Bernie Sanders is right: Drug companies did help cause the opioid epidemic

Bernie Sanders is right: Drug companies did help cause the opioid epidemic - Vox

At Sunday's Democratic debate, Sen. Bernie Sanders (D-VT) made a point about the harrowing opioid painkiller and heroin epidemic that isn't raised enough: "There is a responsibility on the part of the pharmaceutical industry and the drug companies who are producing all of these drugs and not looking at the consequence of it."

The opioid epidemic began when doctors prescribed a tremendous amount of opioid painkillers to help treat pain — a serious problem, given that chronic pain alone afflicts about 100 million Americans. One reason doctors were so willing to prescribe these painkillers, despite the clear risks of addiction and overdose, is heavy campaigning from the pharmaceutical industry.

In fact, Purdue Pharma, producer of the opioid OxyContin, paid hundreds of millions of dollars in fines for its false claims about opioids. The Associated Press reported:

Purdue Pharma, its president, top lawyer and former chief medical officer will pay $634.5 million in fines for claiming the drug was less addictive and less subject to abuse than other pain medications, U.S. Attorney John Brownlee said in a news release. Purdue learned from focus groups with physicians in 1995 that doctors were worried about the abuse potential of OxyContin. The company then gave false information to its sales representatives that the drug had less potential for addiction and abuse than other painkillers, the U.S. attorney said.

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One must be very careful when assigning blame for addiction. To follow the OP logic one would have to accept that doctors believe sales rep's claims more than many other sources of information about pain medication's additive potential.

The opioid epidemic began when doctors prescribed a tremendous amount of opioid painkillers to help treat pain — a serious problem, given that chronic pain alone afflicts about 100 million Americans. One reason doctors were so willing to prescribe these painkillers, despite the clear risks of addiction and overdose, is heavy campaigning from the pharmaceutical industry.

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In essence, we are being asked to shift the blame from (stupid?) doctors to (smarter?) sales reps. Expecting folks to trust doctors that would accept whatever the "snake oil" sales rep claims, at face value, is a far bigger problem than the existence of "snake oil" makers or their sales reps. The sales rep has no power to diagnose a medical problem, prescribe that pain relief product as part of a treatment plan or to make follow-up appointments to assure that a treatment plan is affective and/or being followed.

I have been prescribed pain medication as part of treatment requiring orthopedic surgery on multiple occasions and never had any addiction problems. Drug use vs. drug abuse is largely a matter of patient behavior possibly extending to the skill/advice of the doctor. We, as a society, seem to be constantly seeking someone else to blame thus allowing those most responsible to be considered victims in need of government protection.

ttwtt78640 said:

One must be very careful when assigning blame for addiction. To follow the OP logic one would have to accept that doctors believe sales rep's claims more than many other sources of information about pain medication's additive potential.

In essence, we are being asked to shift the blame from (stupid?) doctors to (smarter?) sales reps. Expecting folks to trust doctors that would accept whatever the "snake oil" sales rep claims, at face value, is a far bigger problem than the existence of "snake oil" makers or their sales reps. The sales rep has no power to diagnose a medical problem, prescribe that pain relief product as part of a treatment plan or to make follow-up appointments to assure that a treatment plan is affective and/or being followed.

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Why wouldn't we accept that premise? The alternative is drug companies pay drug reps for essentially nothing, but we know they're not that stupid. Their job is to inform very busy doctors about new drugs, when they're appropriate, etc. and they get paid great money to do that well, and deliver good information, and to sell those drugs. I've got friends who are drug reps and the good ones are identifiable, paid bonuses, promoted, etc. by how much prescriptions of the drug they're promoting increase. We also have to assume that the marketing people at Purdue, for example, are bright enough to develop effective sales strategies for their reps, and in this case the strategy involved giving out information they allegedly knew was false.

I have been prescribed pain medication as part of treatment requiring orthopedic surgery on multiple occasions and never had any addiction problems. Drug use vs. drug abuse is largely a matter of patient behavior possibly extending to the skill/advice of the doctor. We, as a society, seem to be constantly seeking someone else to blame thus allowing those most responsible to be considered victims in need of government protection.

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Your own experience as a sample of 1 isn't all that relevant in the big picture. There have been a number of studies that show genetic factors contribute to addiction issues, and that individuals with identifiable non-genetic (environmental/personality) risks are also far more likely to become addicted. Bottom line is there are several reasons why legitimate use leads to addiction, and for people at risk prescribing the high potency opiates is like playing with a loaded gun.

I agree with you that the fault is at least significantly with doctors. I'm shocked at how these drugs are prescribed like candy for my mother in law, even after I tell them she handles them poorly and don't want them given to her except for severe pain. I told one doctor that recently and he gave her a prescription for 60 pills, with two refills. They were not potent, but still had a street value of (from what I could tell) about $10 per pill, and she paid $2.37 for a bottle of 60.

Anyway, we've got a serious problem and it will take a coordinated effort across the system to address it. One is that drug companies don't lie about the addiction potential.

Someone employed by a pharmaceutical manufacturer will, like the company itself, inherently stand to gain from demand for these drugs being high. So their concern over the wellbeing of the consumers of the medicines is in conflict, straight away. That conflict of interest can then spread to prescribers. So the prescribing of these drugs therefore requires pretty heavy handed regulation (contracts, oversight, etc.), and that is where I think we've failed. HIPAA and 42 CFR Part II both are extremely protective of addiction and related health information, allowing people who have developed these drug problems to shop around from provider to provider and often times get their addiction needs met despite the fact they are continuously violating their medication contracts (which have become more common for dealing with abusers), and preventing the more open lines of communication between prescribers to prevent abusers from continuing to source these meds.

But then there's the view that restricting supply expedites the addict's pursuit of more dangerous alternatives, e.g. pills sold on the street, or heroin, and so some take the harm-reduction approach and think we should have relaxed regulation around these medicines so that some aren't encouraged to resort sooner to harder drugs.

That debate rages on, and all the while, Big Pharma profits handsomely.

ttwtt78640 said:

One must be very careful when assigning blame for addiction. To follow the OP logic one would have to accept that doctors believe sales rep's claims more than many other sources of information about pain medication's additive potential.



In essence, we are being asked to shift the blame from (stupid?) doctors to (smarter?) sales reps. Expecting folks to trust doctors that would accept whatever the "snake oil" sales rep claims, at face value, is a far bigger problem than the existence of "snake oil" makers or their sales reps. The sales rep has no power to diagnose a medical problem, prescribe that pain relief product as part of a treatment plan or to make follow-up appointments to assure that a treatment plan is affective and/or being followed.

I have been prescribed pain medication as part of treatment requiring orthopedic surgery on multiple occasions and never had any addiction problems. Drug use vs. drug abuse is largely a matter of patient behavior possibly extending to the skill/advice of the doctor. We, as a society, seem to be constantly seeking someone else to blame thus allowing those most responsible to be considered victims in need of government protection.

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We're being asked to share the blame, because yes actually marketing works.

There is a lot of issues when it comes to pain killers.

The use of prescribed painkillers as a drug of choice is not new. In fact it has been accepted socially as a means of coping with stress etc. If you doubt this.. go rent a copy of (are there even copies anymore).. ok "net flicks".. the movie Legally Blonde... with Reese Witherspoon.

In one scene, Reese's character Elle.. tells everyone that she is going to become a lawyer..

Her friend.. another wealthy college girl, says "gee Elle.. can't you just take a Percocet?"

So acceptable that its a funny line about rich college educated girls.

So society is really to blame.