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Tuesday, February 28, 2012

Chronic Pain Fuels Boom in Opioids

By John Fauber
Milwaukee Journal Sentinel/MedPage Today
Originally published on February 19, 2012

Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors, and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison-based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids -- an agenda that critics say was not supported by rigorous science -- the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.


The Pendulum Swings Back

Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Today review of records and interviews found.

Among the misconceptions:
  • The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
  • There is no maximum dose of the drugs that can't be safely prescribed.
  • People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.

Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.

Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.
Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.

"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."

Some chronic pain sufferers do benefit from the drugs, Webster said.

"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long term.

"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."

Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.