Once again, from the Wall Street Journal:
It has been his life's work. Now, Russell Portenoy appears to be having second thoughts.
Two decades ago, the prominent New York pain-care specialist drove a movement to help people with chronic pain. He campaigned to rehabilitate a group of painkillers derived from the opium poppy that were long shunned by physicians because of their addictiveness.
Dr. Portenoy's message was wildly successful. Today, drugs containing opioids like Vicodin, OxyContin and Percocet are among the most widely prescribed pharmaceuticals in America.
Opioids are also behind the country's deadliest drug epidemic. More than 16,500 people die of overdoses annually, more than all illegal drugs combined.
Now, Dr. Portenoy and other pain doctors who promoted the drugs say they erred by overstating the drugs' benefits and glossing over risks. "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 said in an interview with The Wall Street Journal. "We didn't know then what we know now."
Recent research suggests a significantly higher risk of addiction than previously thought, and questions whether opioids are effective against long-term chronic pain.
The change of heart among former champions of opioid use has happened quietly, largely beyond the notice of many doctors. New York psychiatrist Joseph Carmody said he was "shocked" after attending a recent lecture outlining the latest findings on opioid risk.
"It goes in the face of everything you've learned," he said. "You saw other doctors come around to it and saying, 'Oh my God, what are we doing?'"
Because doctors feared they were dangerous and addictive, opioids were long reserved mainly for cancer patients. But Dr. Portenoy argued that they could be also safely be taken for months or years by people suffering from chronic pain. Among the assertions he and his followers made in the 1990s: Less than 1% of opioid users became addicted, the drugs were easy to discontinue and overdoses were extremely rare in pain patients.
Many of those experts now say those claims were weren't based on sound scientific evidence. "I gave innumerable lectures in the late 1980s and '90s about addiction that weren't true," Dr. Portenoy said in a 2010 videotaped interview with a fellow doctor.
1996, Purdue Pharma LP released OxyContin, a form of oxycodone in a patented, time-release form, and rivals followed suit. Today, sales of opioid painkillers total more than $9 billion a year, according to IMS Health, which tracks sales for drug companies.
After spending most of his professional life advocating greater use of the drugs, Dr. Portenoy said there is still little research to show whether patients who embark on long-term opioid therapy will ever be able to stop.
Earlier this year, he said, he asked his mother whether she would stop taking her hydrocodone as part of a scientific study. She said no.
"How difficult is it for her to get off these drugs?" Dr. Portenoy asked. "You have no idea and neither do I, because no one knows."
The whole article is "must reading".
The death toll from prescription painkiller overdose was 16,500 people in 2010. At that rate, as the epidemiologists like to say, we lose as many people to OxyContin in three and a half years as we did during the entire Vietnam War (1964-1975).
Along the way, the profession of medicine has been corrupted. Most people get these drugs by prescription, very often in "pill mills" run by licensed physicians who spend all day writing 'scripts for any cash-carrying customer.
The Centers for Disease Control has a great website, with a great page on the prescription pill overdose crisis.
CDC also has some great public access databases. Would you like to know...
- How many people died by "legal intervention" (i.e., shot or otherwise killed by the police) in the U.S. in 2010? (You can look up multiple years if you are interested in trends.)
- How many black males bicyclists over the age of 25 died after being hit by a car or other vehicle?
- How many women killed themselves by setting themselves on fire?
The CDC knows all (scroll down for the answers, but be sure to make your own guesses first).
police homicides = 412
bicyclists = 49
self-immolation = 29