Is this the Right Question to Ask – Who’s to Blame for the Opioid Epidemic?

Editor’s note: In this editorial from the desk of the Executive Director of the Physician-Patient Alliance for Health & Safety, Michael Wong, JD discusses the the recent documents disclosed in the State of Massachusetts against Purdue Pharma and asks whether this is right question to ask – “Who’s to Blame for the Opioid Epidemic?”

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety

A lawsuit filed by the state of Massachusetts against Purdue Pharma alleges that the company, the Sackler family (which controls Purdue), and Purdue executives misled doctors and patients about the potential addictive qualities of opioids and, in particular, OxyContin, which Purdue manufactures.

The lawsuit alleges that “Purdue Pharma created the epidemic and profited from it through a web of illegal deceit.”

RT if you agree - @purduepharma created the #opioidepidemic and profited from it through a web of illegal deceit Click To Tweet

Moreover, recently released documents related to the lawsuit would seem to indicate a strategy on the part of Purdue and particularly the Sackler family to place blame for opioid addiction on patients. In a recent article, STAT reports:

When Purdue Pharma started selling its prescription opioid painkiller OxyContin in 1996, Dr. Richard Sackler asked people gathered for the launch party to envision natural disasters like an earthquake, a hurricane, or a blizzard. The debut of OxyContin, said Sackler — a member of the family that started and controls the company and then a company executive — “will be followed by a blizzard of prescriptions that will bury the competition.”

Five years later, as questions were raised about the risk of addiction and overdoses that came with taking OxyContin and opioid medications, Sackler outlined a strategy that critics have long accused the company of unleashing: divert the blame onto others, particularly the people who became addicted to opioids themselves.

“We have to hammer on the abusers in every way possible,” Sackler wrote in an email in February 2001. “They are the culprits and the problem. They are reckless criminals.”

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As an attorney, I completely appreciate what the Massachusetts Attorney General is seeking to do in the lawsuit. Finding culpability and responsibility is what the justice department is supposed to do.

However, for those of us facing opioid overdosed patients, concerned about the opioid epidemic, and how to prevent the next patient from becoming addicted to opioids, I believe that the larger and perhaps more important question is – how are we going to fix the opioid epidemic?

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In 2016, the Physician-Patient Alliance for Health & Safety sought to answer this very question.

On August 25, 2016, the Surgeon General issued a letter to physicians urging them to take a part in combating the opioid epidemic. On the Surgeon General website, healthcare providers are encouraged to help solve the opioid epidemic:

“Our nation faces an opioid crisis. Health care providers are uniquely positioned to help communities and their patients #TurnTheTide on the opioid epidemic. Providers can be the solution. Join the movement. Sign the pledge.”

To gauge whether clinicians would answer this call and how clinicians and the public felt about the Surgeon General’s recommendations to fight the opioid epidemic, the Physician-Patient Alliance for Health & Safety (PPAHS) conducted a survey to examine perceptions about the Surgeon General’s appeal to physicians to play an active role in stemming the opioid epidemic.

The survey was comprised of 5 key questions:

Please indicate your clinical role, if any.

  • Have you or will you take the Surgeon General’s pledge?
  • What do you believe caused the “opioid epidemic”?
  • Who do you believe should lead the fight against the opioid epidemic?
  • What tools should doctors have to help fight the opioid epidemic?

The results highlight that the majority of doctors and clinicians agree with the Surgeon General’s letter, with 7 in 10 respondents having, or will, take the pledge.  However, respondents were divided in what has caused the “opioid epidemic”; while over-prescribing of opioids and an overly aggressive emphasis on pain treatment were popular choices, a significant percentage (35%) chose to indicate other reasons.  

What was clear was the sentiment that doctors, rather than government or communities, should be the captains leading the efforts to curb opioid harm.  In order to do so, respondents indicated that an expanded toolset, comprised of educational and screening resources, was needed.

So, while we applaud the efforts of the Massachusetts Attorney General and others to hold those accountable for the opioid epidemic, as caregivers and patient advocates, we need to focus on the larger and more pressing question – how are we going to curb the opioid epidemic?

Doctors in our 2016 survey have told us – the path forward in curbing the opioid epidemic lies in doctors’ offices. We need to provide them a toolset, comprised of educational and screening resources.

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