Dear HIFA colleagues,
Thank you for your inputs into the discussion so far. We are now entering our third week and I would like to introduce Question 5: What is the role of the pharmaceutical industry? We are especially concerned here about whether and how the pharmaceutical industry is a cause of the global opioid crisis.
In our reference document we have the subquestions:
- Has the pharmaceutical industry influenced the development of the problem in your country? What evidence exists?
- What regulatory mechanisms are necessary?
- What can be done to address misinformation from the pharmaceutical industry?
OVERVIEW
It is estimated that there are 40 million people addicted to opioid drugs worldwide. This includes people who use drugs illegally, such as heroin and fentanyl, and people whose addiction has resulted from the legal prescription of drugs such as codeine, oxycodone and tramadol.
It's unknown how many people are addicted to prescription drugs, but it appears to be a fast growing problem in many countries.
The causes are multifactorial. Aggressive marketing and misinformation by pharmaceutical companies are at the centre of our current discussion. (Other factors include lack of reliable information/understanding about safe use among prescribers and users.)
PURDUE PHARMA COMPANY
Probably the best known case is Purdue Pharma, which was an American privately held pharmaceutical company that 'manufactured pain medicines such as hydromorphone, fentanyl, codeine, hydrocodone and oxycodone, also known by its brand name, OxyContin. The Sacklers developed aggressive marketing tactics persuading doctors to prescribe OxyContin in particular. Doctors were enticed with free trips to pain-management seminars (which were effectively all-expenses-paid vacations) and paid speaking engagements. Sales of their drugs soared, as did the number of people dying from overdoses. As well as this, levels of heroin consumption increased significantly following Purdue's aggressive marketing campaign, and it is generally accepted that OxyContin played a huge role in causing this. It did this either through people needing a stronger opioid to match a growing tolerance for OxyContin, and turning to street heroin, or through people losing their prescriptions and turning to Heroin as an alternative. Perhaps the biggest contributor, however, was Purdue changing the OxyContin formula into an abuse-deterrent formulation (ADF), in 2009. Typical OxyContin abuse around the time included crushing up and snorting the pill, or injecting it. This made the high much more intense and euphoric, and made it come on much quicker. The change made the drug much trickier to abuse in this fashion, and as a result, many turned to an even more intense, relatively readily available alternative: heroin... 'On October 21, 2020, it was reported that Purdue had reached a settlement potentially worth US$8.3 billion, admitting that it "knowingly and intentionally conspired and agreed with others to aid and abet" doctors dispensing medication "without a legitimate medical purpose."' https://en.wikipedia.org/wiki/Purdue_Pharma
Several other pharmaceutical companies have been found to have misled the public and prescribers about the risks of opioid drugs.
What is the situation in your country? I understand that addiction to tramadol is a growing problem in Nigeria, for example. Are pharmaceutical companies taking advantage of countries where there may be low capacity to control, as we have seen with big tobacco?
I look forward to your inputs on these topics.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org