City of Chicago Takes on Big Pharma

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The city of Chicago is the latest to file a lawsuit against a handful of opioid painkiller makers –including Johnson & Johnson and Purdue Pharma – for deceiving the public about the risks of the medicines and driving up costs, according to a statement from Chicago Mayor Rahm Emanuel.

“For years, big pharma has deceived the public about the true risks and benefits of highly potent and highly addictive painkillers in order to expand their customer base and increase their bottom line. This has led to a dramatic rise in drug addiction, overdose and diversion in communities across the nation, and Chicago is not immune to this epidemic,” said Mayor Emanuel. “Today, we’re saying enough is enough – it’s time for these companies to end these irresponsible practices and be held accountable for their deceptive actions.”

The lawsuit charges that five of the nation’s largest opioid manufacturers, Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc., Endo Health Solutions Inc. and Actavis plc, knowingly and aggressively marketed these drugs as rarely addictive, while touting benefits that lacked scientific support in order to boost profits. Their efforts to increase the sale of these drugs have been successful, as the sale of opioids has quadrupled between 1999 and 2010. In fact, enough prescription painkillers were prescribed in 2010 to medicate every American adult around the clock for one month

A 2008 investigation reported that 87 percent of all opioids dispensed were to patients using them to treat chronic pain on a long-term basis, even though there is no scientific evidence supporting the long-term use of these drugs for non-cancer chronic pain.

The City’s Health Insurance Plan has reimbursed claims for approximately $9.5 million on these drugs since 2008. The increase in misuse and abuse of these drugs is also generating additional health care costs. For example, estimates of visits to the emergency department in Chicago due to the misuse and abuse of prescription painkillers have been steadily increasing, with a significant increase of 65 percent between 2004 and 2011. It is estimated that in Chicago in 2009, opioid misuse and abuse resulted in 1,080 trips to the emergency room.

Combating opioid abuse with science:

More evidence is emerging to show that tamper-resistant formulations of extended-release analgesic opioids are improving public health by discouraging abuse.

The results should provide some reassurance to physicians concerned about the potential misuse of opioids by their patients, say doctors who specialize in pain treatment and addiction medicine.

Prompted by appeals from physicians and officials at the Food and Drug Administration for a harder-to-abuse pill to ease what many see as a public health crisis, one of the drug maker’s targeted in the city’s lawsuit, Purdue Pharma, launched a tamper-resistant form of its best-selling painkiller oxycodone, marketed as OxyContin.

The change has made a dent in misuse of the drug, research shows. A study in the July 12, 2012, issue of The New England Journal of Medicine surveyed 103 patients entering U.S. treatment programs between 2009 and 2012. Before the crush-resistant form of oxycodone was marketed, 36% chose it as their primary drug of abuse. By 2012, just 13% said they principally abused oxycodone.

A much larger study, published Nov. 3, 2012, in the American Pain Society’s The Journal of Pain, echoes the findings. Researchers examined surveys taken by more than 140,000 patients admitted to 357 U.S. treatment centers between June 2009 and March 2012. Among patients who said they abused a prescription opioid, the proportion misusing extended-release oxycodone fell by half, from 24% to 12%. Non-oral abuse through snorting, smoking or injection fell by 71%, said the study, which was funded in part by Purdue Pharma and Inflexxion Inc., a pharmaceutical risk-management corporation that developed the study assessment.

Researchers discovered that people intent on abusing opioids switched to the nonresistant, extended-release form of oxymorphone, marketed as Opana by Endo Pharmaceuticals. Abuse of that drug skyrocketed by 196%, to 5.5% of opioid abusers, after the abuse-deterrent oxycodone was launched.

In March 2012, Endo released its own tamper-resistant formulation of oxymorphone. In a Nov. 30, 2012, news release, the company cited surveillance data on substance abusers and from U.S. poison control centers showing a 59% decline in misuse of its crush-resistant pill.

Meanwhile, Michael Schiesser, MD, an addiction-medicine specialist in Bellevue, Wash., said the tamper-resistant prescription opioids have sparked an upsurge in the use of an illicit opiate — heroin.