Like many Canadians, I'm deeply troubled by the epidemic of prescription painkiller addiction and the rising number of accidental and deliberate deaths attributed to OxyContin. As a doctor who has treated chronic pain, I have insight into how we got here and what we can do about it.
Recently, the news media have been examining the marketing campaign behind OxyContin, focusing on the relationship between Canadian doctors and Purdue Pharma, the drug's manufacturer. I am among those mentioned in this coverage.
I'd like to explain what I was trying to accomplish by working with Purdue and why I no longer do so.
In the late 1980s, I became aware of the undertreatment of patients with severe chronic pain. Following a groundbreaking paper and a series of randomized and controlled clinical trials, it was concluded that narcotics given to patients with no history of drug abuse could improve the lives of those with chronic pain without greatly causing or contributing to addiction. I started an office practice in the early 1990s, prescribing narcotics to people with severe chronic pain. It didn't work for everyone, but, for a good percentage, these drugs were highly effective.
Purdue Pharma took note of my growing expertise in the field. As the company prepared to launch several forms of narcotic pain relievers, including OxyContin, it offered to sponsor some of my talks at hospitals and continuing medical education events.
I wanted to help teach doctors who were getting very little training in pain management and to help patients who were in pain. I never underplayed the risk of addiction, always urging colleagues to carefully assess patients and to make certain other remedies had been tried first.
I'm proud of the role I played in making opioids more available to patients who need them by teaching doctors how to prescribe them carefully. Opioid pain relievers have helped thousands of Canadians suffer less pain and enjoy active lives. But I have watched with great dismay the rising tide of prescription drug abuse in general, and OxyContin in particular.
In recent years, I've seen doctors overprescribe opioids to patients without screening or monitoring them for addiction. I've seen doctors prescribe powerful narcotics in assembly-line fashion at walk-in clinics.
I no longer believe it to be possible for educational courses paid for by drug companies to be free of corporate bias. But the practice of recruiting and paying doctors to give company-sponsored talks is alive and well – and the practice doesn't end with opioid pain relievers. Blood-pressure pills, diabetes meds and cholesterol-lowering drugs are just some of the remedies for which doctors are recruited to influence their colleagues.
From my medical vantage point, I see a culture of indifference to the influence pharmaceutical money has on many of us. In the past few years, regulations have been strengthened to compel doctors to acknowledge that they have received funding from drug companies, but these rules don't go far enough. We need to make a difference by following the lead set by the United States, where Congress has passed a bipartisan measure requiring that physicians report payments by drug companies.
I call for legislators, drug companies and doctors in Canada to do the same. This should be the first step in changing a culture that's grown far too cozy with corporate interests, and restoring trust between doctors and patients.
Brian Goldman is as an emergency physician in Toronto and the host of White Coat, Black Art on CBC Radio One.