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Doctor who encouraged wider use of opioid painkillers is having second thoughts

Oxycodone
CC/Flickr/Be.Futureproof
The United States is now struggling with a huge and tragic prescription pain-medication problem.

Dr. Russell Portenoy, the New York-based pain-care specialist who helped lead the campaign in the 1990s to make prescription pain medications more widely available, is apparently having second thoughts about the wisdom of that effort.

He now admits that perhaps, just perhaps, he overstated the benefits and understated the risks of Vicodin, OxyContin, Percocet and other prescription opioids, according to an article published Monday in the Wall Street Journal.

"Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation? Well, against the standards of 2012, I guess I did," Dr. Portenoy told WSJ reporters Thomas Catan and Evan Perez. "We didn't know then what we know now."

The phrase “too little, too late” immediately jumps to mind. For as Catan and Perez point out, the United States is now struggling with a huge and tragic prescription pain-medication problem. More than 15,000 Americans die each year as a result of opioid addiction — more than die from all illegal drugs combined, according to the Centers for Disease Control and Prevention. The financial burden of this problem is also enormous. The CDC estimates that health insurers spend more than $72 billion each year on direct medical costs related to the non-medical use of prescription painkillers. 

Dr. Portenoy — who has had financial relationships with more than a dozen drug companies over the years, including those that make and market opioid painkillers — played a central role in getting us to this point.

Apparently, he did it by mixing questionable science with personal charm. Here’s an excerpt from the WSJ article:

Opium-derived painkillers have been around for thousands of years. Early in the 20th century, heroin was sold as a cough suppressant. Heroin addiction in the U.S. skyrocketed. Congress banned the drug in 1924 and doctors became deeply wary about using opioids.

Dr. Portenoy set out to change that. As a young doctor at Memorial Sloan-Kettering hospital in New York, he noticed that opioids were effective in cancer patients with terrible pain.

In 1986, at the age of 31, he co-wrote a seminal paper arguing that opioids could also be used in the much larger group of people without cancer who suffered chronic pain. The paper was based on just 38 cases and included several caveats. Nevertheless, it opened the door to much broader prescribing of the drugs for more common complaints such as nerve or back pain.

Charming and articulate, he became a sought-after public speaker. He argued that opioids are a "gift from nature" that were being forsaken because of "opiophobia" among doctors. "We had to destigmatize these drugs," said Dr. Portenoy.

He rose to chairman of pain medicine and palliative care at Beth Israel Medical Center in New York. His small office is studded with awards and evidence of his offbeat sense of humor. He prominently displays a magazine mock-up that jokingly dubs him "The King of Pain."

At medical conferences, his confident, knowing manner helped smooth the way for his message. Before an audience of government regulators, he once joked that he might tell a patient at low risk of abuse: "Here, [have] six months of drugs. See you later," he said, according to a Food and Drug Administration transcript. Amid laughter, he added, "It's just hyperbole. I don't actually do that."

Steven Passik, a psychologist who once worked closely with Dr. Portenoy and describes him as his mentor, says their message wasn't based on scientific evidence so much as a zeal to improve patients' lives. "It had all the makings of a religious movement at the time," he says. "It had that kind of a spirit to it."

The WSJ article is yet another reminder of how modern medical practices are too often driven by wishful thinking and, of course, money (opioid painkillers rake in $9 billion in sales each year) rather than by solid scientific evidence.

You can read the article on the WSJ website.

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Comments (1)

Deceptive statistics

If one really wanted to stimulate a serious discussion about the benefits and risks of opioids, she would search for the most telling, but missing statistic. What is the percentage of patients who are receiving opioid medication that develop an addiction requiring intervention?
As a Registered Nurse with certifications in Oncology and Alternative Medicine I am involved in the care of both cancer and non-cancer patients on opioids. I can categorically state without an iota of doubt that the vast, vast majority of them do not develop the horrors your inflammatory story highlights.
However, a significant proportion of the patients I see fail to use their opioid medications properly because of the societal stigma attached to them. Out of fear of becoming addicted, they fail to use their medications as prescribed and get into trouble with pain symptoms and side-effects.
Your article gives lots of heat, but little light on this issue so important to so many patients and their families and, I believe, does actual harm.