Earlier this month, the US Senate Finance Committee launched a probe into drugmakers that sell prescription painkillers as well as several patient advocacy groups and physicians due to “an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers." Among those targeted is theAmerican Geriatric Society, a non-profit that boasts about "improving care for older adults."
But the slogan may have a hollow ring after one reads an investigation by The Milwaukee Journal-Sentinel and MedPage Today (see this). The AGS publishes guidelines for physicians nationwide and the 2009 edition, which was the latest such tract, recommended that doctors should consider prescribing opiods for all patients with severe to moderate pain, instead of over-the-counter pain relievers, such as ibuprofen and naproxen, despite growing concerns about addiction and side effects with opioids.
The panel members reportedly relied on research and their experience in revising the guidelines, but acknowledged "existing weak scientific evidence." Moreover, among the 10 panelists who made the recommendations, at least five had financial ties to opioid drugmakers - such as Purdue Pharma, which sells OxyContin - as paid speakers, consultants or advisers when the guidelines were issued. In addition, the panel chair was listed as a paid speaker for one drugmaker the following a year. Among the other drugmakers listed were Pfizer, Endo Pharmaceuticals and Johnson & Johnson (here is the disclosure list, although amounts were not disclosed).
This is big business, after all. Since 2007, top-selling opioids dispensed to people 60 years and older have increased 32 percent, according to an analysis by the Journal-Sentinel and MedPage Today of prescription data from IMS Health, a market research firm. This is double the growth for prescriptions dispensed to those between 40 and 59 years old.
And the investigation notes that groups with industry funding have made "overwhelmingly positive claims" about opioids, such as addiction risks are rare, few patients will need to increase dosages and there is no unsafe maximum dose. These claims can be found in "prescribing guidelines, patient literature, position statements, books and medical education courses." At the same time, serious complications are often ignored - overdosing, increased risk of falls and fractures in older patients and cognitive problems, among other side effects.
These side effects were not included in the 2009 pain guide that was funded by PriCara, which is now part of Johnson & Johnson, and endorsed by the American Geriatrics Society, the investigation found. Instead, the 2009 guide, which you can read here, claimed that opioids allow people with chronic pain to return to work, walk or run, and play sports.
Meanwhile, the guide lists several disadvantages for traditional pain meds such as ibuprofen and naproxen, which are marketed as Advil and Aleve, respectively, but there no disadvantages list for opioid painkillers. But these drugs can cause respiratory suppression, sleep apnea, bowel obstruction, constipation, depression, apathy and increased pain sensitivity, the investigation notes. And the guide used the word "myth" to characterize concerns that patients may need increased doses of opioids over time to control pain.
However, a study published in the Archives of Internal Medicine two years ago collected data on 12,840 Medicare patients with an average age of 80 who had used opioids, traditional anti-inflammatory drugs or non-steroidal anti-inflammatories, such as Celebrex, and found that opioid users were more than four times more likely to suffer a fracture than users of traditional anti-inflammatory drugs. And deaths from any cause were 87 percent more likely among opioid users. Meanwhile, cardiovascular events, including heart attacks, strokes and cardiac death, were 77 percent higher in opioid users than in users of anti-inflammatory drugs (here is the abstract).
In response, AGS president Sharon Brangman offered a statement from its web site to the Journal-Sentinel and MedPage Today: "There is simply no reason to let millions of frail Americans live with horrible pain every day despite having medications that would bring them rapid relief. While we don't advocate casual or improper use of opioids, we do believe that with careful patient selection and monitoring, opioids can be used safely and effectively to treat persistent pain and help avoid its many related costs and complications."
"...Studies have shown that older adults are more likely to experience severe or persistent pain and, as they age, are less able to tolerate severe pain. Collectively, this group is far more likely to suffer from chronic, painful conditions such as arthritis, bone and joint disorders, and cancer than younger adults. Persistent pain or its inadequate treatment can lead to decreased mobility and function, falls, depression, social isolation, poor sleep, and weight loss—let alone unnecessary suffering... Additionally, inadequate pain management often leads to increased emergency room visits and increased re-hospitalization rates."
As we have noted previously, opioid prescribing has led to what is described as an epidemic in prescription painkiller abuse. A 2010 report from the US Centers for Disease Control and Prevention noted that the rise in overdose deaths in the US paralleled a 300 percent increase since 1999 in the sale of prescription painkillers. The drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined (here is the report).
The prescribing trend has also been blamed for a rise in crime. Last week, for instance, the district attorney in Suffolk County, New York, which comprises part of Long Island, released a recent grand jury report about the killing of four people last June by a pair who robbed a pharmacy in search of opioid pain meds. And the report, in part, blamed the "profit motive" of drugmakers for the larger problem (read the report here).
As Andrew Kolodny, who chairs the psychiatry department at Maimonides Medical Center in New York and heads Physicians for Responsible Opioid Prescribing, recently told us: "I can’t think of a better example of what’s wrong with industry influence on medical practice than the opioid analgesic epidemic. I honestly believe that the epidemic of opioid overdose deaths and addiction that we’re dealing with today could have been avoided if we had strict firewalls in place 15 years ago to limit industry influence on medical education and our professional societies" (here is the complete interview).
Thanks to the Milwaukee Journal-Sentinel and MedPage Today for the use of the chart