Beware Big Pharma

"The overall impression that physicians have been left with is that these drugs are very effective and very safe. And that is simply not true." Dr. Irfan Dhalla, University of Toronto family-medicine professor.

The very real issue of pain management for people suffering chronic and unforgiving pain is vastly complicated by the issue of the use of opioids, chemical or naturally-derived, that are highly addictive. Causing members of the medical profession to take a hands-off attitude for fear they may be implicated in causing addictions. It goes further than that, of course, since the inappropriate use of these powerful substances can also cause death.

Narcotic painkillers prescribed for patients require close scrutiny to determine whether they are appropriate to the task at hand, to ensure that the patient fully understands how much can be safely taken (when doctors themselves largely aren't certain about that) and to monitor the larger effect on the patient's health and well-being.

An excessive dose has the potential of triggering respiratory depression. Breathing can slow and stop, starving the heart of oxygen, causing cardiac arrest.

A decade ago, Purdue Pharma had introduced a new pain drug it called OxyContin. This product improved on an older drug, oxycodone, meant for the treatment of terminal cancer pain. A semi-synthetic derivative of opium. Designed in pill form to release a continuous dose over a twelve-hour period, with an initial bloodstream burst, to kill pain.

This new opioid drug was billed as a safe alternative with twice the potent effect of morphine. A high-profile advertising campaign was mounted. A forum that took place in Toronto, introducing OxyContin featured specialists lauding the new drug. Dr. Brian Goldman of CBC fame was among them, encouraging doctors to overcome their suspicion and fear of prescribing pain killers.

Soon enough OxyContin was being widely prescribed. Sales soared, from $3-million in 1998 to $243-million in 2010. "This campaign was amazingly successful. It was probably the most successful marketing campaign in history as far as I know for any class of drug", said Dr. Mel Kahan, a University of Toronto addiction expert.

That success has also resulted in OxyContin being sold illegally, on the street, and criminal gangs are profiting hugely from its runaway sales. And because it is addictive, and because it is potentially dangerous in overdose quantities it has resulted in an uncomfortable number of deaths from overdoses; in Ontario alone 140 people yearly, more than those who die from drowning mishaps.

Purdue, the pharmaceutical company, has produced a valuable product that heightens its bottom line; it's what such companies are in business for. By persuading physicians, through a campaign mounted by its sales personnel, and public relations and advertising, that this was a safe and effective alternative to other pain killing drugs, it was popularly prescribed and not adequately followed by doctors uncertain of dosage.

There simply are not enough pain clinics to deal with an epidemic of chronic pain in the population. People are desperate for relief from their pain. Doctors are conflicted, in wanting to help their patients, but unwilling to commit to the time it would take to follow up on their patients. Physicians are also fearful of becoming involved in conditions leading to addiction and deleterious health impacts.

Canadians, as it happens, appear to use more pain-control drugs than most populations. And things are made more complicated by the fact that some pain specialists who give advice to the community of general practitioners are funded by pharmaceutical manufacturers.