Those who cannot remember the past are condemned to repeat it.
George Santayana
There has been a multitude of public discourse about America’s opioid epidemic, but little mention is made of how it evolved. If we do not heed history, we risk repeating it. A recent 60 minute segment on the subject covered how an FDA whistle blower exposed the failure of FDA to enforce regulations on the supply and distribution of narcotics to retailers such as pharmacies. This is downstream to the epidemic, no mention is made of how the demand for the drugs skyrocketed in the last 20 years. The upstream cause is the change in the prescribing habits of physicians. In a previous blog dated 6/1/17, I alluded to the set of circumstances that might have led to the practice of over-prescribing opioids by American physicians.
- litigation- large lawsuits against those who underprescribed pain medication for terminally ill patients
- legislation- In California, physicians, in order to renew their licenses were required to take training in “pain management”, which advocated liberal use of narcotics for not just terminal cancer pain, but all pain. Pain laws laws promoting generous use of opioids without regard to their real risk of addiction have been passed in many states and have yet to be rescinded.
Now, I discovered,an addition to the list is the pharmaceutical industry’s intentional campaign to promote opioid prescribing and use.
Big Pharma’s Campaign of Misinformation
To The Prescribing Physician: Opiods are safe
- A recent article entitled Smoke ’em Out, in Bloomberg Business Week uncovers who really fueled the opioid movement. It recounts how Purdue, the maker of Oxycontin embarked on a campaign through industry-funded experts, pamphlets, online publications and medical educational programs as well as direct sales representative marketing, to intentionally mislead physicians as to the safety of their product. In the past, Oxycontin was prescribed for postoperative patients and terminal cancer patients, a relatively small market. With intensive marketing, and selling the notion that ordinary backaches, headaches and arthritis needed treatment with opioids, sales for Oxycontin rose from $45 million in 1996 to over $1.5 billion in 2002.
To The General Public: Pain is a Disease Entity.
I often hear people say, “ I am a chronic pain patient,” and they seem very satisfied that their medical problem has been “diagnosed.” Pain is a symptom, not a disease. The cause can be inflammation, ischemia (poor blood supply), muscle spasm, or a space occupying lesion. Treatment should be directed at the cause, not the symptom. If one treats the symptom only, it would mean an endless dependence on the symptom- relieving drug, and that is how the epidemic evolved. It has become very profitable for the pharmaceutical industry but a disaster for society.
Solutions
Lawsuits against large pharmaceutical companies are warranted and may help against this “war on addiction,” but the misinformation that Big Pharma has promulgated needs to be reversed by correct information.
Training– the experts on addiction, recommend that doctors should be trained in the addictive properties of opioids. While that is a valuable first step, it offers little to address the problem of chronic pain, when opioids or other drugs are the only option doctors know. Somehow they need to be trained to recognize the efficacy of non-drug methods of treatment. The most common conditions now being over-treated with opioids- back pain, headaches, and arthritis, involving the musculoskeletal system, can be successfully treated without drugs. This information has not been widely publicized because there is no profit incentive to do so. Very little is taught in medical schools about the musculoskeletal system. Most primary doctors, when confronted with musculoskeletal pain, send the patient for imaging, or refer them to an orthopedist or physical therapist , and prescribe pain medication. Most of the conditions involve soft tissue: ligaments, discs, tendons, not bones. Most can be treated with acupuncture, acupressure and other physical modalities. We can learn from the Canadian medical system. Physcial therapists, who are the most informed about the musculoskeletal system, are, in Canada, allowed to perform acupuncture, whereas in the United States, they are not allowed to insert needles. If we adopt the Canadian system, it would greatly expedite treating these cases. Short of that, at least we can educate the medical community that non-drug treatments are effective and far safer than opioids.
Rehabilitation
Most addiction experts point to the need of placement in rehab centers and treatment with drugs such as Methadone, Suboxone, and Naltrexone. The program is enormously expensive and may entail ongoing need for drugs. Little mention has been made about acupuncture, a safe, inexpensive form of treatment for addiction. This method was discovered in 1972 by Dr. Wen in Hong Kong. In 1977, the method was adopted by the Lincoln Clinic in New York City as part of their detoxification program. In 1985 , the National Acupuncture Detoxification Association (NADA) protocol, using acupuncture points on the ear was adopted in the U.S., and many rehabilitation facilities have been able to train staff to administer it. The treatment is inexpensive, free of side effects, and can be done in an outpatient setting. Research shows that acupuncture when used as adjunctive therapy to Methadone enables lowering the dosage of Methadone required.
The epidemic is serious and requires more scrutiny than what has so far been shared with the public.
