The Lie That Opioids Aren't Addictive

  [PROMOS/MUSIC UP & UNDER]

BOB GARFIELD:  This is On the Media. I’m Bob Garfield. The

investigation by the Washington Post and 60 Minutes has shed light on how the pharmaceutical industry worked to pull the levers of government to protect themselves from prosecution. But their influence doesn't end there because even the public discourse about chronic pain and treatment has been shaped by companies like Purdue Pharma, the maker of OxyContin, with help from physicians, consultants and, yes, the media.

Barry Meier is a reporter for The New York Times and author of Pain Killer: A "Wonder" Drug's Trail of Addiction and Death. He says that before the term “opioid” was coined, painkillers were known strictly as narcotics and were associated with dark alleys and lowlifes.

BARRY MEIER:  Narcotic painkillers like morphine were used almost exclusively in the 1980s and well into the 1990s for the treatment of cancer and other types of terminal pain, and there was well-founded fears here in the United States that even patients who were dying from cancer were not getting adequate treatments of morphine. There was the concern that, you know, at the end of their life these patients would become addicted. And it truly was a significant medical problem.

BOB GARFIELD:  And so, the pendulum swung, and you were there when it kind of changed direction, back in the early 2000s. How did you come to this story?

BARRY MEIER:  We got a tip here at The Times that there was a new drug popping up on the streets called OxyContin, and its producer was promoting this drug as something that was less addicting than previous painkillers but it had become sort of the drug de jour on the streets and there was a huge street trade going on in it.

BOB GARFIELD:  There were people like you who were looking at abuse but there were others who kind of bought into this narrative that pain was undertreated, and perhaps they were a little naïve in doing so. Can you tell me about the kind of stories that were popping up on this subject, the war on pain?

BARRY MEIER:  Yeah, there were, there were tons of them in virtually every major publication. Forbes had an article called, “The Morphine Myth.” Playboy did a big interview called, you know, “The War Against Pain Doctors” or “The War on Pain Patients.”

You know, on the one hand, I think that there's a natural tendency for journalists to seize on, wow, there's a problem, we’ve been laboring under misconceptions about how it should be treated and we can now address what’s like a pervasive problem in the United States. Then there was another class of journalists, many of them with a libertarian dent, who saw, you know, these drugs were safe, they were effective, they were helping people, and their focus was, oh wow, the DEA is smashing down the doors like the ATF would do with, you know, like gun owners and standing in the way between doctors who were really just trying to do the right thing by patients and these patients who desperately needed these drugs.

BOB GARFIELD:  The nanny state is forcing you to live in pain.

BARRY MEIER:  Not even just the nanny state but the police state was doing it. And, and this whole narrative was fueled by misinformation being generated by Purdue and other people, you know, medical leaders in the scientific community, I mean, people who were dealing with scientific evidence like they were political advocates.

BOB GARFIELD:  Aha, the experts, the same crowd cited over and over again, the same research studies. Who were they?

BARRY MEIER:  Dr. Russell Portenoy was unquestionably the most famous and, as it would turn out, most aggressive.

 [CLIP]:

DR. RUSSELL PORTENOY:  The likelihood that the treatment of pain using an opioid drug which is prescribed by a doctor will lead to addiction is extremely low.

 [END CLIP]

BARRY MEIER:  You know, what Dr. Portenoy did, and I believe I was the first person to find this, was to basically take studies that had absolutely no relationship to the long-term use of these drugs and purport that these findings were evidence that these drugs could be used safely with an extremely low addiction rate. He’s the one who coined the idea that there was an addiction rate of less than 1 percent.

BOB GARFIELD:  I just want to focus on this for a moment because it, it's astonishing to me how slight was the supposed research. The Porter and Jick study that that is at the heart of all this wasn't even a study.

BARRY MEIER:  This was a letter that appeared in The New England Journal of Medicine.

BOB GARFIELD:  Eleven lines long.

BARRY MEIER:  Yeah, and it had nothing to do with the long-term use of opioids. It was people who had been treated with opioids, and, and then they were released from the hospital. It didn't follow those people. It didn't look at their use of these drugs over weeks or months. It had absolutely nothing to do with the arguments that were being made by Russell Portenoy or by other advocates of these drugs.

Similarly, there was another study at a headache clinic that was, again, being held up as supportive of the use of opioids or narcotic painkillers. In fact, it's fairly well known that narcotics are a terrible way [LAUGHS] to treat migraines and other severe types of headaches because they create what's known as rebound headaches. And then the third study was a very, very small study dealing with burn patients and, again, tiny study, tiny number of patients, never following these patients over the long term.

I think, you know, underlying that is the fact that the FDA, which is supposed to be sort of the gatekeeper to the approval of these drugs, never required Purdue to do a long-term study to prove the safety and efficacy of these drugs or their ability to addict. They allowed them to basically speculate about that.

BOB GARFIELD:  In the meantime, that pendulum, if it had swung too far to one direction and cancer patients and others with chronic breakthrough pain were being deprived of treatment, around the turn of the millennium, Purdue started taking that narrative very much in the opposite direction, seeking to get OxyContin prescribed for damn near everything. Here is an excerpt from a video series they played in doctors’ offices called, “I Got My Life Back.”

 [CLIP]:

SPOKESMAN:  They don’t wear out, they go on working, They do not have serious medical side effects. And so, these drugs, which I repeat are our best strongest pain medications, should be used much more than they are now for patients in pain.

 [END CLIP]

BOB GARFIELD:  In 2007, Purdue Pharmaceuticals and three of its executives pleaded guilty to criminal charges, based on that campaign. And they were fined $650 million, which sounds like a big number but is really kind of just table stakes in the painkiller market, huh?

BARRY MEIER:  We did the math at one point, it was like a day’s worth of sales or a couple of -- a week’s worth of -- I mean, something de minimus when you looked at the total sales.

BOB GARFIELD:  At some point, a journalist doing his or her due diligence must realize that the narrative is being driven by a relatively small number of people and nobody, as far as I can tell, until you, ever went back to figure out if these were disinterested parties who were honest brokers of legitimate research or shills or some hybrid of the two. How much of this epidemic do you think is attributable to the failings of just basic journalism?

BARRY MEIER:  I do believe that, you know, as journalists, we do have an obligation to do some pretty simple stuff. It took me about three days to do the reporting that made it absolutely crystal clear to me that the studies that were being held up as the holy trinity of the opioid movement had nothing to do with the use of these drugs. There was a gullibility on the part of journalists. There are stores all the time about, you know, cures for this, that or the other thing that when you prick it with a pin or wait a couple of weeks they all turn out to be bogus or ill founded.

There was that but I think there was a much more pernicious side, which were people who really were sort of industry mouthpieces and shills who not only fell for the scientific data but made it sort of a cause célèbre, made doctors who were running pill mills or mistreating patients heroes in this war against pain. And I can tell you that I’m sure while some doctors were improperly prosecuted, it was also abundantly clear that there were a number of doctors who were criminals and who were using their medical license to make money, to trade drugs for sex with their patients, who were acting in the most deplorable ways.

BOB GARFIELD:  You came into this story and have, have kind of chronicled the trajectory of opioids but it's a story you’ve sort of seen before because this wasn't your first beat.

BARRY MEIER:  There was a period of time when I covered the tobacco industry. Right now, what you’re seeing is litigation taking place against opioid makers much in the same way that litigation took place against tobacco companies.

BOB GARFIELD:  The State of West Virginia, for example, suing Purdue.

BARRY MEIER:  Not only suing Purdue but suing every other opioid maker, as well, because by the mid-2000s it was not just Purdue that was promoting opioids, it was a range of companies that were making these drugs. And what’s sort of fascinating here is that while the tobacco saga took decades of litigation to come to that breaking point, the opioid problem, it's not a long-term health problem. People can become addicted or severely dependent on these drugs within a matter of a few weeks or months. So what we have is this public health crisis unfolded kind of in rapid speed. It's much faster than tobacco and, in many ways, much more complicated.

Not only do you have the corporate imperative to sell product, you have a criminal imperative to get these laboratory drugs, like fentanyl, onto the street. So now because we'd never dealt with the pharmaceutical end of the problem when we might have, we’re now dealing with criminal enterprises that are selling drugs that are even more deadly than their pharmaceutical cousins.

 [MUSIC UP & UNDER]

BOB GARFIELD:  Ah, Barry, many thanks.

BARRY MEIER:  My pleasure, Bob.

BOB GARFIELD:  Barry Meier is a reporter for The New York Times and author of Pain Killer: A "Wonder" Drug's Trail of Addiction and Death.