The Opioid Crisis Part 3: The Secretive Family Behind the Crisis
For over 20 years one family, the owners of Purdue Pharma and makers of Oxycontin, have used their money and influence to change the way physicians prescribe narcotics, and Oxycontin in particular, which was approved for use in cancer patients with severe, unresponsive pain. Here’s two very startling reports about how the role they’ve played in the opioid crisis.
In 2007, three former Purdue Pharma executives pleaded guilty to criminal charges for misleading regulators, doctors, and patients about the drug’s addictiveness. Consequently, the company paid $600 million in fines to resolve civil and criminal charges for “misbranding” OxyContin—the once best-selling opioid. This fine was a drop in the bucket relative to the billions Purdue Pharma and other drug companies continue to rake in because of the drug epidemic they helped create. It’s time Americans demand that the drug companies that fueled and benefited from the opioid epidemic fund efforts to end it.
A National Emergency
The current opioid craze took root in 1984, when Purdue Pharma began promoting oxycodone (OxyContin)—a slow-release form of morphine—as a non-addictive pain medication. Oxycotin and other opioids are anything but non-addictive. Many addicts and drug dealers know them as “white man’s heroin” or “killer.”
The American opioid epidemic snowballed into such a catastrophic public health crisis that the Trump White House recently declared it a national emergency. Solving this crisis will require an all-society response; however, more than anyone else, companies that manufacture and sell opioids ought to fund efforts to solve this problem, but they are unlikely to volunteer to do so.
Propaganda Masquerading as Marketing
Drug companies have spent millions marketing opioids as non-addictive. Their efforts worked: one of the most infrequently used classes of drugs is now one of the most frequently used classes of drugs. Once reserved primarily for use among hospitalized cancer patients and for end-of-life care, opioids are now prescribed to over half of all U.S. hospital patients.
Central to this remarkable marketing coup was selling the notion—the big opioid lie—that less than one percent of patients would become addicted to opioids.
Merriam-Webster defines propaganda as “the spreading of ideas, information, or rumor for the purpose of helping or injuring an institution, a cause, or a person; ideas, facts, or allegations spread deliberately to further one’s cause or to damage an opposing cause.”
According to Joseph Goebbels—a prominent member of the Nazi propaganda machine that convinced German soldiers and citizens that it was their duty to exterminate Jews—“If you tell a lie that is big enough and keep repeating it, people will eventually come to believe it.” Goebbels’ infamous quote also warned that successful propaganda depends on suppressing concern about the truth: the group wishing to promote a big lie must also “use all of its powers to repress dissent, for the truth is the mortal enemy of the lie.”
Looking back on the evolution of the current opioid epidemic, the marketing of opioids looks like profitable propaganda. The big opioid lie was repeated so often that doctors eventually believed it was true despite previously thinking otherwise. As if on cue, doctors prescribed these drugs with increasing frequency, believing it was the right thing to do.
In accordance with Goebbels’ strategy, those wishing to convince people that opioids were not addictive also used their power to hide the truth. They crafted and promoted the concept called “pseudoaddiction,” claiming that it refers to the treatment-related syndrome of abnormal behavior that develops as a direct consequence of inadequate pain management. As such, addictive patient behavior was a signal for a need for more—not less—of the drug. In truth, “pseudoaddiction” is simply a made-up concept; it amounts to another lie, another piece of propaganda.
Promoting The Fifth and False Vital Sign—Pain
In his award-winning book, Dreamland: The True Tale of America’s Opiate Epidemic, Sam Quinones details how even the Joint Commission, which is the largest hospital regulatory body, got on board with the brilliant drug industry propaganda.3 In 2001, the Joint Commission declared that pain represents the fifth vital sign, something that should be monitored as closely and often as body temperature, pulse rate, respiratory rate, and blood pressure.
With the mandate for close monitoring of pain came the demand for aggressive amelioration of it. In fact, Medicare reimbursement rates became tied to results of government-sponsored patient satisfaction surveys that ask patients about how well they felt the hospital managed their pain. That’s also why pain charts are now plastered on hospital (and clinic) walls. These charts depict pain on a scale of 1-10 with corresponding smiley and sad faces and are designed to remind providers to ask about and control patient pain.
In due course, healthcare providers came to believe every patient’s pain levels should be kept to a minimum, and that opioids are the most effective means of doing so. Moreover, doing anything less could result in a hospital being cited by the Joint Commission or the doctors being reprimanded by hospital administrators, shunned by peers, or sued by patients.
It might seem bizarre that physicians jumped on board with the notion of pseudoaddiction, but they did. Eventually, however, the compounding wreckage of liberal opioid use overwhelmed the propaganda. Today, many doctors realize they were duped and are once again thinking of pain simply as a symptom rather than a vital sign that can or should be measured frequently. They also know opioids are powerful substances to which many patients will become addicted with high dosages or sustained use, appreciating also that some patients will become addicted even after short-term exposure to low dosages.
Last year, the American Medical Association (AMA) officially acknowledged the danger of thinking of pain as a vital sign that should be aggressively treated. The guild’s president stated that physicians played a role in the opioid epidemic and they were ready to take responsibility for it. The AMA’s main solution is to stop repetitively asking patients about their pain as a matter of routine.
Protesting Costly Change
The AMA’s decision to discourage doctors from routinely inquiring about pain drew outrage from pain specialists, including a past president of the American Academy of Pain Medicine. He claimed that the new AMA policy would set pain management back three decades. Such a response is not surprising.
Asking pain management specialists to get on board with reversing this trend would be like asking the fox to guard the hen house. Wittingly and unwittingly, pain specialists earned sizeable incomes from prescribing opioids and then treating patients who became dependent on them.
Translating Policy Into Practice
It generally takes 15 to 17 years for medical research findings and policies to become routine practice. Robert Pearl, MD provides a great case example in his new book: Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong.4 In the early 1980s, Dr. Barry Marshall, an Australian physician, discovered that stomach ulcers were almost always caused by a specific bacterium and treatable with antibiotics. Medical peers protested, continuing to believe that spicy food and stress were the usual culprits. Frustrated by such resistance, Marshall infected himself with the bacterium and allowed an ulcer to develop before treating himself (successfully) with antibiotics and published the results of his personal and well-documented experiment in the Medical Journal of Australia. Yet medical management of peptic ulcers didn’t begin to change for 20 years, when Marshall received a 2005 Nobel Prize for this work.
Even in the face of abundant evidence that liberal use of opioids is not effective and is harmful to the health of patients and the broader society, as well as criminal charges and company fines for promoting such practices, changes in medical care remain slow. Case in point: earlier this year, I had the opportunity to witness how difficult it is to un-ring the opioid bell. While visiting my friend Nancy Thom in California, her son, Wes, landed in the hospital for a painful infection that stemmed from a needle tip breaking off in his ankle while shooting heroin a few weeks earlier.* Despite being a self-disclosed heroin addict in the early stage of recovery, he was given opioids that he could have done without.
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