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Studies downplayed risks of OxyContin and other opioids

Rating:
5/5,
  1. Basoodler
    PORTSMOUTH, Ohio — Over much of the past decade, the official word on OxyContin was that it rarely posed problems of addiction for patients.

    The label on the drug, which was approved by the FDA, said the risks of addiction were “reported to be small.”

    The New England Journal of Medicine, the nation’s premier medical publication, informed readers that studies indicated that such painkillers pose “a minimal risk of addiction.”

    Another important journal study, which the manufacturer of OxyContin reprinted 10,000 times, indicated that in a trial of arthritis patients, only a handful showed withdrawal symptoms.

    Those reassuring claims, which became part of a scientific consensus, have been quietly dropped or called into question in recent years, as many in the medical profession rediscovered the destructive power of opiates. But the damage arising from those misconceptions may have been vast.

    The nation has been overwhelmed by an ongoing epidemic of addiction to prescription painkillers — more widespread than cocaine or heroin — that has left nearly 2 million in its grip, according to federal statistics.

    “It turns out that the doctors didn’t know what they were talking about,” said Barbara Howard, whose daughter Leslie, a home-care nurse, died of an overdose in 2009 in this small Appalachian town devastated by the epidemic. She had developed a habit after knee surgery. She left behind a 9-year-old son.

    “Leslie trusted the doctors. We thought the doctors knew what was best. But they didn’t. We — and lots of the other victims — had no warning.”

    A closer look at the opioid painkiller binge — retail prescriptions have roughly tripled in the past 20 years — shows that the rising sales and addictions were catalyzed by a massive effort by pharmaceutical companies to shape medical opinion and practice.

    Opioids are a class of powerful drugs, often used for pain, that includes morphine, heroin and brand names such as OxyContin, Vicodin and Percocet.

    For years, doctors had been cautious about prescribing opioids to anyone except patients with cancer or in acute pain.

    But drug manufacturers and some pain specialists helped create a body of scientific research assuaging the long-standing worries about opioids and pushed to expand the use of the drugs in people with chronic pain — bad backs, arthritis, sore knees.

    Their studies reported minimal risks of addiction and dependence. These, in turn, were accepted by the FDA and the nation’s medical journals. State medical boards made their rules for prescribing opioids more liberal. Academic and industry articles dismissed the old fears as “opiophobia.”

    These reports reached doctors through marketing efforts and told them that there were few risks in using opioids to treat chronic pain.

    But according to a Washington Post examination of key scientific papers, a court document and FDA records, many of those claims were developed in studies supported by Purdue Pharma, the maker of OxyContin, or other drug manufacturers. In addition, the conclusions they reached were sometimes unsupported by the data, and when the FDA was struggling to come up with an opioid policy, it turned to a panel populated by doctors who had financial relationships with Purdue and other drugmakers.

    A review of 16 key clinical trials on the subject shows that five were funded by Purdue and an OxyContin distributor, two were co-authored by Purdue employees, and two were sponsored by other drug companies making different opioids. None of the 16 studies showed clear warnings about the addiction dangers or the physical dependence generated by the drugs. The low rate of addiction reported in these studies is at odds with more recent findings indicating that diagnoses of addiction are common in opioid patients.

    Internal company documents indicate that one of the key published studies sponsored by Purdue — the one reprinted 10,000 times — omitted suspected cases of withdrawal symptoms. The published paper offered assurance that only two of more than 100 OxyContin patients had withdrawal symptoms; the internal documents showed that at least 11 exhibited possible signs of withdrawal, and some experts say it is likely that at the doses given most of the patients would have experienced withdrawal.

    To refine its policy on opioids, the FDA convened a key meeting in 2002 and invited 10 outside experts for advice. Five of them reported having served as speakers or investigators for Purdue. Three others reported working as speakers for or as advisers and consultants to other pharmaceutical companies.

    One of those FDA advisers, Russell Portenoy, who was then the chair of the Department of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York, has since expressed regret for his evangelism on behalf of opioids.

    He was “trying to create a narrative so that the primary care audience would . . . feel more comfortable about opioids,” Portenoy said in a 2010 interview with Andrew Kolodny, the chief of a group seeking to rein in drug use, Physicians for Responsible Opioid Prescribing. “Because the primary goal was to destigmatize [opioids], we often left evidence behind. . . .

    “To the extent that some of the adverse outcomes now are as bad as they have become in terms of endemic occurrences of addiction and unintentional overdose deaths, it’s quite scary to think about how the growth in that prescribing driven by people like me led in part to that occurring.”

    Through a spokesman, Portenoy declined to comment for this report, but he has said that he continues to believe that many patients with chronic pain can benefit from opioids, though the estimates of how many patients may become addicted are larger than previously thought.

    At the time of the 2002 FDA meeting, Portenoy reported being a speaker for Purdue Pharma. He also reported involvements on contracts and grants with Parke-Davis, Boehringer Ingelheim, Elan, Ortho Biotech, Endo, Ametek, Medtronic, Purdue Pharma, Pfizer, Janssen, Abbott, Curatech, Ortho-McNeil and Searle.

    James Heins, a spokesman for Purdue, said that “it is implausible that our marketing caused an upsurge in overall prescriptions of opioids or in the incidence of abuse” because the company commands only a small portion of the painkiller market.

    Moreover, he said, the notion that the risk of addiction was small was “not based on studies funded by Purdue but rather on the larger body of medical literature and clinical experience.”

    Even today, he said, it is difficult to say exactly how many people who are prescribed opioids become addicted.

    In few places are the effects of the opioid epidemic clearer than in Portsmouth, a town near Ohio’s borders with West Virginia and Kentucky. About 10 percent of babies are born addicted to opioids. At one point, nine “pill mills” operated out of this region of 80,000 people. About 20 people a year die of drug overdoses. Last year, for every resident, more than 100 doses of opioids were prescribed and dispensed.

    Ask someone here whether the risks of opioid addiction are minimal, and some snort or roll their eyes.

    “Around here, we call it ‘pharmageddon,’ ” said Lisa Roberts, the public health nurse for the town, whose primary job is to reduce the fatalities associated with drug use. “This has been absolutely devastating to Appalachia. From what we’ve seen, the risks of addiction were tremendous.”

    For decades, many doctors had been wary of prescribing opioids except for use by cancer patients and the terminally ill.

    In 1992, for example, a survey of state medical board members, most of them physicians, found that only 12 percent described prescribing opioids for an extended period for chronic pain as a “lawful and generally acceptable medical practice.”

    Advocates for opioid prescription, backed in part by drugmakers, set about seeking to change those attitudes. More than 20 states changed their rules. And in December 1995, these marketing efforts surged as Purdue Pharma introduced OxyContin, a controlled-release form of the opioid oxycodone.

    From 1996 to 2000, the company doubled its sales force from 300 to 671, according to a 2003 report by what was then the General Accounting Office. The amount of sales bonuses Purdue Pharma offered tied to OxyContin grew from $1 million a year to $40 million a year. It sponsored pain-related websites, advertised in medical journals and paid influential doctors such as Portenoy to talk to other physicians.

    As the number of overdoses and reports of addicts rose in the early 2000s, key questions arose. How were the addicts becoming addicted? Was it by going to the doctor with a legitimate pain and getting a legitimate prescription? Or was it just people seeking a high and buying the prescription drugs off the street?

    If it was only the latter, limiting prescriptions might have little direct effect on the problem and could penalize pain sufferers.

    But it was both. Although many addicts started on opioids just to get high, experts say, a good portion arrived at their habits after coming into contact with opioids after a doctor’s visit for a legitimate pain. That’s how Leslie Cooper came to the drug, and it is reportedly the way some celebrities became addicted: Rush Limbaugh, Matthew Perry, Cindy McCain.

    Other trials have reported that significant numbers of pain patients are addicted. In one review out of Yale School of Medicine, investigators found that diagnoses of addiction are “common” in patients given opioids for back pain, with as many as 24 percent engaging in “aberrant” or peculiar ways of taking the pills.

    Early on, officials at the Drug Enforcement Administration perceived the danger to patients.

    “The company’s aggressive methods, calculated fueling of demand and the grasp for major market share very much exacerbated OxyContin’s widespread abuse and diversion,” a November 2003 memo from the agency said. “The claim in Purdue’s ‘educational’ video for physicians that opioid analgesics cause addiction in less than one percent of patients is not only unsubstantiated but also dangerous because it misleads prescribers.”

    But amid the marketing blitz, concerns about addiction in patients appear to have faded from the medical profession.

    The FDA, which must approve drug labels, allowed Purdue to say on its label: “The development of addiction to opioid analgesics in properly managed patients with pain has been reported to be rare.”

    The agency warned that drug abusers and addicts might try to obtain the drugs, but it indicated that the risks seemed minor for patients: “We do not know how often patients with continuing (chronic) pain become addicted to narcotics, but the risk has been reported to be small.”

    The agency, however, would later change its mind.

    By 2008, the claims that the risks of addiction in patients were small were removed from the OxyContin label, after “extensive negotiations” with Purdue, an FDA spokeswoman said.

    “The labeling information, including language regarding addiction, has evolved over time as data has become available,”Morgan Liscinsky said.

    The FDA did not say what evidence led the agency to allow the previous claims or what new findings led it to ask for the removal of those claims.

    Early on, however, the agency relied on industry experts for advice. In the 2002 FDA meeting, for example, eight of the 10 invited experts had connectionswith pharmaceutical companies. Of those, five had served as speakers, consultants or investigators for Purdue, including Portenoy and Kathy Foley, a neuro-oncologist at Memorial Sloan Kettering Cancer Center. Together, Portenoy and Foley had published a key study on opioids in 1986 that found that only two of 38 patients seemed to abuse the drugs and that both had histories of substance abuse.

    “Their past work with industry should not preclude them from sharing their expertise with government agencies or their peers in the medical community,” Heins, the Purdue spokesman, said.

    The FDA and doctors also could turn to a spate of other trials that seemed to suggest there was little reason to worry that chronic pain patients could get addicted to opioids.

    Take, for example, a 2003 report in the New England Journal of Medicine, which reviewed the conclusions from several studies.

    “The general finding is that patients with chronic pain . . . can achieve satisfactory analgesia . . . with a minimal risk of addiction,” it said, while questioning the use of high doses.

    What may be most striking about the paper, though, is that its lead author has become one of the top critics of opioid prescribing habits. But Jane Ballantyne, a pain specialist at the University of Washington, said that at the time there were very few clinical trials that showed any sign of an addiction risk.

    “There were very few studies then that suggested that any more than 8 percent of people on prescription opioids exhibited addiction-type behaviors,” Ballantyne said. Now, she said, the understanding is that the number may be as high as 50 percent.

    How did all these studies — co-authored by doctors with university affiliations and published in academic journals — lead to conclusions that now are in dispute?

    One reason, according to critics, is that most of the studies were conducted by drug companies.

    “A pharmaceutical company that has a vested interest in promoting their product should not be seen as a reliable source of safety information,” Orman Hall, director of the Ohio Department of Alcohol and Drug Addiction Services. “Some of those estimates are ludicrous.”

    Consider the 16 clinical trial reports that Ballantyne highlighted and used in her article, which reflect the medical literature at the time. Her summary did not discuss sponsors of the studies. But of those 16, six were sponsored by Purdue Pharma or co-authored by its employees, one was sponsored by Mundipharma, which distributed OxyContin and other opioids, and two were sponsored by another drug company or co-authored by drug company employees.

    In the trials, patients were given an opioid for pain, but in most, there were no systematic checks for withdrawal symptoms or addiction. Instead, in most of the trials, regardless of whether they were sponsored by drug companies, the investigators generally found that the benefits of pain relief outweighed the risks of side effects such as constipation and dry mouth.

    If investigators were looking for signs of addiction, they weren’t looking hard.

    “In the absence of rigorous evaluation and surveillance, it’s hard to know whether the low levels of addictive behavior reported in those studies are accurate,” said David Fiellin, a professor of medicine at Yale with an expertise in addiction.

    Fiellin noted that the design of the study can dramatically change the results and that entrusting the design to scientists with conflicts of interest could introduce bias. What patients are admitted to the trial? How are side effects measured? How large are the doses?

    “All of those are scientific decisions that should be made by people without any regard for how the findings will affect the company’s bottom line,” Fiellin said, adding that the government could play a larger role in funding.

    In one of the studies sponsored by Purdue that Ballantyne covered, and that played a large role in the marketing of OxyContin, there appear to have been significant discrepancies between the data that were gathered and those that were published.

    A March 2000 issue of the Archives of Internal Medicine published a study that followed 106 arthritis patients treated with OxyContin for several months.

    Six times during the trial, researchers intentionally stopped the doses.

    Remarkably, according to doctors who study addiction and dependence, there were no reports of withdrawal during those respites.

    Two patients had withdrawal problems, but one was at the end of the study, and the other had simply run out of the medication.

    “Withdrawal syndrome was not reported as an adverse event for any patient during the scheduled respites,” the authors reported.

    The trial also showed that the drug was effective and was embraced by the Purdue marketing team, which ordered 10,000 reprints to distribute to its sales staff, with instructions to highlight the finding on withdrawal.

    But according to company documents disclosed in a court case, the paper left out several cases of withdrawal.

    Inside Purdue, supervisors and employees reviewed a more complex set of data, according to a document signed by company attorneys and prosecutors, which accompanied a 2007 settlement in which federal prosecutors charged Purdue with misbranding the drug.

    The document has not previously been linked to the Archives article.

    “Multiple” patients, a company review said, “directly stated or implied that an adverse experience was due to possible withdrawal symptoms.”

    Eleven study patients “reported adverse experience due to possible withdrawal symptoms during these periods,” according to the court document.

    How did this discrepancy arise?

    One of the authors of the Archives article, Roy Fleischmann, a clinical professor of medicine at the University of Texas Southwestern Medical Center at Dallas, said the authors were given the data by Purdue.

    “We reported on the data which was provided to us,” he wrote.

    He said the discrepancy may have arisen because some of the side effects — such as insomnia, nausea and anxiety — were not characterized by Purdue “as withdrawal symptoms, although, in retrospect, they probably were,” he said in an e-mail.

    Doctors who have treated OxyContin addicts, and some former addicts, moreover, say that considering the doses given to the patients in the trial and its duration, even the internal document undercounted patients reporting withdrawal symptoms. They say the majority of patients were likely to have suffered withdrawal symptoms when the drug was cut off.

    At the doses given in the trial, most patients are “pretty consistently” going to have withdrawal symptoms, said Phillip Prior, a board-certified addictionologist in the Portsmouth area who has treated thousands of patients addicted to opioids.

    He said the lower estimates are “flawed conclusions from a very flawed study.”

    “I’ve never seen anyone come off of them and not get withdrawal,” said Billie Taylor, 42, a former addict who works at a treatment center in Portsmouth. “I would have quit a lot earlier if it had not been for the withdrawal. You feel like you want to die. Even if you take them at prescribed levels, you get withdrawal.”

    “You could say these marketing tactics are merely concerning,” Prior said. “But I think of them as satanic. What the data are telling us is that these drugs are ruining people’s lives.”

    12/31/12

    http://bangordailynews.com/2012/12/...nplayed-risks-of-oxycontin-and-other-opioids/

Comments

  1. Magilla
    This has reached epidemic levels really nationwide, however in areas such as Appalachia/Ohio, Florida, and New England especially so, so much to the point most everyone knows someone directly or is related to someone who was or is addicted to opiates, primarily Oxycodone, Hydrocodone, etc. What really scares me is they allowed this to happen knowing the dangers but ignoring them in the name of the almighty dollar, what happens when, as we are seeing now, this is figured out, laws are changed, and it becomes impossible for many people to continue getting their DOC. Well, I'll tell you what happens, Heroin happens, which is what at least in New England, a Heroin epidemic we are in the midst of currently. Not to mention the amount of people who are on MMT/Suboxone for a pill habit, which in many cases is like shooting a bird with a bazooka! It is unfathomable Doctors and the Government agencies/FDA/etc, let this happen in the way it did as many of us saw this coming from the beginning, how didn't they? Or did they...? Makes me cringe just thinking about it!
  2. profesor
    It gets even worse. Opiates like good old morphine are much less addictive and very cheap, as medicines go, but doctors are afraid of these well-known, manageable drugs because they have a bad reputation and will attract unwelcome attention from the DEA.
    Oxycontin is much more addictive, but because it was new and it had Big Pharma backing, it was prescribed widely.
    Ideally the medical industry would re-examine the old, well researched pain management drugs and prescribe them in a careful, considered way.
    But no, you can bet that patients suffering in pain will continue to get either inappropriate newer drugs, or nothing at all.
  3. Basoodler
    ^ was there.. agree 100% with the above statement .. Since I Joined DF I have repeatedly discussed my experience in Portsmouth and the 150 miles around it that are also effected



    Out of curiosity I looked around for some of the publications mentioned. Specifically Dr Portenoy. (I am OCD about making sure as much info as possible is provided at times :p)

    As I find them I will upload here..

    1)Opioid Treatment Guidelines
    Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain (2009)

    2) Breakthrough Pain (he actually gives figures for ketamine as a form of pain relief in this)

    3) Opioid Analgesia Handbook (43 pages)
    Fine P, Portenoy RK: Opioid analgesia. New York: McGraw Hill, 2004.

    The intent of this book is to help clinicians make practical sense of the varied and often conflicting issues (pharmacological, clinical, and regulatory) surrounding opioid pharmacotherapy, in order to promote the most healthful outcomes possible for patients in pain. The aim is to improve knowledge and skills related to both the principles of prescribing and the management of risk. In this way, healthcare professionals and those they serve may benefit increasingly from the unique therapeutic potential of this drug class, and fear less the undeniable, yet manageable, potential for harm.

    4) Effectiveness of Opioid Therapy in chronic Pain
  4. Basoodler
    Doctor who encouraged wider use of opioid painkillers is having second thoughts

    Dr. Russell Portenoy, the New York-based pain-care specialist who helped lead the campaign in the 1990s to make prescription pain medications more widely available, is apparently having second thoughts about the wisdom of that effort.

    He now admits that perhaps, just perhaps, he overstated the benefits and understated the risks of Vicodin, OxyContin, Percocet and other prescription opioids, according to an article published Monday in the Wall Street Journal.

    "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," Dr. Portenoy told WSJ reporters Thomas Catan and Evan Perez. "We didn't know then what we know now."

    The phrase “too little, too late” immediately jumps to mind. For as Catan and Perez point out, the United States is now struggling with a huge and tragic prescription pain-medication problem. More than 15,000 Americans die each year as a result of opioid addiction — more than die from all illegal drugs combined, according to the Centers for Disease Control and Prevention. The financial burden of this problem is also enormous. The CDC estimates that health insurers spend more than $72 billion each year on direct medical costs related to the non-medical use of prescription painkillers.

    Dr. Portenoy — who has had financial relationships with more than a dozen drug companies over the years, including those that make and market opioid painkillers — played a central role in getting us to this point.

    Apparently, he did it by mixing questionable science with personal charm. Here’s an excerpt from the WSJ article:
    Opium-derived painkillers have been around for thousands of years. Early in the 20th century, heroin was sold as a cough suppressant. Heroin addiction in the U.S. skyrocketed. Congress banned the drug in 1924 and doctors became deeply wary about using opioids.

    Dr. Portenoy set out to change that. As a young doctor at Memorial Sloan-Kettering hospital in New York, he noticed that opioids were effective in cancer patients with terrible pain.

    In 1986, at the age of 31, he co-wrote a seminal paper arguing that opioids could also be used in the much larger group of people without cancer who suffered chronic pain. The paper was based on just 38 cases and included several caveats. Nevertheless, it opened the door to much broader prescribing of the drugs for more common complaints such as nerve or back pain.


    Charming and articulate, he became a sought-after public speaker. He argued that opioids are a "gift from nature" that were being forsaken because of "opiophobia" among doctors. "We had to destigmatize these drugs," said Dr. Portenoy.


    He rose to chairman of pain medicine and palliative care at Beth Israel Medical Center in New York. His small office is studded with awards and evidence of his offbeat sense of humor. He prominently displays a magazine mock-up that jokingly dubs him "The King of Pain."

    At medical conferences, his confident, knowing manner helped smooth the way for his message. Before an audience of government regulators, he once joked that he might tell a patient at low risk of abuse: "Here, [have] six months of drugs. See you later," he said, according to a Food and Drug Administration transcript. Amid laughter, he added, "It's just hyperbole. I don't actually do that."


    Steven Passik, a psychologist who once worked closely with Dr. Portenoy and describes him as his mentor, says their message wasn't based on scientific evidence so much as a zeal to improve patients' lives. "It had all the makings of a religious movement at the time," he says. "It had that kind of a spirit to it."
    The WSJ article is yet another reminder of how modern medical practices are too often driven by wishful thinking and, of course, money (opioid painkillers rake in $9 billion in sales each year) rather than by solid scientific evidence.


    http://www.minnpost.com/second-opin...use-opioid-painkillers-having-second-thoughts
  5. Basoodler
    What Kind of Doctor Uses His 82-Year Old Mom to Promote Addictive Painkillers?


    The answer? One who is now under U.S. Senate investigation for his ties to the pharmaceutical industry and the prescription drug epidemic annihilating families in the U.S. and Canada.

    (MYRTLE BEACH SC) - The Wall Street Journal (WSJ) recently published an article highlighting one of society's deadliest problems, by Thomas Catan and Evan Perez. One person they focused on was Russell Portenoy, MD, a long-time pusher of painkillers as a spokesperson for pharmaceutical companies such as Purdue Pharma, maker of OxyContin. consequences of death and addiction.

    Catan and Perez wrote that Portenoy is now having "second thoughts" about his "life's work" of prescribing dangerous and addictive painkillers for chronic pain. I can't help but think that the good doctor's "second thoughts" may be due to the U.S. Senate investigating him and his ties to the pharmaceutical industry and the prescription drug epidemic annihilating families in the U.S. and Canada.

    It's interesting that while Portenoy says he overstated the benefits of opioids he doesn't think we have an epidemic of prescription drugs. Might be a good idea for him not to be wringing his hands so much as he did in the definition of the word "epidemic." Body language is very telling. Portenoy and other spokespersons influencing the medical profession promoted painkillers for almost two decades leading to the prescription drug epidemic the U.S. Senate is finally investigating -- note that the U.S. Senate is investigating the epidemic and not the FDA.

    "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," Dr. Portenoy said in his interview with The Wall Street Journal. "We didn't know then what we know now."

    Nice try Dr. Portenoy, but you were very aware of the addictive qualities of painkillers that you and your paid consultants for the pharmaceutical industry pitched. You and pharma were directly responsible for the greatest marketing ploy ever perpetrated on the U.S. and Canada which has resulted in hundreds of thousands of deaths and addictions. Let me refresh Dr Portenoy's memory where he pontificated to the medical profession that less than 1% of individuals taking opioids (painkillers) would become addicted and patients could easily discontinue these dangerous drugs such as OxyContin --and that overdoses were "extremely" rare in pain patients. Over his career, Dr. Portenoy has disclosed relationships with more than a dozen companies, most of which produce opioid painkillers. "My viewpoint is that I can have those relationships, they would benefit my educational mission, they benefit in 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," he said. Portenoy even referred at one time to his 82 year old mother who has taken hydrocodone for her arthritis for 15 years. "If you insist on regulation, then you're consigning my mother and many millions of people like my mother to live in chronic pain," he said. Earlier this year Portenoy asked his mother whether she would stop taking her hydrocodone as part of a scientific study. Her reply was "no." "How difficult is it for her to get off these drugs?" Dr. Portenoy asked. "You have no idea and neither do I, because no one knows." Oh but I know Dr. Portenoy because a couple of years ago you replied to one of my articles in Salem-News.com wherein you stated: "I wanted to write and urge you to remember the millions with poorly controlled pain as you pursue your advocacy agenda. The consensus report released by the committee that I co-chaired was not about opioid therapy, but rather, about the need for fundamental reform of a system that fails to help huge numbers of patients -- of all ages -- and is both inefficient and too costly. It is not surprising that your piece is based on innuendo and unjustified assumptions when it (sic) there is so little in our report that relates to your issue. Hopefully, an increasingly informed public will only mirror the disappointment that I felt when reading a piece that dismisses the needs of so many suffering people in a stretch to make a point.

    Stretch to make a point? I believe I have been the one for the past 10 years sounding the alarm on the addictive qualities of drugs such as OxyContin -- and I have not had any second thoughts -- our families are being destroyed because of sheer evil and greed. So if you have a loved one who does not want to participate in any scientific studies may I suggest a fine private hospital in New Canaan, Connecticut called Silver Hill Hospital In fact just this year, Silver Hill Hospital announced the opening of a chronic pain and addiction center with its medical director one Seddon R. Savage, MD and President of the American Pain Society (APS) -- coincidentally the APS is also under U.S. Senate investigation.

    In fact, one of the biggest pushers for painkillers is J. David Haddox, DDS, MD and Vice President of Health Policy at Purdue Pharma as well as their spokesperson Haddox had been listed in black tie events at Silver Hill Hospital, most recently in November 2012 as a member of the Silver Hill Hospital Board of Directors. But Haddox is not listed on the

    J. David Haddox, DDS, MD

    hospital website as a Board of Director member. Seems that Haddox lends his name to the hospital as a director for black tie events attracting celebrities such as Neil Sedaka and Martha Stewart, but not on the website. I wonder why.
    Maybe Dr. Haddox recalls an employee of Purdue Pharma being given a prescription for an addictive painkiller -- not by their primary care physician, but rather a physician executive with the company -- and when the employee became addicted was fired and admitted to Silver Hill Hospital for treatment.

    Pretty convenient, being on the Board of Directors of Silver Hill Hospital for treatment of a non-addictive drug, wouldn't you think? Portenoy and Haddox may need to draw straws to determine who wears the title "King of Pain" best -- you know since Portenoy now seem to be having "second thoughts" and Haddox as "spokesperson" for Purdue Pharma is "discrete" about his association with an addiction treatment hospital.

    Salem-News.com Investigative Reporter Marianne Skolek, is an Activist for Victims of OxyContin and Purdue Pharma throughout the United States and Canada. In July 2007, she testified against Purdue Pharma in Federal Court in Virginia at the sentencing of their three CEO's - Michael Friedman, Howard Udell and Paul Goldenheim - who pleaded guilty to charges of marketing OxyContin as less likely to be addictive or abused to physicians and patients. She also testified against Purdue Pharma at a Judiciary Hearing of the U.S. Senate in July 2007. Marianne works with government agencies and private attorneys in having a voice for her daughter Jill, who died in 2002 after being prescribed OxyContin, as well as the voice for scores of victims of OxyContin. She has been involved in her work for the past 8-1/2 years and is currently working on a book that exposes Purdue Pharma for their continued criminal

    Marianne is a nurse having graduated in 1991 as president of her graduating class. She also has a Paralegal certification. Marianne served on a Community Service Board for the Courier News, a Gannet newspaper in NJ writing articles predominantly regarding AIDS patients and their emotional issues. She was awarded a Community Service Award in 1993 by the Hunterdon County, NJ HIV/AIDS Task Force in recognition of and appreciation for the donated time, energy and love in facilitating a Support Group for persons with HIV/AIDS

    http://www.salem-news.com/articles/december192012/russell-portenoy-ms.php
  6. Thirst4knowledge
    Perhaps I am thinking too simplistically, or maybe I've become too cynical over the years, but surely the pharmaceutical companies who develop highly addictive drugs ensure an ongoing lucrative business? Wouldn't it be interesting to know the behind-the-scenes discussions that take place during trials and whether the addictive nature of these medications is truly seen as a plus or a minus.

    Just a thought.
    T4K
  7. Basoodler
    ^ that is actually a good point.

    In my opinion this guy was in the wrong for some of the studies and advice he gave. Here is the thing though, what about the individual doctors that prescribed oxicontin for minor back pain? What about the FDA who also went a long with it.

    Its not like this doctor specifically wrote billion scripts to cause the problem. Sure he made some dishonest claims. I also know that doctors all over country jumped on this cash cow like Santa on some milk and cookies. Doctors a highly intelligent (at least we hope they are they are not sheep and chose greed over common sense.

    Dr. Portenoy is probably clearing his schedule for the next several years. He is under this bus and it is about to start running him over then backing up to hit him again. What about the other doctors who acted just as bad or even worse?
  8. profesor
    I don't agree with the WSJ and strongly disagree with the articles that cite that particular article/interview. For one thing it sounds like character assassination. Portnoy was right about opiods, he was simply wrong about OxyContin.
    Of course he gives figures for ketamine in pain management. It was introduced during the Vietnam war as a painkiller for soldiers in the field. That was it's original purpose and continues to be, partly because it is safer than other anesthetics for surgery.
    The other thing is that crucifying Dr Portnoy is not going to help the epidemic, no matter how greedy or malicious he might have been (but I'd at least give him the benefit of the doubt).
    It is the pharmacuetical companies that are the irresponsible dealers. I think they would have dug their claws into any doctor who called for a reconsideration of opiods in general.
    I suspect I might get a bunch of strong remonstrations by former opiod addicts, but pain management is the number one issue as our society ages and boomers enter their senior years. To go back to not using opiods even in the terminally ill is a giant step backwards.
    For christsakes can't we just ban OxyContin and use cheap, generic opiods appropriately?
  9. profesor
    PS I think Basoodler has done a great job here, and has done a thorough job as usual. I hope he won some award for 2012, it would be deserved!
    But I remember the days before Dr Portnoy, and when meditation and other techniques were considered airy-fairy. Those were not pretty times, there was a lot of needless suffering.
  10. Basoodler
    ^ I believe you are spot on with the character assassination. He is the scapegoat.

    I remember when oxicontin first hit Portsmouth . we knew it was addictive.. Hell I knew several people who were addicted to vicoden or pecocet. Hell, when everyone figured out how the pain clinics worked it was game on. Oxicontin was extremely common in a minute.

    Granted I worked nights at a grocery store and hung out with people who loved drugs. Lost some friends to OC too

    Anyway if you are going to blame the pharm industry.. I agree.. But I think its more complicated.. What about the people who ran the 24 hour pain clinic / pharmacy combos.. But that may just be a Portsmouth thing I don't know
  11. Thirst4knowledge
    This is so reminiscent of the Librium/Valium scenario. When first marketed,they were being handed out like sweeties. Patients and doctors initially raved about them. It wasn't until a few years had passed that their addictive properties were revealed. Stories such as the above, how they had ruined lives and families. And then it wasn't long after that, in the 70s, that Hoffmann-La Roche were investigated by the British monopolies commission with regard to their pricing policies. Further scandal.

    More recently, there was the Paroxetine/Paxil/Seroxat controversy with following documentaries, lawsuits and Alison Bass's book which exposed deception in the research and marketing of Paxil. On January 2nd of this year (yesterday) the Mail Online carries a warning article about how Seroxat should not be prescribed to the under 18s....and how this has only just come to light. I remember reading about this a few years ago - when Glaxo et al were still in denial about it!

    And anyone remember Thalidomide?

    By naming other drugs one might assume that I am starting to go off topic but throughout the decades I have seen these pharmaceutical giants enjoy huge profits whist not behaving in the ethical manner one might expect from a medicine based business that supposedly assists society by it's products.

    As for blaming doctors -I don't know if this is still the case, but years ago medical representatives often had little or no medical background when they were sent to approach doctors around the world. They sometimes had fancy handles but they were salesmen. Salesmen have targets to reach, doctors are pushed for time, salesmen don't tend to dwell on the negative aspects of their products(be this drugs or cars) and people often only hear what they want to hear .....and doctors are people .... some of them depressed and addicted themselves! They also have thousands of drugs to remember and prescribe; granted they have been able to use National Formularies and computers for information but often these only state the basics- and sometimes that is not even accurate because it is written by the pharmceutical companies themselves.

    There have always been the scapegoats as the Big Boy's Network closes ranks.

    Another thing ; my generation was raised believing that doctors were Godlike and beyond repute. Their diagnosis and treatment was never questioned. I think we now live in an era of less naivety where we know there is corruption and greed within companies, that doctors are human, often poorly informed themselves and consequentially sometimes make bad decisions.....decisions that leave us to deal with the consequences. Many of us now have the ability (via technology) to research what goes into our bodies, and so I think we should also remember self-responsibility. We should trust less, and take an active part in the decision making of our own treatments. Either way you look at it, we shouldn't suffer needlesssly ....or by our own ignorance.

    Which is how I arrived at DF.
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