by Dr. Richard Bankowitz
December 6, 2017
Since the early 1990s, Big Pharma has run aggressive campaigns to push doctors to prescribe opioids. These campaigns, based on little or no evidence, claimed that opioids were safe and non-habit forming. Lawmakers are now reviewing how these false claims contributed to the opioid epidemic America faces today. For example, a coalition of 41 states’ attorneys general have a class-action lawsuit against five major opioid manufacturers because of their misleading advertising and marketing.
Sadly, and perhaps tragically, it’s happening again. Drugmakers are once again using the opioid epidemic as a marketing opportunity. Manufacturers of abuse deterrent formulations (ADF) opioids are making questionable claims to push doctors to prescribe their drugs.
It’s true that the ADF pills are nearly impossible to crush, snort, or inject. But patients can abuse these medications just as easily as any other pill by simply taking more of the drugs, making the term “abuse deterrent” something of a misnomer. Plus, these drugs can fall into other people’s hands and be misused.
Opioids kill about 142 people a day. We can’t accept the notion of “safe” or “non-addictive” opioid painkillers without strong supporting proof. Drug makers frequently point to one study in the New England Journal of Medicine that found the use of OxyContin may go down with access to ADFs. Unfortunately, data shows this leads to increased use of illicit opioids, including heroin.
And other studies tell a different story of the usefulness of ADFs. A recent ICER review of ADFs found they provided limited value in reducing the risk of misuse or addiction.
We need to stop thinking that abuse-deterrent opioids are “safer” than other opioids for pain management. There are many other steps we can take. In fact, the Journal of the American Medical Association(JAMA) urged the federal government to take 10 steps to stop the opioid epidemic. Guess what didn’t make the list: Use of “less addictive” opioids and ADFs.
The JAMA recommended doctors prescribe opioids more cautiously. It called for efforts to restrict or eliminate the marketing of opioids for chronic pain treatment. Evidence based guidelines suggest non-opioid and non-pharmacologic treatments always be used first. If needed, opioids should be used only after discussion with patient about options as well as risks and benefits. These guidelines do not recommend ADF treatments. Let’s focus on patient needs and do what works—not rely on untested claims.
Albert Einstein defined insanity as doing the same thing over and over again and expecting different results. It doesn’t take an Einstein to know the opioid crisis won’t be solved by the same marketing tactics that got us here in the first place.
Dr. Richard Bankowitz is chief medical officer of AHIP.