It is no secret that opioids are addictive even when used as prescribed. That is why they were highly restricted until fairly recently. It is also no secret that there is no evidence of the long-term usefulness of opioids in chronic pain despite unethical Pharma marketing.
Now Pfizer, the second biggest drug company in the world, has agreed to add warnings to the dangerous drugs that cause as many as 60 deaths a day in the U.S. Pfizer will disclose that opioids “carry serious risk of addiction—even when used properly,” says the Washington Post, and promises “not to promote opioids for unapproved, ‘off-label’ uses such as long-term back pain. The company also will acknowledge there is no good research on opioids’ effectiveness beyond 12 weeks.”
The disclosures and warnings Pfizer has pledged are not a mea culpa. The city of Chicago sued five opioid makers in 2013—Johnson & Johnson, Purdue Pharma, Teva Pharmaceutical Industries, Endo Health, and Actavis—but Pfizer was not one of them. Pfizer, which sells one opioid painkiller, was not named in the lawsuit, and there’s no admission of wrongdoing.
Instead, Pfizer is voluntarily drafting an opioid marketing code, a spokesperson told FiercePharma, because Pfizer considers opioid misuse a “public health issue” and is “happy to stand alongside them [Chicago] to ensure that painkillers are marketed responsibly. We want to make sure that the right people who need it have it.” The code reflects Pfizer’s current marketing policies, said the spokesperson, and follows FDA risk-management programs for extended-release and long-acting opioids.
Pfizer makes and markets the extended-release opioid painkiller, Embeda, which is not as central to the opioid addiction epidemic as Purdue’s long-acting opioid OxyContin.
Chicago’s lawsuit and similar suits brought by Santa Clara and Orange County charge the companies with a two-decade conspiracy to profiteer on opiate sales. In addition to disseminating misleading medical information that downplayed addiction and lied about the long-term effectiveness of opioids, the municipalities charge the opioid makers with creating faux “patient” groups that scream “more opioids” and buying the opinions of respected doctors. Chicago health plans spent millions of dollars on opioids, reported Crain’s Chicago, which the city says were inappropriately prescribed to city employees.
Few if any studies show that workers kept on opioids return to work more quickly, and much of the medical literature points to the opposite. Workers who remained on opioids for more than seven days during the first six weeks after an injury were more than twice as likely to be disabled and out of work a year later, according to a study in the journal Spine. In another study in Spine, workers who received early opioid drugs in morphine equivalent amounts of more than 450 mg “were, on average, disabled 69 days longer than those who received no early opioids” and their “risk for surgery was three times greater.” The study concludes that “Given the negative association between receipt of early opioids for acute LBP [lower back pain] and outcomes, it is suggested that the use of opioids for the management of acute LBP may be counterproductive to recovery.”
Workers who received high opioid doses actually stayed out of work three times longer in a California study and experienced “delayed recovery from work-place injuries,” say other data.
Ineffective for Chronic Pain
As AlterNet recently reported, Pharma churned the chronic pain market to sell opioids despite their ineffectiveness. “Despite more than a decade of booming use of narcotic painkillers for chronic pain conditions, solid evidence of the long-term safety and effectiveness of the drugs is scant to nonexistent,” reported John Fauber of the Journal Sentinel.
After a decade of Pharma promising doctors and patients that opioids are good and necessary for chronic pain, two government-sponsored research papers published in the Annals of Internal Medicine in 2015 revealed that there have been only short-term studies of opioid pain relief and almost no data support their long-term use.
As Pfizer will now concede, there is “no good research on opioids’ effectiveness beyond 12 weeks.” And that is not all. Opioids can actually make pain worse, says Richard W. Rosenquist, of the Cleveland Clinic; a phenomenon called opioid-induced hyperalgesia or OIA.
“I have personally treated patients who were terrified to titrate off opioids because they were afraid of returning pain, only to find they were in less pain once off the opioids,” writes Sridhar Vasudevan, in Multidisciplinary Management of Chronic Pain, which offers many non-surgical, non-opioid treatments for chronic pain.
Many chronic pain patients without terminal or malignant pain have drunk the Kool-Aid. The real problem is the media’s “misunderstanding” of opioids and chronic pain, much to the pleasure of Big Pharma. They do not remember that 20 years ago, before Pharma marketing, it would have been unheard of to treat chronic pain with narcotics.
Opioid casualties are not just young people who turned to heroin after they could not get opioids. Elderly patients have especially been hurt by the opioid craze. “Older brains and bodies are prone to drug complications, from falls and respiratory failure to cognitive problems and dementia,” and “because older bodies metabolize drugs less quickly, those medications tend to build up in their ￼￼￼￼￼￼￼￼￼￼￼￼￼bodies” said a 2014 expose in USA Today.
Pfizer is right and could be commended for admitting that opioids are addictive as prescribed and that they do not work after a few weeks. However, this was known about opioids during the entire 20-year opioid addiction epidemic.
Martha Rosenberg is an investigative health reporter and the author of “Born With a Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp the Public Health (Random House).”