Opioid overdoses, both fatal and nonfatal, increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states,according to the latest review of emergency-room admissions data by the Centers for Disease Control and Prevention, published Tuesday. On the same day, the Journal of the American Medical Association released the results of a year-long study from Minneapolis-area Veterans Affairs clinics showing that opioids were no more effective against common forms of back and joint pain than acetaminophen. These new findings underscore a tragic irony of the deadly epidemic: Though it has by now morphed into a problem of both licit substances, such as hydrocodone and oxycodone, and illicit ones, such as heroin, the opioid epidemic’s roots lie in a wave of permissive prescribing of opioids that turns out, in hindsight, to have been unjustifiable even as good pain-management practice.
That permissiveness did not just happen. Long-standing medical caution, based on fears of addiction, had to be overcome if pharmaceutical companies were to boost sales. About two decades ago, firms began aggressively marketing opioids, including funding ostensibly expert medical opinion and ostensibly grass-roots “patient advocacy,” with names such as the American Academy of Pain Management and the U.S. Pain Foundation.
Which brings us to a recent report on chronic-pain advocacy organizations, published by Claire McCaskill, Mo., the ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee. The report shows that nearly $9 million flowed from opioid manufacturers to some 14 nonprofits between January 2012 and March 2017. Individual doctors affiliated with these groups accepted more than $1.6 million in speaking fees and other payments from the opioid industry between 2013 and the present. Most of the groups touted the benefits of opioid prescriptions and raised objections to the most significant recent federal effort to rein in excessive opioid prescribing, the CDC’s 2016 guidelines.
Useful as it is, the McCaskill study arrives after a quarter-century in which opioids have already killed hundreds of thousands of people. As the backlash has grown, including with class-action lawsuits, opioid makers have shied away from the most aggressive marketing tactics, such as support for ostensibly neutral patient and professional groups. Purdue Pharma, maker of OxyContin, recently announced it will no longer market the drug directly to doctors. The flow of funds documented by McCaskill probably represents only a fraction of what went on before 2012, when opioid prescribing seems to have peaked.
There is still no legal requirement to disclose industry connections, only an ethical one. And the 14 organizations in the study tend to interpret that duty minimally. Before McCaskill’s staff inquired, some disclosed no information on a regular basis; others listed companies by name, indicating that they gave “at least” a certain amount; but none provided full disclosure of names, specific amounts and purposes of the donations. The opioid-makers and the nonprofits they supported, ostensibly on behalf of pain patients, have lost credibility in recent years. If they want to recover it, they are going to have to do better.