Opioids: Continued

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Opioids: Continued

Recently, we have featured several great Touches focusing on opioids, opioid use, and the opioid epidemic. I am in agreement with Dr. Ilahi in that pain is the fifth vital sign contributing to the current epidemic. But, I also believe that big pharma (namely Purdue) has been an even bigger contributor.

In the 1980s, Purdue Pharma supported research by Portenoy and Foley that concluded, “opioid maintenance therapy can be a safe, salutary, and more humane alternative to surgery or not treating a patient with chronic pain.”1

In the 1990s, when their patent expired for MS Contin (which had reached sales of $88 million), they did not want to lose out on their share of the $462 million Schedule II opioid market. As a result, they developed and produced Oxycontin. Prior to the introduction of Oxycontin, the number of new opioid prescriptions was between 2 and 3 million per year. The year after Oxycontin’s release, the number of new prescriptions jumped to 8 million. This followed a huge ad campaign by Purdue including the “I got my life back” video that was played on a loop in more than 15,000 doctors’ offices, as well as over 20,000 elaborate, industry-sponsored “educational” programs for healthcare providers. During this time, Purdue spent $40 million on sales bonuses.

In 2000, they gave The Joint Commission (formerly JCAHO) a grant to produce a pain assessment and management manual which stated that the side effects of opioids had been exaggerated, and that physical dependence had been wrongly confused with addiction. The report also stressed the patient’s right to appropriate assessment and management of their pain. Unfortunately, there was no standard for treating pain with drugs or other interventions included in the report.

This is a short version of what can be said about big pharma’s contributions to the opioid epidemic. The problem is real. We need to react and be responsible, but not over-react. We have to help our patients with their pain with the responsible inclusion of narcotics and alternative methods.

A fantastic read for those interested in gaining more insight to the current epidemic is Dreamland by Sam Quinones.2

Kim Furry, MD
[email protected]

1. Portenoy, RK, Foley, KM. Chronic use of opioid in non-malignant pain: report of 38 cases. Pain. 1986;25(2):171-186.
2. Sam Quinones. Dreamland: The True Tale of America’s Opiate Epidemic. London: Bloomsbury Press; 2015.


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