- Addiction to and death from prescription painkillers is now a public health crisis in the United States.
- In the early 1990s, medical “experts” and “thought leaders” made claims convincing the medical community and the public that prescription painkillers were non-addictive when used in the long-term.
- Financial conflict of interest between opioid manufacturers and medical “experts” was the driving force in promoting opioids, resulting in 400,000 deaths since 1999.
Approximately 400,000 people have died of opioid drug overdoses since 1999. The misuse and addiction to opioids, particularly prescription painkillers, is a serious national crisis that is affecting public health as well as social and economic welfare. The U.S. Centers for Disease Control and Prevention (CDC) estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, which includes the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.1 2
Russell Portenoy, MD: “The King of Pain”
One may ask how did we reach at this point? In the mid-1980s and early 1990s, physicians seldom prescribed opiates outside the hospital in-patient environment due to the fear of addicting patients. Opioids were mainly prescribed to cancer patients or those recovering from accidents and after painful operations, such as heart by-pass or other types of major surgery.3 4
It was not until the early to mid 1990s that “medical experts” led by Russell Portenoy, MD, began to allege that long term opioid use was safe and addiction to opioids were minimal.3
At one point, Dr. Portenoy, once known as the “King of Pain” had a stellar reputation in the medical and research community. He authored numerous articles, chapters in books and won several awards. He was the Chairman of Pain Medicine and Palliative Care at Beth Israel Hospital in New York.3
At the time, Dr. Portenoy argued that that there was no downside to opioids being taken for months or years by people suffering from chronic pain. Among the assertions he and his supporters made in the 1990s were based upon a letter written by Hershel Jick, MD and his assistant Jane Porter published in 1980 in The New England Journal of Medicine that showed that less than one percent of opioid users became addicted, the drugs were easy to discontinue and overdoses were extremely rare in patients.3 4
Since this letter was published in what is known as the most prestigious medical journal in the U.S, its influence snowballed in a dangerous way.5 Dr. Jick, the lead author of the letter has repeatedly said that his letter to the editor has been completely misinterpreted and that it was based only on hospitalized patients and did not apply to patients after they left the hospital.3
Dr. Portenoy Backtracked His Position on Opioid Addiction
More recently, Dr. Portenoy has backtracked on his previous position on opioids and admitted he was wrong about the addictive properties of opioids. Dr. Portenoy and other doctors who promoted indiscriminate use of opioid drugs have openly admitted that they overstated the benefits of the drugs while paying no attention to the addiction risks associated with the drugs.3 4
In an interview with The Wall Street Journal in 2012, Dr. Portenoy said, “Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation? Well, against the standards of 2012, I guess I did.” He adds, “We didn’t know then what we know now.”4
Dr. Portenoy said that for such a widely used pain therapy, there is little scientific evidence that opioids are safe and effective for long-term use. He stated that, “Data about the effectiveness of opioids does not exist.4
In reference to the letter in The New England Journal of Medicine in 1980 describing hospitalized patients briefly given opioids, Dr. Portenoy now says he should not have used the information in lectures because it was not relevant for patients with chronic non-cancer pains.4
In a recent court declaration, Dr. Portenoy said that, “The opioid manufacturers should have tempered their positive messaging about opioids with a greater focus on risk, particularly as early signals of opioid risk emerged,”6 He added that, “Drug makers also should have responded as evidence of increasing adverse affects mounted to increased awareness and reduce inappropriate or risky prescribing.”
“Follow the Money”
The relationship between pharmaceuticals, physicians and researchers is typically one that is heavily dependent on financial conflicts of interest. Dr. Portenoy and his pain center have received millions of dollars of funding from several pharmaceutical companies including Purdue Pharma, the manufacturer of Oxycontin, and other drug manufacturers such as Mallinckrodt, Wyeth, Baxter and Pfizer. Portenoy has also admitted to having financial relationships with more than a dozen companies, which mostly manufacture opioids.
Dr. Portenoy defends his financial relationships with drug companies by saying, “My viewpoint is that I can have these relationships [and] they would benefit my research mission and to some extent they can benefit my own pocketbook, without producing in me any tendency to engage in undue influence or misinformation.”3
Newer studies show that opioids are not effective in non-cancer patients. Such studies were available in the past but were intentionally ignored.3 According to a report authored by Arthur Gale, MD in in Missouri Medicine:
Purdue Pharma has paid over $600 million in fines for misrepresentation of the addictive properties of Oxycontin and three of their chief executives were criminally charged. But does that restore the lost or ruined lives of the tens of thousands of victims and their families? And what has happened to Portenoy and the other “experts” and “thought leaders” who falsely promoted the safety of opioids? What has happened to the Joint Commission and the Federation of State Medical Boards and hospital lawyers all of whom played ‘follow the leader’ and climbed on the opioid bandwagon and advised doctors they had better treat pain with opioids or possibly face sanctions or malpractice claims? The answer is a resounding nothing.3
There are important lessons to be learned from the opioid crisis. One lesson is that industry sponsored research may be among the worst enemies of good science. Another lesson is that simple disclosures of conflicts of interest are insufficient to ensure the integrity of scientific research. Perhaps the most important lesson, however, is that doctors are not always right.
1 Healy M. Who’s to blame for the nation’s opioid crisis? Massive trial may answer that question. Los Angeles Times Sept. 18, 2019.
2 National Institute of Drug Abuse. Opioid Overdose Crisis. DrugAbuse.gov January 2019.
3 Gale A. Drug Company Compensated Physicians Role in Causing America’s Deadly Opioid Epidemic: When Will We Learn? Missouri Medicine 2016; 113(4): 244-246.
4 Catan T, Perez E. A Pain-Drug Champion Has Second Thoughts. The Wall Street Journal Dec. 17, 2012.
5 Zhang S. The One-Paragraph Letter From 1980 That Fueled the Opioid Crisis. The Atlantic June 2, 2017.
6 Feeley J. Opioid Evangelist Switches Sides in Case Alleging Pharma Abuse. Bloomberg Apr. 8, 2019.