A series of recent settlements related to claims against advertising companies and drug manufacturing companies involved in the sale and marketing of opioid drugs are encouraging, and will require accountability for promoting highly addictive drugs such as OxyContin as non-addictive. is required. These settlements, ranging from $350 million to $465 million, provide optimism for people living with opioid use disorder, especially given that they include funding to support treatment for such people. It provides a perspective.
However, questions remain about what impact these criminal and civil lawsuit settlements will have on the opioid overdose epidemic in the future. Coupled with the observation that opioid marketing practices have not changed despite past lawsuits, underrecognition of addiction and overprescription of highly addictive drugs that cause pain and related symptoms remains a problem.
The role of marketing in the creation of the opioid overdose crisis
The number of drug overdose deaths exceeded 106,000 in 2021, with opioids being the main cause. His history with the opioid crisis dates back to the 1990s. At that time, opioid prescriptions began to proliferate in response to various regulatory guidelines in medicine, coupled with misinformation spread through advertising about the safety of long-term use of opioids for chronic pain. Since the American Pain Association published guidelines emphasizing the importance of addressing pain at every patient visit, the medical field has developed a culture and practice of assessing pain as the “fifth vital sign.” . At the same time, the pharmaceutical industry launched an aggressive marketing campaign to promote the use of opioid painkillers. Marketing strategies included downplaying the risk of addiction, marketing unapproved indications, and offering financial incentives to prescribers. Promotional materials claiming that the risk of opioid painkiller addiction is “small” despite a lack of supporting research led to a false sense of confidence regarding the safety of opioids in the long-term treatment of non-cancer-related pain.
A study on the link between opioid overdose deaths and opioid marketing found that the more doctors who received opioid marketing, the higher the rate of opioid overdose death in the following year. In fact, for each additional doctor who received the marketing, the overdose death rate was 12% higher. Interestingly, marketing's impact on opioid prescription rates is primarily due to the number of interactions between marketers and physicians, such as receiving paid meals from drug representatives, rather than the total amount spent on marketing. did. Therefore, although some medical centers have restricted interactions between drug sales representatives and physicians, these policies have not been widespread enough to realize large-scale impact.
What can you do if your lawsuit backfires?
More than an industry-wide warning, lawsuits and sanctions against opioid manufacturing and advertising giants like Purdue Pharma have led competitors to increase marketing spending by as much as 160% to promote opioid prescriptions. Other compensation strategies used by opioid manufacturers include restructuring through mergers and acquisitions and shifting focus from painkillers to other areas of drug development. But there is little evidence that new products will not be targeted by similar aggressive marketing techniques, raising fears that history will repeat itself. Given that the link between marketing practices and the opioid overdose crisis has been established across studies, several strategic steps may shape the path forward for clinicians and policy makers. .
First, licensed health care providers who prescribe controlled substances with addictive potential (opioids, benzodiazepines, etc.) must receive education to learn how to assess and reduce risk, especially for those who are more susceptible to addiction. is required.
Second, licensed prescribers must be educated about the signs and symptoms of addiction and how to effectively manage and treat it, especially addiction to prescription drugs. Research shows that one in four healthcare providers receive addiction training as part of their medical education, and highly effective, evidence-based treatments are available for opioid dependence. Despite this, less than half of medical and emergency care providers surveyed considered opioid use disorder. It's completely treatable. Limited training and addiction stigma combine to exacerbate existing problems of underdetection and undertreatment of opioid and other addictions.
There is a growing recognition that it is not easy for healthcare professionals to become familiar with the complex disease of addiction, and there is a need for a wide range of resources to expand physicians' knowledge about addiction.
Finally, policies regarding continued marketing to both physicians and consumers need to be reconsidered, especially for medicines with a high potential for addiction. More than a decade ago, the Institute of Medicine issued recommendations for physicians and medical centers to reduce the influence of advertising on prescribing behavior and maintain public trust in the medical profession. Although these recommendations have not been widely adopted, it is important to revisit what we have learned from the opioid overdose crisis and how clinicians and policy makers can bring about change before the next wave of drugs and crises. Now is the time to fully consider what you can do.
Photo: Jeffrey Hamilton, Getty Images
