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 Debunking widely accepted opioid myths

25.11.21. Opioid use and misuse is having a critical impact on patients, their families, and the health system. Every day in Australia, there are over 150 hospitalisations and 14 emergency department admissions that involve opioid harm; and three people die from drug-induced deaths involving opioid use. Australia currently ranks eighth internationally on the numbers of defined daily doses of prescription opioids per million population and pharmaceutical opioid deaths in Australia now exceed heroin deaths by a significant margin. Clearly, there is a problem here and Jacob Sullum reports on two recent court rulings in the US which are important for our chronic pain sufferers:

Since 2014, state and local governments have filed thousands of lawsuits against pharmaceutical companies they blame for causing the “opioid crisis” by exaggerating the benefits and minimizing the risks of prescription pain medication. The theory underlying these cases is pretty straightforward: Drug manufacturers lied, and people died.
Two recent rulings — one by a California judge, the other by the Oklahoma Supreme Court — show how misleading this widely accepted narrative is. Both decisions recognize that undertreatment of pain is a real problem, and that bona fide patients rarely become addicted to prescription opioids, let alone die as a result.
Three California counties, joined by the city of Oakland, started the flood of litigation against opioid manufacturers seven years ago when they filed a complaint arguing that the companies they sued created a “public nuisance” by encouraging increased use of their products through a false or misleading marketing campaign. The four jurisdictions sought more than $50 billion in damages.
Following a bench trial that began on April 19 and wrapped up at the beginning of last month, Orange County Superior Court Judge Peter J. Wilson concluded that the plaintiffs had failed to prove any of their allegations. In a scathing 42-page ruling issued on Nov. 1, Wilson said the supposedly incriminating statements cited by the plaintiffs were neither false nor misleading.
As Nora Volkow, director of the National Institute on Drug Abuse, noted in a 2016 review of the evidence, “addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities.” The California plaintiffs nevertheless argued that it was false or misleading to say that “most” pain patients who take opioids do not show signs of addiction.
That statement is consistent even with the plaintiffs’ claim that one in four patients become addicted, an estimate that Wilson concluded was not supported by the evidence. “The more reliable data,” he said, “would suggest less than 5%, rather than 25%.”
Similarly, the plaintiffs portrayed the concept of “pseudoaddiction,” which posits that doctors might mistakenly view patients desperate for pain relief as “drug-seeking” addicts, as nothing but a marketing ploy. But as Wilson noted, “this is a medically recognized term,” and California law acknowledges the potential for such confusion.
The plaintiffs viewed any suggestion that an opioid “improves function” as deceptive. But Wilson thought it was “beyond debate” that opioids can improve function by controlling pain well enough for a patient to resume quotidian activities such as shopping, cooking and cleaning.
Wilson noted that the plaintiffs “made no effort to distinguish between medically appropriate and medically inappropriate prescriptions.” Since both California and the federal government have determined that the benefits of medically appropriate opioid use outweigh its risks, he said, a rise in prescriptions by itself cannot constitute a “public nuisance.”
A week later, the Oklahoma Supreme Court rejected similar claims against Johnson & Johnson, one of the defendants in the California case. The court said Cleveland County Judge Thad Balkman, who in a landmark 2019 ruling held the company liable for his state’s opioid-related problems, “erred in extending the public nuisance statute to the manufacturing, marketing, and selling of prescription opioids.”
Like Wilson, the justices emphasized the distinction between use and abuse. While “improper use of prescription opioids led to many of these (opioid-related) deaths,” they said, “few deaths occurred when individuals used pharmaceutical opioids as prescribed.”
The court noted that “opioids are currently a vital treatment option” for chronic pain, “a persistent and costly health condition” that “affects millions of Americans.” It added that the Food and Drug Administration “has endorsed properly managed medical use of opioids (taken as prescribed) as safe, effective pain management, and rarely addictive.”
That is not the impression left by the lawsuits that seek to blame drug companies for opioid-related deaths, which nowadays overwhelmingly involve illicit fentanyl. Patients should not have to suffer from unrelieved pain simply because the medication they need can be abused.

{ 4 comments… add one }
  • Pensioner Pete 25/11/2021, 4:23 am

    CBD oil is legally available from many chemists, which works wonders for pain relief, there is no longer a need to use pharmaceutical opioids which are addictive, whilst the CBD oil is not addictive.

    Link to information regarding the CBD oil: https://www.medicalnewstoday.com/articles/319475#benefits

  • ozman 25/11/2021, 8:23 am

    Gee PP, sounds promising.

    “While CBD is a promising option for pain relief, research has not yet proven it safe and effective, and the Food and Drug Administration (FDA) have not approved CBD for treating pain.”

    But unlike the experimental quaccine that is being forced on people, CBD hasn’t been proven safe and effective. Must be a typo. I will have to inform Greg Hunt.

    • Penguinite 25/11/2021, 8:32 am

      I like quackcine! How about ‘fauxine’? Did you read that Pfizer has asked a US Judge to allow it 50 years to dribble out documents under an FOI request concerning the veracity of their offering?

    • Pensioner Pete 25/11/2021, 9:01 am

      When I had prostate cancer which became metastatic cancer spreading to my hip joint, the pain was truly something else, all the way up the spine, I used CBD oil for the pain, and no word of a lie, the pain ‘vanished’ within a few minutes and lasted pain free near all day. Should this happen to me again, CBD oil will be the treatment as I know from personal experience it does work, minus any side effects other than a lowering of blood pressure as it also serves to relax oneself.

      What a shame or injustice, call it as you will, that we cannot make our own pain relief medicine at home for personal use, think of the savings to the government in costs for expensive pharmaceutical drugs and the other costs involved with someone experiencing this type of terrible pain, and consider the cost benefits to society as a whole as those with chronic pain issues are then able to become productive members of the community again.

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