Above Photo: Lee Fang: “They’ve coordinated a massive network of different foundations and medical societies to promote more use of these drugs for all kinds of different purposes.” (image: David Feldman Show)
Janine Jackson: In 2014, a class of drugs known as opioids were involved in more than 28,000 deaths, or 61 percent of all drug overdose deaths, according to the Centers for Disease Control. The rate of opioid overdoses has tripled since the year 2000. Recent data show two different but related trends: an increase in so-called illicit opioid overdoses, largely due to heroin, and then this 15-year increase in overdose deaths involving prescription opioid pain relievers. Those drugs, like oxycodone and hydrocodone, or brand names like OxyContin and Vicodin, account for more than 16,000 fatal overdoses each year. The CDC says they’re comfortable using the term “epidemic” to describe the crisis.
Pharmaceutical companies say they lament the addiction and fatality problems tied to their products, but they also seem determined to resist efforts to address them, suggesting to do so would have to mean taking away relief from people in pain. It’s a medical story, certainly, but it’s also one that calls for following the money, and that’s what our guest does. Lee Fang is an investigative journalist whose work appears on The Intercept, among other places. He joins us now by phone from San Francisco. Welcome back to CounterSpin, Lee Fang.
Lee Fang: Hey, thank you so much for having me.
JJ: Let’s talk a little about how we got here, to an opioid crisis. Any time a powerful drug exists, there’s an opportunity for abuse, of course. But this isn’t just a tragic tale of unintended consequence; there are some factors, aren’t there, in how these particular drugs were introduced?
LF: Right. For some of the bigger, well-known opioids, like OxyContin, manufactured by Purdue Pharma, these drugs were kind of rushed to market. There’s evidence to suggest that early warning signs that showed how truly addictive OxyContin is were ignored in the approval process, and that the company did not really present evidence showing how dangerous and how likely patients were to overdose on OxyContin through their approval process.
But the larger story of how we got to where we are today, where there’s an epidemic that you referenced, not just from prescription opioids, but the recent surge in heroin use and heroin overdoses is also linked to the prescription opioid industry. Four out of five heroin users got started on opioid painkillers, many of those folks receiving those drugs just being prescribed by their doctors. And in America alone, about 81 percent of the global supply of oxycodone products, and almost 100 percent of hydrocodone products, such as Vicodin, are used by Americans. So this is a uniquely American crisis.
But to understand where we got to where we are today, it’s really a marketing strategy that’s been employed over the last 20, 25 years, in which these pharmaceutical companies have pressured doctors, suppressed evidence, and they’ve coordinated a massive network of different foundations and medical societies to promote more use of these drugs for all kinds of different purposes, everything from minor tooth pain to minor back pain. There’s clear evidence that the pharmaceutical companies are part and parcel of the recent surge we see in opioid use.
JJ: I want to just draw on one point that you just made. As you note, Americans are 5 percent of the world’s population, but we consume virtually all of the hydrocodone products like Vicodin and huge percentages of the oxycodone. And so you kind of have to ask, have other countries just not embraced the miracle? You know? They don’t understand that this is a better mousetrap? Or maybe it comes down to marketing.
And that brings us back to a company like Purdue Pharma, that produced OxyContin for many years. You talk about downplaying risks of addiction. I understand that they were telling their sales representatives to tell doctors that the risk of addiction was less than 1 percent, and it seems as though there was a gap between what they knew internally and what they were putting out to the public. And, of course, that’s what’s so troubling to us on this, is to know that a company can know something and yet regulators don’t know it, and so of course the public doesn’t know it.
LF: Yeah, that’s right. You know, this story is very similar to how, for example, tobacco companies use a vast political network and marketing strategy to push their product despite overwhelming signs showing the health concerns of their product. Or the oil industry using very sophisticated political strategies to suppress science.
So for Purdue Pharma, they took a multi-pronged approach. In addition to the typical pharmaceutical strategies—aggressively bringing on sales reps to push doctors, to persuade them with different types of financial and other incentives to prescribe OxyContin and other opioids—there was also a more public-facing strategy, where Purdue Pharma created a national network of different pain foundations. So these pain foundations would create marketing tools that would bring in people suffering from certain types of pain, from pain doctors and specialists, and pressure them to use opioids as the main type of recourse.
JJ: Right.
LF: So between 1996 and 2002, Purdue Pharma funded more than 20,000 pain-related education programs, almost ten a day, seven days a week. During that time, Purdue conducted more than 40 national pain-management training conferences, in vacation spots like Boca Raton and Scottsdale, paying for more than 5,000 physicians to attend. And they also helped create and fund specialty centers, academies for pain sciences, that would take doctors and give them all types of materials, and prescribing guidelines to encourage the use of OxyContin and other opioids.
And for certain areas of the country, they even created specialized regional pain foundations that would market the drug. So the Appalachian Pain Foundation, based in West Virginia, they were well-funded by Purdue Pharma, and they’d arrange meetings between doctors and local reporters.
There’s also evidence to suggest that Purdue Pharma and other pain companies would coordinate grassroots networks of pain patients. So when reporters would write stories saying there’s this growing opioid epidemic, there are these problems with addiction, they would coordinate to send angry emails to reporters and claim that they were being stigmatized unfairly, to push back against reporters and editors who were starting to peek around and look at this type of dynamic.
JJ: Right. And, of course, the reason that that would have resonance is that there was a moment in which it was understood that pain was undertreated. And there are people who have severe pain and who want it to be taken seriously, and none of this is to undermine the situation that those people face.
But that’s why that kind of narrative, that claims to harness a grassroots voice or a voice of patients, particularly patients in pain, can be very persuasive. And yet you get another aspect of the story from the fact that Purdue, for example, the makers of OxyContin, they’re saying that they’re patient advocates, but when patients get together, like some in Ohio did, to have a class action to say that they’d become addicted to OxyContin, well, then Purdue wants to block that.
LF: Right. But like for any grassroots lobbying campaign, they seized on a legitimate grievance, and that’s the undertreatment of some pain conditions. And they layered on some untrue claims, such as these guidelines and these marketing materials that claimed that opioids were not addictive, or were not at high risk of addiction, and they organized individuals and these kind of very PR-savvy foundations to push this false claim.
JJ: Well, let’s talk about what’s going on now. Because in response to what even media are calling attention to as an alarming crisis going on, in terms of an explosion of abuse and of overdoses from opioids, the CDC said that they were going to put forward these non-binding guidelines to do with their prescription. And what happened then? The documents were leaked, essentially, and what happened?
LF: Yeah, so last year, as the CDC took up guidelines that, as you mentioned, are voluntary but provide a government-endorsed idea of maybe best practices, as they were working on these guidelines to maybe discourage the high rates of opioid prescribing, a copy of the guidelines were leaked, and we really saw the political machine of the opioid companies move into high gear. We saw a number of pharma-funded groups immediately attack the CDC. So there’s evidence to suggest that members of Congress, working at some level in conjunction with pharma companies, threatened the CDC with an investigation, saying that this was unfair, that they were not having the right, open process.
Another group, called the Washington Legal Foundation, which, speaking of tobacco, they were very famous during the ‘90s in taking tobacco money and then filing lawsuits against places that were attempting to regulate tobacco, acting kind of as a neutral-sounding front. I mean, “Washington Legal Foundation” is kind of benign-sounding. Anyways, Washington Legal Foundation is funded by Purdue Pharma, makers of OxyContin, and they threatened the CDC with legal action over the guidelines.
And according to the Associated Press, a group called the Pain Care Forum, another one of these pharma-funded fronts for the opioid industry, organized regular meetings in Washington among lobbyists and other painkiller advocacy groups to start pressuring policymakers, pressuring the people at the CDC, to, if not back away from these guidelines, to water them down. So we know from a lawsuit filed by the city of Chicago that the top lobbyist for Purdue Pharma actually controlled the Pain Care Forum, and the company of course also funds Pain Care Forum. So it’s the same constellation of groups that has existed for a very long time now, kicking into political gear attacking the CDC.
And after the CDC released a preliminary version of these guidelines, I believe last December, they received even more criticism, both from Capitol Hill, from some allies of the pharmaceutical industry, and from these political groups and these foundations, financed and controlled by pharmaceutical companies.
And after an open comment period, finally the CDC handed down its guidelines in March of this year, and the guidelines basically say, for most types of routine pain-related health issues, doctors should not prescribe high dosages of opioids as the first choice. I mean, anything from ibuprofen to other kinds of pain-care management therapies should be tried first, and then, if those don’t work out, the high-dosage opioids might be acceptable. And, again, these are voluntary guidelines.
JJ: And after the guidelines came out, has there not been pushback since, that we’re now going to revisit it and go back and bring more, quote unquote, “stakeholders” to the table? I thought that that sort of reopening had been achieved, in a way, by the industry side.
LF: Yeah, and that’s the kind of interesting dynamic here. So we did a storyrecently, again on the guidelines. And, you know, as we go into midterm elections, we just kind of, by circumstance of the Senate election map, we have a lot of senators from the Northeast, which is a region that’s been heavily hit by the opioid and heroin epidemic, up for reelection this year. So these legislators, from places like New Hampshire and Pennsylvania and Ohio, are adamant about taking something to voters saying that they’ve dealt with the opioid crisis, they’ve been leaders in passing big legislation, fixing the problem. And the administration, the Obama administration, is also eager to say that they’ve done something big.
But the big package coming out of Capitol Hill in just the last few weeks, that supposedly addresses the opioid crisis, mostly provides some money and incentives for drug treatment of addiction, and for increasing the supply for first responders with Narcan, which is an overdose drug that helps revive someone who’s in overdose on an opioid. And these are positive developments.
But as we pointed out in our piece recently, the legislation does nothing to crack down on pharmaceutical companies to try to limit the overprescribing of opioids. And, in fact, might actually be a step backwards, because there is the provision in the bill that sets a new task force, which will have industry and other stakeholders in the process, to review the CDC guidelines. So there’s a potential in the future that the industry might have a second shot at going after the CDC guidelines that they’ve been so concerned about.
JJ: It’s very interesting that the response is to put more of industry representation on the decision-making body. If I could just pull out to a bigger picture view, it sounds as though what we’re saying is, you can’t have a government panel on climate change without the oil industry, because that’stheir thing, you know. There’s something funny about this philosophy that says that you can’t have a panel about change, it’s not legitimate, unless it’s like 50 percent ardent, invested advocates for the status quo. You know? As though you’re not legitimate to be in the room discussing something unless you make money off it. It seems a very kind of strange attitude for government regulators to take up, frankly.
LF: Yeah, and we’ve seen this strategy employed recently on a whole number of issues where there’s a lot of public support. You know, the public is demanding some type of government response to the opioid crisis. And if you look at how lobbyists are attacking other popular issues, you know, payday lending is another one: Republicans on Capitol Hill have given up on trying to repeal the Consumer Financial Protection Bureau. Their claim now, their kind of strategy over the last few years, has been to instead say, these regulations, they need to be formulated with the input of industry. They’ve been trying to add new commissioners and advisors to the board that are representatives from the payday-lending industry and from other financial firms on Wall Street, hoping that by having more of a stake in the process of creating these rules, they can weaken them or make them effectively useless in a procedural way.
So this is a similar strategy that we’re seeing here: Now it seems too difficult to repeal the CDC guidelines, the previous effort by these front groups to derail them through lawsuits, or the threat of lawsuits, that was a failure. So the next phase is, OK, we can’t get rid of the CDC guidelines, how do we create this new body that will oversee them that will have representatives from industry?
JJ: Let me ask you, finally—it’s not really a pivot, because it’s the same issue. If the industry backing didn’t raise questions about the sincerity of the claims of some of these groups and pain foundations and some of the individuals involved here, their claims that they’re really only concerned with people in pain and providing them access to pain relief, well, the role that some of these same folks are playing in the marijuana legalization story would seem to raise questions about that driving interest in pain relief. There is some connection between these two stories, isn’t there?
LF: Yeah, that’s I think the next wave of reporting, and a big policy fight going into the future. We’re seeing a number of studies now suggesting that marijuana can be an effective treatment for some pain management, and in some cases even more effective than powerful prescription opioids. And so we’ve seen Elizabeth Warren and other legislators try to convince government agencies like Medicare and the Veterans Administration to at least allow some patients to seek medical marijuana, and that there should be more studies on this approach.
But interestingly enough, as the opioid industry has attempted to gain influence or buy off the anti-drug and pain-related foundation world, some of the largest anti-drug advocacy groups in America, like the group called CADCA, Community Anti-Drug Coalitions of America — one of their largest donors is actually Purdue Pharma. And they, notably, even though opioid drug abuse is one of the biggest problems faced in the drug abuse community, mostly sat on the sidelines when it came to the CDC guidelines fight. They kept their mouth closed and did not encourage people to go and promote the guidelines, which really contrasts with their approach to marijuana, where they’ve held rallies and organized grassroots lobbying drives to keep marijuana prohibition, and to continue the criminalization of marijuana.
JJ: It seems there’s just no substitute for following the money. I’d like to thank you very much for connecting those dots for us, Lee Fang. We’ve been speaking with Lee Fang. You can find his work on this and other issues online at<a href=”https: theintercept.com=”” “=””>TheIntercept.com.
LF: Thank you so much, Janine.