Inside Medicine: A true tale of (corporate) drug abuse


By Dr. Michael Wilkes -
Published 12:00 am PDT Saturday, May 19, 2007

Talk in hospital hallways this past week has focused on the guilty plea and the $634 million penalty imposed on Purdue Frederick Co. pharmaceutical executives.

By way of background, OxyContin, sold by Purdue Frederick, is an extremely powerful, long-acting and effective narcotic used to treat serious cancer pain. OxyContin's addiction potential came to the attention of the FDA shortly after it was approved, when critics claimed that OxyContin's addiction is as severe as heroin's.

This should be no surprise, since both are opium-based pain relievers. Opioids, such as OxyContin and heroin, block pain messages to the brain and lead to increased feelings of pleasure and euphoria.

There is little debate that OxyContin is addictive and has wide abuse potential. Knowing this, but still driven for income and profit, the manufacturer Purdue Frederick heavily promoted the drug in a false and misleading manner, attempting to convince doctors that it was not addictive and could be used for less- serious pain.

Doctors worry a great deal about getting patients addicted to medicines. In fact, doctors often use these worries to defend why they are reluctant to prescribe narcotics even when patients have real, documented and substantial pain (cancer, broken bones, surgery). As a result, undertreatment of pain is a serious problem that we are attempting, with only limited success, to deal with in medical schools and in hospitals.

But the story that has been poorly told, because it is less catchy, is that OxyContin, when used appropriately, is an amazing pain reliever. There are few drugs like OxyContin that are capable of treating the pain of cancer. And, yes, it's addictive, but for someone who is dying of cancer, the worry about addiction is misplaced -- it doesn't really matter.

One of OxyContin's great advantages is that it is long- lasting, so patients need take only one pill every 12 hours rather than several pills every two to three hours. This is a huge advantage to people with severe, endless pain in their bones or abdomen for whom we don't want medication to keep wearing off.

So, when used as intended, OxyContin has the potential to greatly improve the quality of very sick people's lives. When abused, it can kill. But so do alcohol and automobiles.

Purdue Frederick wanted more profit than could be obtained from treating severe pain. It used a false "safety" argument to aggressively market the drug to nonexpert physicians, resulting in OxyContin's rise to become one of the top 25 best-sellers between 2000 and 2005.

What Purdue Frederick executives knew, but didn't tell doctors, was that the drug caused a powerful high, was dangerously addictive and had killed patients.

So instead of working to improve the care of people in pain, they made things worse by assuring doctors that this drug was safe. Late last week, the company and three top executives admitted using lies, distortions and half-truths to sell their product. Worse, they have set back our attempts to improve the treatment of severe pain.

While $634 million is a staggering amount for most companies, it is but a fraction of Purdue Frederick's dollar profit.

But it's time for a reality check. Across America, people are jailed on minor drug offenses -- some selling OxyContin illegally. At the same time, the Purdue Frederick three walk free. It seems these men deserve prison terms as well, and that Purdue Frederick should be forced, for say, 10 years, to turn over profits related to the sale of OxyContin to help fund substance-abuse treatment programs