Painkiller companies are now globally exporting addiction for profit — just like Big Tobacco

 

The US is in the midst of a harrowing opioid painkiller and heroin epidemic, which led to a record number of drug overdose deaths (more than 52,000) in 2015.

Unlike other drug epidemics, the current one did not start with an illicit substance. It began with legal drugs: opioid painkillers like OxyContin and Percocet, which were heavily marketed by pharmaceutical companies to sell as much of their product as possible.

The marketing, which downplayed the risks of opioids, was so misleading that in 2007 Purdue Pharma, producer of OxyContin, paid hundreds of millions of dollars in fines for it. The US Drug Enforcement Administration claimed in 2003 that Purdue’s marketing was “aggressive, excessive and inappropriate” and “very much exacerbated” abuse and criminal trafficking of opioids.

But instead of learning the lessons of the American opioid epidemic, a new report by Harriet Ryan, Lisa Girion, and Scott Glover of the Los Angeles Times suggests that drug companies are simply taking their message to a global audience.

The incentive for the companies is obvious: As US officials crack down on opioids and hurt companies’ profits (sales for OxyContin have steadily fallen since 2011), opioid producers are turning to a broader audience around the world to make up for the lost revenue. But for public health officials, this creates a real risk of spreading the opioid epidemic — which has been largely contained to the US so far — to a global scale.

We’ve seen this story before. As former US Food and Drug Administration Commissioner David Kessler told the LA Times, “It’s right out of the playbook of Big Tobacco. As the United States takes steps to limit sales here, the company goes abroad.”

What’s more, opioid companies aren’t significantly changing their messaging as they expand. Instead, they’re once again promoting the idea that opioids are safe and effective, even as opioid painkiller overdoses have killed tens of thousands in the US.

This is what Big Tobacco has done in the past few decades

 Eric Feferberg/AFP via Getty Images

We’ve seen this story before: As Americans smarten up to a dangerous drug’s risks, the drug companies take their product to other parts of the world.

Over the past few decades, the US has started to win the fight against tobacco. After the US surgeon general’s 1964 report linked tobacco to lung cancer and heart disease and aggressive education campaigns followed, smoking rates in the US have drastically dropped. The percentage of US adults who identified as current cigarette smokers fell from more than 42 percent in 1965 to less than 17 percent in 2014.

Given that as many as 540,000 people die from tobacco-related causes every year, this trend has saved a lot of lives and should continue to do so.

But what was good for public health was bad for tobacco companies. So they began pushing their product outside the US and Europe. Not only have they aggressively marketed cigarettes but they’ve fought anti-tobacco laws and regulations abroad — like mandatory labels that would warn consumers about the risks of tobacco use. The result is that tobacco companies have seen profits surge, even as their business in the US and Europe declined.

 

“EURO” is Europe; “AMRO” is the Americas; “SEARO” is Southeast Asia; “WPRO” is the Western Pacific; “EMRO” is Central Asia, the Middle East, parts of North Africa, and Horn of Africa; and “AFRO” is the rest of Africa.

The Tobacco Atlas

This is essentially what the Sackler family — which runs Mundipharma, a network of companies that sells OxyContin — is now trying to do to make up for its US losses. The LA Times reported: “A network of international companies owned by the family is moving rapidly into Latin America, Asia, the Middle East, Africa and other regions, and pushing for broad use of painkillers in places ill-prepared to deal with the ravages of opioid abuse and addiction.”

The marketing campaign claims opioids are safe and effective. They’re not.

 Education Images/UIG via Getty Images

It would be one thing if opioid companies were now marketing their products more responsibly than they did in the US. After all, pain really is undertreated in much of the world.

The Times found, though, that Mundipharma is not approaching its marketing in a new, safer way:

In Brazil, China and elsewhere, the companies are running training seminars where doctors are urged to overcome “opiophobia” and prescribe painkillers. They are sponsoring public awareness campaigns that encourage people to seek medical treatment for chronic pain. They are even offering patient discounts to make prescription opioids more affordable.

Not only has Mundipharma hired an international team of medical experts to push its message, but it’s brought on celebrities as well. In one ad campaign in Spain, topless actors, musicians, and models told the public that they don’t have to live with chronic pain — and that it should be treated as a serious medical condition. (After the Times asked about the ads, they were removed from YouTube.)

A Mundipharma spokesperson told the Times that the company was taking into account lessons from the US epidemic. But the Times found the opposite — unearthing promotional materials that downplayed opioids’ risks. (For a full breakdown of the evidence, read the Times’s full story.)

The global campaign repeats the same dangerous message that opioid companies pushed in America

 Education Images/UIG via Getty Images

Mundipharma’s strategy has two prongs. One: Get doctors and patients to approach chronic pain as a serious, treatable medical issue. Two: Dismiss the deadly risks of opioids as overblown and unwarranted.

This is essentially what opioid producers did in the US. In the late 1990s and 2000s, with the help of the federal government, opioid companies pushed the “Pain as the Fifth Vital Sign” campaign, persuading doctors and patients that they needed to treat pain as a serious medical issue. And in opioid marketing, drug companies hired patient advocates and doctors to tell patients and other physicians that the drugs were safe and effective.

As a 1998 Purdue Pharma advertisement put it, "We now find that these medicines are much safer, much more powerful, much more versatile than we used to think. And we feel that they should be used much more liberally for people with all sorts of chronic pain.”

Except this wasn’t true at all. The evidence always indicated that opioids can be very dangerous. What Mundipharma now calls “opiophobia” is a healthy dose of skepticism toward drugs that can be addictive and kill people.

And the research has never shown that opioids are effective in the long term for chronic pain. A 2014 study, for example, concluded, “There is evidence of short-term efficacy (moderate for pain and small for function) of opioids to treat [chronic low-back pain] compared with placebo. The effectiveness and safety of long-term opioid therapy for treatment of [chronic low-back pain] remains unproven.”

Yet opioid companies ran with their claims, making a lot of money in America as people got addicted and, increasingly, died.

Annual Review of Public Health

Since 2011, that green line (noting opioid sales) has fallen off for OxyContin. So the drug’s producers have decided to go global with the same message that worked so well for profits in the US — with little regard for the risks.