What the Latest @NatCounterPunch Opioid Article Doesn’t Want You To Know

What the latest @NatCounterPunch Opioid Article Doesn't Want You To Know, Lynn Webster, MD, The Painful Truth, Pain

I was troubled to see a recent story in the online publication, Counterpunch. It starts off by declaring the root cause of the opioid crisis is Pharma’s contribution to professional societies for “educational” programs. Counterpunch reports that the funding was provided to advocate for “more aggressive identification and treatment of pain.” Ironically, the tag line to the online media site is “Tells Facts, Names and Names.”

So let me discuss some of the facts that the Counterpunch reporter omits:

Opioid Educational Programs 

The reporter states that “20,000 pain-related ‘educational’ programs were sponsored by Purdue Pharma,” and that the company “launched a multifaceted campaign to encourage long-term use of opioids for chronic non-cancer pain.”

I have no idea if that number of educational programs is correct. However, the content of those programs is important.

I also don’t know to what extent the educational programs encouraged long-term use of opioids for non-cancer pain. I struggle with what it means to encourage long-term use of opioids. That statement sits there implying that opioids are always inappropriate for long term use in non-cancer pain. This is certainly an issue debated today, but it is inaccurate to suggest opioids should never be used for non-cancer pain over the long term.

The reporter also omits an obvious fact: educating physicians about opioids does not necessarily mean that you’re encouraging physicians to use opioids inappropriately.

Pharma funded education generally comes in two formats. Either the program is presented as continued medical education (CME), or it is provided as a promotional program.

  1. Continual medical education programs, such as the ones sponsored by Purdue and other Pharma, can be valuable in teaching physicians how to manage pain with or without opioids. It can also teach physicians how to avoid opioid abuse if an opioid is prescribed. It doesn’t say that if you have a patient who is in pain, you should automatically give an opioid.
  2. Promotional programs are intended to make prescribers aware of the strengths of the products. But what most people do not know is that the content of the promotional programs is limited to what is in the FDA-approved package insert. Companies cannot make any claim about their products that the FDA has not approved. If a company fails to comply with these guidelines, there are serious consequences, as was reported about Purdue’s misrepresentation a decade ago.

There is reasonable debate about the extent to which opioids should be used in treating non-cancer pain. This is the exact reason why there must be educational programs. And who, other than Pharma, is going to pay for the educational programs?

REMS (Risk Evaluation and Mitigation Strategy) 

In fact, the FDA has required opioid manufacturers like Purdue to spend tens of millions of dollars to educate prescribers on how to mitigate the risk of long-term use of opioids for non-cancer pain. This initiative is called the Risk Evaluation and Mitigation Strategy (REMS).

The content of the REMS educational material has been defined by the FDA, not Pharma. In fact, Pharma is not allowed to participate in developing any of the content for the REMS education.

The FDA expects nearly 200,000 physicians to be educated on Pharma’s dime by March 2017. Only about 50,000 providers have received the education so far. This means there will be many more Pharma funded educational programs in the next few years. That is a good thing, not a bad thing.

I wrote about this topic in a Pain Medicine News guest editorial in July 2012. In my article, I wrote that pain professionals must “ensure pharmaceutical companies do not push marketing messages into educational programs. Established firewalls, already in place, must be used to prevent undue influence.”

In that editorial, I continued, “One firewall is unrestricted grants. Educational content at (AAPM) [American Academy of Pain Medicine] meetings is supported, in part, by unrestricted grants from pharmaceutical or medical device companies. These grants specify that the grantor have no control over the content of the presentation. A second firewall is the AAPM disclosure policy. Speakers and session leaders must fully disclose relevant financial relationships, including research grants; honoraria or other payments; and advisory board or speakers’ bureau commitments. These relationships are published openly and are available for scrutiny by session attendees. The nationally recognized Accreditation Council for Continuing Medical Education (ACCME), which directs continuing medical education (CME), has set these standards.”

As medical professionals, we affirm that corporate marketing priorities must never direct CME content.

Sweeping Accusations Against Pharma 

The Counterpunch story’s anti-Pharma bias continues as it makes sweeping accusations against the industry. For example, it concludes, “As Pharma cashes in on drugs to treat addictions it causes, the FDA approves new opioids while warning about others and…taxpayers are paying for the whole opioid mess.”

The “opioid mess” is more complicated than the reporter suggests. The pharmaceutical companies profiting from addictions are generally not the same companies that are developing drugs for the treatment of pain.

Pharma is a great target for people who want to rage at someone, or some entity, for all of the opioid-related problems of our society. However, Counterpunch fails to offer alternative ways in which physicians are going to be educated about how to minimize the use of opioids and reduce the harm from opioids unless Pharma funds the programs.

Failure To Offer Opioid Alternatives or Public Education 

Pharma certainly has incentives to sell their products. However, with the proper firewalls in place, educational programs can help provide better care to patients and serve an overall public health benefit.

The Counterpunch article could have educated the public about the need for more education at all levels of society and embraced the organizations willing to do so.

That would have been a public service.


Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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