Led by OxyContin, sales of prescriptions of opioid drugs totaled $8.4 billion in 2011, up from $5.8 billion in 2006, according to data supplied by IMS Health, a drug market research firm.
"We've never really exposed so many people to so much drug for so long," Sullivan said. "We don't really know what the long-term results are."
The Pendulum Swings Back
Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Todayreview of records and interviews found.
Among the misconceptions:
- The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
- There is no maximum dose of the drugs that can't be safely prescribed.
- People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.
Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.
Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.
Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.
"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."
Some chronic pain sufferers do benefit from the drugs, Webster said.
"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long-term.
"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."
Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.
Over the past decade as many as 100,000 Americans have died from opioid overdoses and millions have become addicted to the drugs, said Andrew Kolodny, MD, a New York psychiatrist and opioid addiction specialist who co-founded Physicians for Responsible Opioid Prescribing.
"This is an out of control epidemic, not caused by a virus or a bacteria," said Kolodny, chairman of psychiatry at Maimonides Medical Center in New York. "This epidemic has been caused by a brilliant marketing campaign that dramatically changed the way physicians treat pain."
The pharmaceutical industry's alliance with pain groups is part of familiar playbook.
It has occurred with other organizations, though those financial relationships aren't always fully disclosed, said David Rothman, PhD, president of the Institute on Medicine as a Profession, part of Columbia University College of Physicians & Surgeons.
"They (drug companies) expect a certain return for their money and the sad thing is, they often get it," he said.
Maximum dose
Consider the American Pain Foundation, which has substantial financial ties to companies that make narcotic painkillers: a patient guide available on its web site it claims there is no maximum dose for opioids as long as they are not combined with other drugs such as acetaminophen. The dose of any painkiller, the Foundation claims, can be gradually increased over time.
Critics of the use of opioids for chronic pain say that is a dangerous misinterpretation of information gleaned from the experience of treating cancer pain in hospitalized patients.
It should not be applied to chronic, non-cancer pain sufferers who are not getting their drugs in a hospital setting, said Sullivan, the University of Washington professor.
A philosophy of "no maximum dose" can lead to more people on high doses of the drugs, which, in turn, can result in serious problems, including more falls and fractures in older people, respiratory depression, overdoses and fatalities, he said.
Even when the dose is increased gradually, high doses add more risk, especially in people who take other prescription drugs, use alcohol, have a medical condition such as sleep apnea, or who take an opioid in a manner other than how it is prescribed, Sullivan said.
"Risk goes up with dose, even if it is well done," he said.
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