The recent spate of settlements against advertising and pharmaceutical manufacturing companies surrounding the sales and marketing of opioid drugs such as OxyContin has ignited interesting conversations around the role of promotion of these highly addictive drugs and its connection to the opioid crisis. Settlements, with cases ranging in value from $350 to $465 million, are welcomed, especially since they include funding to support individuals struggling with opioid use disorders.
However, despite optimism, concerns about the potential influence of these criminal and civil suit settlements on curbing the opioid overdose epidemic persist. This, coupled with the fact that opioid marketing practices have not substantially changed in light of past lawsuits, suggests that both the under-recognition of addiction and the overprescribing of high addiction potential medications for pain and related conditions remain fundamental issues.
MedCity News, in its insightful article, provides a succinct overview of the history of the opioid crisis. The crisis can be traced back to the 1990s when opioid prescribing began skyrocketing in response to various regulatory guidelines in medicine. This was exacerbated by the spread of misinformation through advertising about the safety of long-term opioid use for chronic pain. Notably, opioid marketers downplayed addiction risks, marketed for unapproved indications, and provided prescribers with financial incentives.
These strategies, combined with the healthcare field’s adoption of a culture of treating pain as a “5th vital sign,” led to a surge in the use of opioids. Studies noted a direct link between opioid overdose deaths and opioid marketing. The higher the number of physicians who received opioid marketing, the higher the opioid overdose death rate in the following year. Suprisingly, the greatest influence on prescription rates was not the total dollar amount spent on marketing but the number of interactions between marketers and doctors, such as meals paid for by drug representatives.
However, despite previous lawsuits and sanctions, major players in opioid manufacturing and advertising such as Purdue Pharma, have not curbed aggressive marketing practices. In fact, they have prompted competitors to substantially increase marketing spend to promote opioid prescribing. Other strategic moves by opioid manufacturing companies include restructuring via mergers and acquisitions, and shifting focus from pain killers to other drug development areas.
Looking ahead, a few strategic steps could mitigate repetitions of this crisis, particularly emphasising provider education on risk assessment and mitigation, recognizing signs and symptoms of addiction, and managing and treating addiction effectively.
Also, the recommendations from the Institute of Medicine over a decade ago, which urged physicians and medical centers to reduce the impact of advertising on prescribing behaviors and uphold public trust in the medical profession, could be revisited. Policymakers and clinicians must consider the lessons learned from the opioid overdose epidemic before the next drug or wave of the crisis.