In January of 1980 a seemingly harmless letter was sent to the New England Journal of Medicine. This letter was all but a single paragraph but would become the primary talking point for hundreds or thousands of pharmaceutical salespeople in the 1990s and 2000s. The letter, known as the Porter and Jick letter, was not a formal study or even a submission of formal research. It was just a note stating that the authors had been using opioid-based painkillers without any notable signs of addiction. It did not say much else – it was only one paragraph. The entire letter is to the right and linked here.
It is not entirely clear what happened when, but it is fair to speculate that armed with the letter – published in the NEJM – pharma sales professionals had the information they needed to convince some in the medical community that opioids were safe and non-addictive. Somehow they managed to convince enough doctors to try to treat chronic pain sufferers with these medications and these doctors became the leading voice in pain treatment. It didn’t hurt that doctors were provided with financial incentives (kickbacks, commissions, rebates) to try the new drugs.
The early successes became keynote topics at annual medical conventions and before long those doctors who refused to treat chronic pain were painted with a brush of inhumanity. How could a doctor, who had the ability to treat chronic pain, refuse to do so? Especially in light of all the successes the early adaptors were having. These first three paragraphs summarize much of what Sam Quinones describes in his ground-breaking work Dreamland.
It is not irrational to conclude that many of the 5 million opioid prescription pain pill abusers today owe part of their problem to the possibly fraudulent use of the Porter & Jick letter. It is estimated that there are enough prescription pills prescribed in the USA that every adult (259 Million) could have their own bottle. No less than FOUR PERCENT (200,000) of the 5 million pill abusers will become heroin addicts and no less than 15,000 of those will die from heroin overdose. In fact nearly SEVENTY PERCENT (33,000) of all drug overdose deaths (52,000) involve opiates. Can blame be rationally cast on the Big Pharmas? Link to Photo on the Right.
Regardless of how you feel about their involvement in the mass distribution of opioid pain killers, what happened next is also interesting to consider. As more and more abusers became addicted, demand grew for methods and medicines to relieve their addiction. Naturally, the Big Pharma companies produced medications that would help ease the pain and discomfort associated with physical withdrawal. Methadone was followed with brand names such as Subutex and Suboxone. You might think that the producers of these medications would be eager to undo the complications associated with the faulty use of the Porter & Jick letter. But it seems to me that these medicines are desperately needed, are in low supply, and are therefore expensive to use. Why is that? Why would Big Pharma not flood the market with these life saving and epidemic ending medications? Have you asked yourself this question? Have you thought about it?
Questions like this don’t end here – there are more questions.
You know that addicts in early recovery cannot sleep, they are anxious, they are depressed, some are suicidal. So of course they need to be treated with sleeping meds, antidepressants, anti-anxiety meds, and hey maybe we can get another addiction with benzos like Xanax and Klonopin. Link to Photo on the Right.
Naturally, the addiction epidemic continued to grow – almost unabated for a decade in some regions of the country. Demand for methods and medications continued to grow. Big Pharma produced another brand called Vivitrol. This drug would help addicts maintain long-term recovery by preventing the effect of opiates in the brain and the central nervous system. A simple monthly injection would eliminate the rush and following euphoria that addicts become accustomed to when shooting heroin. Again – you would think that Big Pharma would want to flood the market with this drug in an effort to turn the growth trend of the opiate epidemic. But that is not what has happened. The drug is not easy to get and it is so expensive that very few independent heroin addicts can afford it. Again – why? Why would it benefit the big pharmas to not solve the opiate crisis? Questions like this drive me insane – but there are still more.
Narcan. Again, invented and branded as an opiate overdose antidote, Narcan was introduced to the market that was CREATED BY the BIG PHARMAS with the questionable use of the Porter and Jick letter. It is now recommended that every home, every school, every public facility have Narcan on hand in the event of an accidental opiate overdose. Of course you have to pay for it. As I vomit in my mouth, I hesitate to write that maybe Big Phama invented Narcan so that its addicted customers don’t die. Not because they care about human life – but because those dead customers are dead revenue streams. It is a sick thing to imagine – but It is hard for me to not carefully consider the true motives. Again, why are these companies not bending over backwards to get this stuff into the market for free?
Finally we come to the end. The television advertisements that make me want to look for lawyers and lawsuits – sometimes nooses too. Lately, at least in the hotbeds of the epidemic, the airwaves are flooded with commercials not for Cialis, not for Viagra, no not those, but for Movantik. Movantik is yet another brand medication offered to the public for Opioid Induced Constipation (OIC). It as if the Big Pharmas are saying to us — yes we have caused you tremendous pain, yes we have helped you to lose everything, yes many of you have suffered tragic deaths – so the least we can do is help those of you still addicted to take a shit – a big healthy shit. Because we want you to be comfortable sheep while we boost our stock price on revenues generated across a lifecycle of dependence that we created using ingenious marketing and a simple 1 paragraph letter from a simple doctor to the New England Journal of Medicine in 1980.
God help us all.
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