An unthinkable death toll continues to rise due to the opioid crisis in America. Since 2000, more than 165,000 people have lost their lives to opioid overdoses in the U.S. alone. Countless more now live with physical dependence and addiction.
Families and communities are left with endless questions, but very few answers. How can we prevent more lives being lost? Isn’t there a better, safer way to treat pain?
Chronic pain patients have a right to quality healthcare and relief from their suffering. But, recent research shows very little evidence to support the effectiveness of opioids in treating chronic pain.
So, why do sales of opioid painkillers continue to rise? Why were 227 million opioid prescriptions written in the U.S. last year, enough to give a bottle of pills to 9 out of 10 adults? A new investigation reveals just how much drug-makers have spent to protect the sales of their dangerously addictive prescriptions.
Drug-makers Pay Big to Prevent Restrictions on Opioids
The Pharmaceutical Research and Manufacturers of America, a trade group representing companies in the pharmaceutical industry, has said: “We and our members stand with patients, providers, law enforcement, policymakers and others in calling for and supporting national policies and action to address opioid abuse.”
Yet, the Associated Press and Center for Public Integrity have discovered a different reality in their investigations:
- Between 2006 and 2015, opioid drug-makers and their allies spent over $880 million nationwide on lobbyists and campaign contributions to legislators and congressional candidates.
- Groups supporting limits on prescribing spent just $4 million.
- Drug-makers maximize their political influence by funding countless advocacy groups to help them fight any legislation that might place limits on opioids.
- In the midst of attempts to limit prescriptions in the last 10 years, drug-makers and their advocacy groups employed an average of 1,350 lobbyists in each state capital.
Pharmaceutical companies have put themselves in a position to influence legislators significantly—using the power of their pocketbooks.
Most recently, they’ve lobbied in favor of laws that would require insurers and pharmacists to promote “abuse-deterrent” formulas of opioids—supposedly harder to crush or dissolve. But, 24% of people surveyed in the drugs’ trials got around the deterrent properties and abused it anyway.
What’s worst: 66% of people switched to other opioids—like the cheaper, more-readily-available heroin. Most importantly, these abuse-deterrent formulas are patent-protected, meaning no affordable, generic versions are available.
Patient Advocates or Pawns of the Pharmaceutical Industry?
The Washington Post provides a detailed report on the industry’s legal happenings, highlighting their strategic use of advocacy groups. Here’s just one example:
- In 2013 in Tennessee, 900 babies were born addicted to drugs—nine times as many in 2001—because their mothers took prescription opioids during pregnancy.
- In 2014, Republican state Rep. Ryan Williams hoped to stop this trend and tried to repeal a 2001 law, which said doctors could refuse to prescribe opioids only if they directed patients to an “opioid-friendly” doctor.
- The repeal failed, after the American Cancer Society’s Cancer Action Network (CAN) and the Academy of Integrative Pain Management lobbied against it—even though the repeal wouldn’t affect prescriptions for cancer patients.
- The CAN received $125,000 last year from major opioid producers.
- The Academy received 15% of its funding from pharmaceutical companies, and its state advocacy project is funded entirely by drug-makers.
- Purdue Pharma, the inventors of OxyContin and one of the nation’s largest opioid sellers, gives money to both groups.
- In 2015, despite continued lobbying against it, Williams’ repeal finally passed.
Groups like the CAN and the Academy are patient advocates and want lawmakers to consider the needs of cancer and chronic pain patients. Yet, they continue to oppose opioid restrictions even when cancer patients are specifically exempt.
Can’t we make positive change without denying patients’ rights to quality healthcare?
Executive Director of the Academy, Bob Twillman, says it best: “Most of the time we’re saying, ‘Gosh, yes, there should be some limits on opioid prescribing, reasonable limits, but I don’t think they would be in favor of that.” (‘They’ being the group’s financial benefactors—pharmaceutical companies.)
Are Doctors Prescribing Too Much?
Despite the number of prescription-opioid-overdose deaths, the number of prescriptions that doctors write remains high. Last year’s numbers saw just a small decrease from the 240 million narcotic painkiller prescriptions written in 2014. The Centers for Disease Control and Prevention (CDC) puts it simply: “Higher prescribing of painkillers is associated with more overdose deaths.”
Like their opiate cousin heroin, opioid painkillers are powerfully addictive. Users build up tolerance fast, need to increase dosage, and develop a physical dependence over time. Yet, some doctors still write opioid prescriptions for things like back pain and headaches. The unused pills are the most dangerous—60% of Americans have leftover narcotics at home, and 20% of those people have shared them with someone.
In an attempt to combat the problem, Aetna, a health insurance provider, has recently started to contact its doctors who are “falling within the top 1 percent of opioid prescribers within [their] specialty.” None of the doctors notified by Aetna were suspected of fraud or abuse in prescribing opioids. But, excluding oncologists, these doctors prescribed more than 12 times as many opioids as their peers.
Aetna’s aim in reaching out to “superprescribers” isn’t to question doctors’ clinical judgments, by any means. They’re simply providing them with the numbers and an “opportunity to improve,” according to their chief medical officer, Harold Paz. “By nature, doctors are data-driven…If you show them how they’re doing, they’ll want to do better.”
The Most “Humane” Treatment?
In the ’80s, previously “opiophobic” doctors began prescribing opioids for all pain types. First, Dr. Hershel Jick analyzed 11,882 patients treated with narcotics and published a letter in 1980, stating, “the development of addiction is rare in medical patients with no history of addiction.”
Then, Dr. Russell Portenoy, a pain-management specialist, treated non-cancer pain patients with opioids and, in 1986, reported that, “opioid maintenance therapy can be a safe, salutary and more humane alternative” to surgery or to not treating chronic pain. Portenoy has since admitted that the goal back then was to de-stigmatize opioids so “we often left evidence behind.” Nonetheless, by the ‘90s, humane pain treatment became a priority.
We’ve witnessed just how high the risk of addiction truly is, though it’s often downplayed. Case in point: In 2007, the executives at Purdue Pharma pleaded guilty to misleading the public about the addictive nature of OxyContin and settled their case by paying $600 million in fines.
In response to growing awareness about opioids addictiveness, the CDC just released new guidelines for physicians in March of 2016, urging them to consider a medication’s effectiveness relative to its potential for harm before refilling prescriptions.
When Humane Becomes Insane
Beyond their addictive potential, research studies show weak or no evidence that prescription opioids are actually effective treatments for chronic pain. In March, the Director of the CDC, Dr. Tom Frieden, addressed the insanity of the opioid epidemic: “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.”
Though he says we need more data about long-term use of prescription opioids, Frieden summarized some of the existing studies and their “consistently poor results:”
- Opioid treatment may actually worsen pain and functioning, possibly by increasing a patient’s pain perception without the drug.
- For chronic non-cancer pain, as many as 26% of patients may develop opioid dependence.
- Overall, 1 out of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years after their first prescription.
What Do Pharmaceutical Companies Really Want?
So, if opioids have yet to prove effective in the treatment of chronic pain and more prescriptions are linked to more deaths, why do pharmaceutical companies continue to lobby against reasonable opioid restrictions?
Dr. Andrew Kolodny, an outspoken advocate for opioid reform, says “The opioid lobby has been doing everything it can to preserve the status quo of aggressive prescribing.” In his eyes, “They are reaping enormous profits from aggressive prescribing.”
When the DEA announced its intent to classify kratom as a Schedule I substance, many kratom advocates were baffled and suspected pharmaceutical companies of foul play. Kratom is an herbal supplement that isn’t an opioid, yet has helped over 100,000 people in the U.S. treat pain and even wean themselves off of opioids.
It will now share the same drug class as heroin—making it harder to study and highly stigmatized. For some perspective: kratom is connected to about 30 deaths total—across the entire world—while prescription opioids kill an average of 52 people every day in the U.S.
Facing the Facts and Moving Forward
We may not have conclusive evidence on the effectiveness of opioid painkillers just yet, but what we do know is this:
- The U.S. is the biggest global consumer of opioids, accounting for almost all of the world’s total hydrocodone (Vicodin) and 81% of its oxycodone (Percocet).
- Unintentional overdose deaths from prescription pain relievers has more than quadrupled since 1999.
- By 2002, “opioid analgesic poisoning” was listed as a cause of death more commonly than either heroin or cocaine.
Is the solution to ban opioids altogether? Unlikely. But we can work toward sustainable solutions for the future.
In the words of Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA): “Scientific insight must strike the right balance between providing maximum relief from suffering while minimizing associated risks and adverse effects.”