Archives for May 2012

ProPublica reports that The American Pain Foundation has shut down just as two U.S. senators are launching a probe into the heavy financial support it received from painkiller-makers. Syndicated columnist Judy Foreman, author of the upcoming book “A Nation in Pain: Healing Our Biggest Health Problem,” considers the news and its background.

Okay, everybody, deep breath.

The US Senate on Tuesday launched what ProPublica, a generally terrific online investigative news organization, says is a probe into the makers of “narcotic painkillers” and the manufacturers’ ties to groups that advocate sane, responsible use of them. (By the way, “narcotic” is a loaded word; scientists prefer the less stigmatizing “opioid.”)

Let’s hope the Senate runs a genuinely open, fair investigation and that, in the laudable effort to examine the relationship between Big Pharma and advocacy and research groups, it doesn’t abandon pain patients who need the drugs and use them responsibly.

In the meantime, three thoughts. First off, what counts as an “epidemic?”

In a letter reportedly sent to drug makers by Chuck Grassley, an Iowa Republican, and Max Baucus, a Democrat from Montana, the Senate probe is necessary because of an “epidemic” of accidental deaths and addiction due to opioid pain relievers.

Government figures show there were 14,800 overdose deaths in 2008 that involved opioids (far fewer, incidentally, than from alcohol or cigarettes). And many of those 14,800 deaths, the data show, involved other drugs besides opioids. Is that an opioid overdose epidemic?

Secondly, the underlying assumption here is that if Big Pharma pays for advocacy groups or research studies, this automatically means that the advocacy groups or the researchers are tainted. Frankly, it often does. When research or advocacy is supported by Big Pharma money, it should raise red flags. But that’s also the easy, knee-jerk assessment. In truth, it’s often hard to know when the appearance of a conflict of interest is a real conflict.

Thirdly, the underlying problem is that pain researchers and advocacy groups more or less have to turn to Big Pharma for funding because nobody else has the money. The federal government, ideally, should be funding more pain research, but, aside from the fact that the government is broke, it does not hold pain research as a priority. Out of the massive budget for the National Institutes of Health, only 1.3 percent goes for pain research, even though pain is the main reason people go to doctors.

Big Pharma, obviously, is a mixed blessing. For better and for worse, we live in a capitalist system and the companies that make our drugs care mostly about profits. And they’re sometimes unscrupulous. In 2007, Purdue Pharma, the maker of OxyContin, pleaded guilty to federal criminal charges that it misled regulators, physicians and consumers about OxyContin’s addiction risk.

But it’s still a shame, I think, that one of the most valuable pain advocacy groups in the nation, the American Pain Foundation, has collapsed this week, as the Senate investigation gets under way. It posted an announcement on its website saying that it has ceased to exist, effective immediately, because of “irreparable economic circumstances.”

The American Pain Foundation did get 90 percent of its funding from pharmaceutical companies, as page 16 of its 2010 annual report shows. As a journalist trying to sort all this out, I really wish it didn’t. That’s a monstrous red flag.

But who will take up the cause of pain patients if groups like the APF disappear?

It is wonderful that Blue Cross Blue Shield of Massachusetts is concerned about pain reliever abuse and that the company has consulted with some physicians about ways to curb it.

But it is extremely likely that the policy the company is set to put in place July 1, which allows patients to fill a 15– day prescription and one additional 15-day supply, will end up doing more harm than good, becoming yet another barrier for legitimate pain patients who need opioid medications.

There’s no question that a few physicians prescribe too many opioids and a few patients scam their doctors for more. But the far larger problem is under-treatment of the pain of 100 million Americans, some of whom appropriately need opioid medications.

Blue Cross’ new policy, while it may stem from legitimate, benign motivation, could end up making the lives of pain patients more difficult than they already are. Blue Cross is concerned about “doctor-shopping,” that is, patients going from doctor to doctor to get drugs in order to abuse them. But the truth is that many legitimate pain patients go from doctor to doctor not to abuse drugs but to find someone who understands and can treat their pain.

As for the concern that people who fill opioid prescriptions wind up with medicine cabinets full of left-over pills?

That’s absolutely true. In fact, according to federal government figures, that’s where most of the drugs that get diverted to street users come from. But the federal government has a totally inadequate policy for solving this.

The Drug Enforcement Administration designates on day a year (this year it was April 28) as “take-back” day (actually four hours, from 10 a.m. to 2 p.m.) during which people can take their unwanted drugs to disposal sites.

Driving the hysteria about opioid abuse is the fear of addiction. But even with long term use, the risk of addiction is far short of the 100 percent that the public seems to think. The risk of addiction is estimated to be between 4 and 26 percent, and that’s according to a conservative group, the Physicians for Responsible Opioid Prescribing.

There’s another root cause at play here. Basically, though most people haven’t digested it yet, the “war on drugs” has failed.

That’s not my conclusion. It’s the conclusion, issued in June, 2011, of the Global Commission on Drug Policy, a group that included former heads of state, Kofi Annan (the former Secretary-General of the United Nations), Paul Volker (former chairman of the Federal Reserve), George P. Shultz (former US Secretary of State) and others.

“The global war on drugs has failed,” said the group, “with devastating consequences for individuals and societies around the world….Arresting and incarcerating tens of millions of  these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”

Blue Cross’ new policy may end up being benign. But it smacks of the old war on drugs mentality. And if it plays out that way, it could end up hurting pain patients.