 billion.”

The Harvard study references a 1986 article in which the author, Marilee Donovan, found that 45 percent of patients in a large medical and surgical unit reported agonizing pain. Of those patients, less than half reported that the healthcare team ever asked about their pain.

The findings in Donovan’s piece led one pain specialist to refer to the conditions as “absolutely medieval.”

Consensus about the use of opioids for treating non-cancer related pain continued to shift well into the ’90s. Even influential organizations, such as the American Pain Society and the American Academy of Pain Medicine published reports stating that the likelihood of addiction to opioids was low, especially in patients with no history of misuse or abuse.

Purdue Pharma, the maker of OxyContin, a time-release opioid painkiller prescribed for “the management of moderate to severe pain,” took advantage of the healthcare industry’s changing attitude toward opiate painkillers. As detailed in a Los Angeles Times investigative report, Purdue Pharma went to great lengths to position OxyContin as the drug of treatment for all kinds of pain.

The company’s aggressive marketing efforts included some of the following:

  • Between 1996 and 2000, Purdue doubled its sales force and created lucrative incentives for sales representatives
  • The company paid out $40 million in bonuses to reps in 2001 alone for hitting sales goes of the extended-release oxycodone
  • Developed a database to pinpoint high-volume prescribers in an effort to focus their marketing efforts
  • Offered coupons to first time patients where the initial prescription was free, 34,000 of which were redeemed by 2001
  • Hosted all-expense-paid conferences at lavish resorts for physicians

Theodore J. Cicero, a neuropharmacologist at Washington University School of Medicine, in St. Louis, told the L.A. Times that taking OxyContin in 12-hour intervals might be “the perfect recipe for addiction.” Cicero added that not all patients will experience 12 hours of relief, their pain will return and “the beginning stages of acute withdrawal” will kick in. “That becomes a very powerful motivator for people to take more drugs,” Cicero said.

Despite President Trump’s declaration that opioid crisis is a national emergency, an action that would funnel federal resources to local and state authorities to combat opioid overdoses and addiction, no formal steps to implement any programs have been taken. A White House spokesman told Medscape that president is considering all potential options.

“It certainly seems like there’s an opportunity here to prevent additional deaths,”

Dr. Jay Butler, president of the Association of State and Territorial Health Officials said to Medscape, adding, “not only to save lives but to reduce the overall rate of addiction in our country.”

A combination of aggressive, often misleading and fraudulent, marketing, as well as over-prescribing prescription painkillers has led to the crisis of opioid addiction the nation is now battling. Addiction is a treatable disease and with more federal resources, better evidence-based approaches and medically assisted treatment opportunities, the country has a chance for healing, despite the miscalculations made governmental, pharmaceutical and healthcare professionals.