Watch this 1998 Purdue Pharma marketing video for OxyContin

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If the patients this advertisement was targeting were really suffering unbearable pain that couldn’t be treated any other way then do you really think Purdue Pharma would have bothered making this commercial at all?

“I’m not so sure about these opiods my doctor is recommending” isn’t the kind of response you’d normally expect to hear from someone in constant agony. And we all now know full well that Purdue Pharma engaged in all manner of kickback schemes, incentive programs and misleading marketing campaigns to ensure that their products would be over-prescribed.

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Your story is harrowing and also makes me rage froth a little at the mouth. I cannot take opiods and that unwillingness to find you alternatives is despicable. I was so relieved when I migrated to Argentina - here you don’t ever, ever, get them prescribed for anything. Seriously.

My partner had a double mastectomy and got diclofenac. From immediately after regaining consciousness. And was fine like most everyone else (they may have been given something the first 12 hrs in hospital but they were lucid as heck). I’ve also accompanied patients in hospital who’ve had ffs and were managed on analgesics.

And US Americans always freak out about how cruel that must be, like ‘third world brutality’ but actually, they don’t let you suffer much pain down here at all - just turns out that most things can be managed without opiods. In fact, the biggest issue I’ve had is that in the final years I worked that job, so many US Americans went into ffs surgery already taking daily opiods that even letting them take theirs (decision of higher ups), they were unable to feel comfortable and kept insisting they’d need more and better.

For chronic pain there is a ton of kinesiology, tens machines and exercises prescribed to you, so you go to the doctor with the tennis elbow or sciatica or the disc and get ten sessions, renewable, prescribed to you. I’ve found out that the tens machine is the bees knees for my occasional sciatic nerve pinches, though seems that a tolerance could easily be developed if it was trying to do long term chronic pain and probably would start to lack.

None of this is perfect and your point about the need to discover more and better pain management drugs is right on, but I would say that the ‘virtually never opiods’ policies work at least as well if not much better than the ‘take this’ policies.

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No clue if this is true, but I’ve been told by someone who used to work adjacent to the lobbying of doctors, that the rise in prescription drug tv commercials was the result of tighter regulations against kickbacks and other sweet deals.

  • ‘Used to be the pharmaceuticals could host a bunch of doctors at a 5 star resort and educate them about such and such drug between rounds of golf and midnight buffets, but once that was outlawed too, the drug companies had to go on tv and ‘educate’ the patients directly.’

So you seem to be on to something there. I did try to piece together info on the anti kickback law vs prior legislation and collate to advertising laws/policy but couldn’t get enough info with specific years to make a call about the veracity of that guy’s statement.

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Yeah, pretty much since forever. I mean one of the reasons that we HAVE the food and drug act is all the soldiers that got addicted during the Civil War.

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Yes, I am missing the part that the 1% was a bald-faced lie. Since the U.S. government’s own numbers say the addiction rate is 0.4%.

I’m not defending Purdue at all. They did shitty things.

I’m pointing out that our response to the opioid crisis has done terrible damage as well. Largely because we oversimplify the root causes and lay all the blame on one or two villains. Horrible, despicable actions have been committed against pain patients in the name of fighting this crisis.

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Let’s see what the National Institute of Health has to say about that claim:

Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.”50(p99) The company cited studies by Porter and Jick,51 who found iatrogenic addiction in only 4 of 11 882 patients using opioids and by Perry and Heidrich,52 who found no addiction among 10 000 burn patients treated with opioids. Both of these studies, although shedding some light on the risk of addiction for acute pain, do not help establish the risk of iatrogenic addiction when opioids are used daily for a prolonged time in treating chronic pain. There are a number of studies, however, that demonstrate that in the treatment of chronic non–cancer-related pain with opioids, there is a high incidence of prescription drug abuse. Prescription drug abuse in a substantial minority of chronic-pain patients has been demonstrated in studies by Fishbain et al. (3%–18% of patients),53 Hoffman et al. (23%),54 Kouyanou et al. (12%),55 Chabal et al. (34%),56 Katz et al. (43%),57 Reid et al. (24%–31%),58 and Michna et al. (45%).59 A recent literature review showed that the prevalence of addiction in patients with long-term opioid treatment for chronic non–cancer-related pain varied from 0% to 50%, depending on the criteria used and the subpopulation studied.60

Basically the only way you get “less than 1% addiction rate” is if you rely on the drug companies’ cherry-picked studies to the exclusion of all other data.

Nobody here is saying we should demonize patients seeking relief from chronic pain. We are saying the Purdue Pharma people who made this marketing video are human garbage who didn’t give a shit about the lives they willfully destroyed by pushing opiods on people who didn’t need or even necessarily want them.

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  1. Opioids are just not appropriate for long term and chronic pain management.

I was with you on 1 and 2. But you lose me here. Opioids are certainly not the ideal way to deal with chronic pain, but for many they are the safest and most effective treatments we have. Taking that option away before we have something better because non-patients are overdosing from street drugs cut with fentanyl doesn’t seem like the best trade off.

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Again, I don’t deny that Purdue did awful things. Advertising of prescription drugs and kickback schemes are wrong an evil.

What I’m criticizing is that our oversimplified view of the problem drives “solutions” that do real damage.

The opioids are not the problem. They are important, useful, effective, and relatively safe drugs for intense pain. The problem is the ads, the kickbacks, the manipulation, the irresponsible prescribing, the failure to re-evaluate patients, the lack of supervision when taking patients off of the meds, and the illegal street drugs cut with powerful synthetic opioids of unbelievable dosages.

“I’m not so sure about these opiods my doctor is recommending” isn’t the kind of response you’d normally expect to hear from someone in constant agony.

Do you know anyone who lives with debilitating chronic pain? I know a couple, and they’ve certainly asked questions like this in an effort to learn if there are options their doctors have overlooked.

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No one in this forum has suggested we punish the addicts or outlaw all medical uses of opiods.

We’re saying that the people engaged in business practices like this—getting obscenely rich by pushing opiods directly to the public while knowingly and repeatedly misrepresenting the risks those drugs posed—are horrible human beings who belong in prison.

Are you seriously suggesting that cannabis is 25 times more addictive than opiods? That’s… quite a position.

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(Disclaimer: I worked for major Fortune 500 pharmaceutical companies but am speaking here on my own title. )

It is more complicated than that. With social healthcare and government agencies like the EMA and FDA involved pharmaceuticals ARE political.

This has been made worse by the current system where state and independent parties like universities rarely if ever finalise new pharmaceutical discoveries instead selling them to commercial companies that then own the patents and rights.

A good example from history was the polio vaccine that was created in a university so there was no commercial entity holding any rights to it. Now with COVID that never happened because the entire infrastructure of independent research does not exist anymore

So now pharmaceuticals are political withoutside commercial parties that want a voice in the matter.

Add to this that deciding on the merits and downsides of a drug is extremely complicated. Any form of good testing will always come with a quagmire of ethical problems that would make Hobbes swallow his quill pen, and you have to travel that maze of statistics where truths, deliberate misdirection, and stupid mistakes are hard tell apart even for the initiated, and very few can do the mathematics of necessity of healthcare anyway

… so you need specialists that are very hard to check without the knowledge and skills of these same specialists. And we all know the current relationship between politics and science >:(

So as free consumer and voter (and possible patient) you should have access to information on drugs and therapies but no party that can give you that should be trusted completely. Good Luck With That, sorry.

A fun example from here in the Netherlands:

  1. Companies cannot advertise
  2. The drugs market is close to a monopsony since major insurance conglomerates do al the buying
  3. Doctors must always first propose drugs that are in your insurance (Note: So they can’t upsell expensive options A good rule in itself!)

So unless you dive into the matters yourself you may not even ever know there is an alternative you for your own reasons and situation would be happy to pay for OR pressure the government to add it to insurance. And again that dive is complicated!

So there is an argument for advertising. That argument was created by handing over medical research to the commercial market. The solution may be in more government control on research, ending patents on essential goods like certain drugs, and maybe even government producing these for their own.

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Yes, I’ve read this web blog that seems to be supported by CBD products! /s

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We always talk about how medicine is evidence-based, but the thing with pain is, there is no objective evidence of it.

So if I go to the doctor and say “I have been having very bad tummy aches and I am fairly certain it is gallstones”, based on the evidence available to him, I’m no different to a dozen patients that week saying the same thing (and being more dramatic about it) due to mild indigestion. It makes perfect sense for him to dismiss them and me equally, because the alternative would be a ton of wasted resources, unethically excessive medical intervention, and overprescription of painkillers.

But if I eventually show up at the ER for the exact same complaint, and happen to have jaundice which I hadn’t even noticed, then it’s all systems go, because that’s an objective sign. I’m pumped full of lovely smack on the spot, I get ultrasound, MRI and endoscopic drain-cleaning within 24 hours, and my gravel-filled shithead of a gallbladder is burning in hell a few weeks later.

So in my case, I guess it all worked out. But it’s fucked up that for a few years, I had to periodically wait out three to twelve hours of very nearly unendurable pain, when a dollar’s worth of morphine would have fixed it instantly, but it’s illegal for me to make that call, and it can only happen if someone else guesses that my subjective experience warrants it.

To my mind, the whole approach to pain (and other purely subjective conditions that can be treated with drugs, like anxiety) is backwards, even from a purely medical standpoint. The expert in how much pain you’re in is you; so you alone should be responsible for the kind and amount of pain medication you need. The broken logic of the current approach invites this whole industry of people lying to each other, which leads to people arbitrarily getting both not enough and far too much pain medication.

It’s true that even if you could get opioids from vending machines, you’d still have manufacturers telling dangerous lies about their products. But at least, like with tobacco, you could trust the medical industry for advice, instead of having your doctor be the person used to launder the lies.

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I am not sure of the accuracy of this but I have read that this advertising is found only in NZ and the USA.

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I was doing my residency in the early 90’s. It was a very common occurrence for drug reps (whether it was Perdue or not is lost in my misty memory) sponsor lavish dinners at places we could never have afforded on our salaries, so of course we all went, so they could present academic-sounding, authoritative-seeming papers and studies that “proved” that if you were treating “legitimate” pain, it was impossible to lead into addiction. If someone did become addicted, it was just proof that they had been lying to you about their pain, so it was their fault. It took some experience in the real world to realize that they were absolutely full of shit. One thing I should point out about myself you may not know. I am a pediatrician. Just let that sink in for a few. Yeah, I hate these folks with a blazing passion.

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Complicating the story of bad drug companies is the story of bad policies guided and enforced by the DEA which make Dr.s afraid to appropriately prescribe opioids. As with all drugs, most people who use opioids (even for non-medical reasons) are not addicted to them, but our policies are created as if the opposite is the case. And it’s very important to remember there is a profound difference between being dependent upon a drug (like chronic pain patients who live and work because of their drug use) and being addicted to a drug (continued use in the face of negative consequences).

The response to the bad behaviors of the drug companies has been typically overbroad and, predictably, unnecessarily deadly. As Dr.s were discouraged from prescribing pain meds, patients had to get them on the unregulated (and often poisonous) black market, where no health professionals can advise on their proper use.

opioid-deaths-CDC-1999-2017
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Ultimately, I think our collective attitudes towards drugs and those who take them fuel the damage done to drug-takers much more than the manufacturers of those drugs. This new book deserves a lot of attention.

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No one in this forum has suggested we punish the addicts or outlaw all medical uses of opiods.

But they have made comments calling facts as lies (such as the “less than 1%” addiction rate, which is well supported by the government’s data).

This kind of oversimplification and scapegoating of one particular bad actor leads to bad policies. Thousands of patients have already lost access to opioid treatments that were serving them well because of these bad policies.

Technically, opioids haven’t been haven’t been outlawed (yet), but insurance companies are routinely denying coverage, doctors and pharmacists who’ve done nothing wrong are being lied to and threatened, and patients (and their family members) are being blackballed (which interferes with their treatment for other health issues).

This is already happening. And the justification given is that we have to do something about the problem Purdue created (supposedly single-handedly). The fact of the matter is that very few of the opioid-related overdose deaths are not patients taking the medication they were properly prescribed. But that’s where the policies are aimed. One of the terrible ironies of these bad policies is that they often cut patients off abruptly, which actually increases the risk of addiction.

Several of the comments here are the exact kind of misinformation that fuels these bad policies that compound the problems rather than addressing the actual causes.

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You’re the one claiming cannabis is 25 times more addictive than opioids so maybe you’re not in the best position to judge.

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And then there is shit like this:

Yup, great time to be a doc. /fucking_S

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