Counties in California sue manufacturers of opioid analgesics

May 24, 2014, 10:10 pm

This week, two counties in California sued five manufacturers of opioid analgesics, accusing them of carrying out a “campaign of deception” to boost sales of their products. According to a report in the Los Angeles Times:

In sweeping language reminiscent of the legal attack against the tobacco industry, the lawsuit alleges the drug companies have reaped blockbuster profits by manipulating doctors into believing the benefits of narcotic painkillers outweighed the risks, despite “a wealth of scientific evidence to the contrary.” The effort “opened the floodgates” for such drugs and “the result has been catastrophic,” the lawsuit contends.

The five defendants named in the suit are: Purdue Pharmaceuticals (OxyContin), Teva/Cephalon (Actiq and Fentora), Janssen (Duragesic and Ultram), Endo (Opana, Percoset, and Percodan), and Actavis (Kadian and various generics.)

The 100-page filing is extremely detailed and the best document I know outlining the history of how use of opiate analgesics for chronic non-cancer pain — viewed as carrying a high risk of addiction and overdose not even 2 decades ago — became so common that in 2010 over 16,000 overdose deaths were linked to prescription opioids. According to the allegations, the defendant pharmaceutical companies engaged in a deceptive and fraudulent campaign to destigmatize opioids and minimize the associated risk of addiction. Tactics they used included: co-opting professional societies and so-called patient advocacy groups; exercising improper influence on panels that created guidelines for use of opioid analgesia; creating deceptive advertising to both health professionals and the lay public; and collaborating in the production of biased CME programs and scientific papers.

The legal filing  is extremely powerful and essential reading for anyone who treats pain and/or prescribes opioid analgesics. Some excerpts:

“To shift medical convention and unleash this epidemic, Defendants engaged in a campaign of deception that: (1) misrepresented the efficacy of opioids, (2) trivialized or obscured their serious risks and adverse outcomes, and (3) overstated their superiority, compared with other treatments. Defendants supported, encouraged, and directed employees, front groups, and doctors they identified as “Key Opinion Leaders (“KOLs”) to publicize biased and misleading studies and promotional materials and conduct thousands of medical education programs that were deceptive and lacked balance.”

“Although opioids may initially improve patients’ function by providing pain relief in the short term, there were — and are — no controlled studies of the use of opioids beyond 16 weeks and no evidence that opioids improve patients’ function in the long-term. Indeed, research such as a 2008 study in Spine has shown that pain sufferers prescribed opioids long-term suffered addiction that made them more likely to be disabled and unable to work. Despite this lack of evidence, and evidence to the contrary, Defendants consistently promoted opioids as capable of improving patients’ function and qua lit of life.”

“Defendants needed a way to explain why so many chronic pain patients on opioids seemed to be addicted: they ask for drugs by name, seek refills earlier than their supplies should have run out, hoard drugs, or self-escalate their doses. Defendants, led by Purdue, managed masterfully to turn these recognized signs of addiction into a way to sell more opioids through the concept of ‘psuedoaddiction'”


Related post:

The money and influence behind “Pain as the Fifth Vital Sign”

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