In the latest installment of his ongoing investigation for the Milwaukee Journal Sentinel and MedPage Today, John Fauber looks for the source of America’s prescription painkiller boom (graphic), outlining what he describes as “a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.”
Beginning 15 years ago, the network helped create a body of dubious information that can be found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.
Apparently, that network has been effective. Federal data shows that prescription painkiller sales have quadrupled in the past decade or so, Fauber found, and some of those sales may not have been warranted.
A band of doctors who get little or no money from opioid makers has begun to challenge the hype behind the drugs. They say pharmaceutical industry clout has caused doctors to go overboard in prescribing the drugs, leading to addiction, thousands of overdose deaths each year and other serious complications.
Several of the pain industry’s core beliefs about chronic pain and opioids are not supported by sound research, the Journal Sentinel/MedPage Today investigation found. Among them:
- The risk of addiction is low in patients with prescriptions.
- There is no unsafe maximum dose of the drugs.
- The concept of “pseudoaddiction.”
That concept holds those who display addictive behavior, such as seeking more drugs or higher doses, may not be actual addicts – they are people who need even more opioids to treat their pain.
His investigation dips deep into each of those beliefs and how they helped push painkillers. For a case study, see this companion infographic.
John Fauber wrote a tight and compelling piece, and Big Pharma should never be given a pass, but in some ways it also raised reasonable and unanswered questions.
1. If industry funding is the core problem why didn’t Mr. Fauber choose to reveal source Dr. Mark Sullivan’s ties to pharmaceutical companies Wyeth and Eli Lilly? It is publicly available information on the COPE website. Excluding pertinent conflicts of interest leaves the paper open to charges of slanting the information to fit their premise regardless of their intent. In the interests of transparency, conflicts of interest should be revealed for all sources.
2. Mr. Fauber stated that more and more opioids are prescribed for chronic pain conditions such as fibromyalgia, but there was no objective source for the statement. So did he make it up? A search of PubMed showed the most recently published survey in the United States to have been published in 2006 – and even then a reading of the full paper revealed a lack of specific statistics. There was a 2011 paper, but prescribing habits in Australia were not pertinent to this particular story.
Additionally since 2007 the United States FDA has approved three drugs (duloxetine, milnacipram, pregabalin) specifically as first-line pharmacological treatments for fibromyalgia – none of which are opioids.
A legitimate question is whether opioid prescriptions in fibromyalgia diminished as doctors had more options? It is understandable that Mr. Fauber didn’t include this information, assuming he fact checked, but by making an unsupported and unattributed statement he ran the risk of giving readers incomplete information at best and misleading or false information at worst. Even if you don’t cite original sources you should at least check them. If your mother says she loves you make sure she’s actually your mother.
5. Nor did Mr. Fauber explain why pseudoaddiction is a false concept given that researchers and doctors have no standard, objective test to measure pain. Regardless of the answer, it is a reasonable question.
4. It would be interesting to do a follow-up piece explaining how the lack of medical knowledge about chronic pain mechanisms, as well as possible psychosocial overlays and a lack of effective pharmaceutical options, for example might also influence prescribing patterns. Situations are rarely as simplistic as the black hats vs the white hats.
And as the comments showed, perhaps the main stakeholders – patients who live with chronic pain – should have also been interviewed as well – as a sidebar if nothing else. Although most patients are not experts on the science they are the experts on their personal experience. Ultimately patients have the right and freedom to decide which treatment options they wish to pursue.
Just my 2 cents.