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Last updated: Wed, Jun 26, 2024
Conservative provocateur Rush Limbaugh seems a strange poster child for the dangers of prescription pain meds. Nevertheless, he turned himself in to Florida authorities as a long-time addicted user of illegally-obtained prescription pain pills.
Ronald Reagan's market liberalization program of the 1980s didn't neglect oversight of the pharmaceutical industry. The FDA's approval process for prescription drugs was "expedited" in the 80s, in part owing to pressure to make treatments available for AIDS patients. Tracking of adverse drug reactions by the FDA was stopped. Direct-to-consumer advertising of prescription drugs was allowed for the first time.
The pharmaceutical industry introduced a raft of highly-touted pain drugs during the 1980s and 90s, including both narcotic and non-narcotic medications. These included Bextra, Vioxx, Celebrex, Oraflex, and, most infamously in the pain world, OxyContin (generically, oxycodone). OxyContin, as it was introduced, was an opiate drug (formerly sold in another form as Percodan) in an extended-release form. Because of its extended-release delivery, it was marketed to both doctors and patients as less-addictive than existing opiates.
Diversion of medical drugs into the black market was a recognized problem as early as 1990. This included not just prescription opiates, but also pseudoephedrine, an ingredient in many over-the-counter cold/congestion medications, which was used to manufacture methamphetamines. A Connecticut law enforcement official in 1994 estimated that as much as 30% of drug abuse involved diverted medications.1 OxyContin acquired the sobriquet "hillbilly heroin" when it became the narcotic of choice for users in the Appalachian region, many of whom were unemployed middle-aged males. Street users had worked out that OxyContin could be crushed and injected to provide rapid delivery to the brain, a fact that the FDA (and ostensibly Purdue Pharma, OxyContin's owner) had whiffed on.
U.S. prescriptions for OxyContin increased from 300,000 in 1996 to 6,000,000 in 2000, while revenues increased from fify million dollars to one billion dollars. OxyContin accounted for 80% of Purdue Pharma's revenue in 2001. Law enforcement was aware that medical drugs were showing up on the street in large numbers and didn't know what channels they followed to arrive there. Nevertheless, they were convinced that a major route to the street passed through doctors' offices. Doctors were prosecuted for running "pill mills," and "doctor shopping" (obtaining pills from more than one physician) became a crime.
In 2001 and 2002 deaths from medical pain pills exceeded those from heroin, making these pills public enemy number one in the eyes of the DEA. This was, at that time, largely an American problem. A 2008 United Nations report indicated that 90% of worldwide consumption of pain medication occurred in Europe and North America. In 2007, Americans consumed 99% of the world's legal hydrocodone and 83% of its oxycodone (the ingredient in OxyContin).2 Congressional hearings were held. In 2001, West Virginia sued Purdue Pharma in an attempt to recover costs that it claimed were caused by overprescribing of OxyContin. This suit was settled in 2004 for ten million dollars.
While diverted narcotic pain medicines caused addiction and death among illicit users, Celebrex and Vioxx, non-narcotic Cox-2 inhibiters used to treat arthritis, were found to cause heart problems in their users. In the absence of legal requirements to report these problems, this information was slow in reaching doctors and patients. This lead to a flurry of court cases, followed at a short lag by calls for "tort reform."
Purdue Pharma and three of its executives were tried in 2007 for misleading the world about the addictive potential of OxyContin. This resulted in fines of $645 million, most of which was assessed against the company. Merck, the owner of Vioxx, was the big loser, finally making five billion dollars in settlements, and Pfizer, the owner of Celebex and Bextra, was finally liable for $894 million in settlements. The Senate, in a 93-to-1 vote, established a post-release reporting system for negative drug effects.
While narcotics were easily available on the black market, research during this period reconfirmed problems delivering appropriate pain treatment in the medical system. A 1994 study of emergency room practice found that white patients received stronger pain relief than did Latino patients for comparable injuries (long-bone fractures), while a similar 1995 study found a similar discrepancy between white and black patients. Additional studies found rather complex discrepancies between treatment of men and women in pain. None of these studies was able to determine the underlying causes of the discrepancies: bias among care providers, cultural differences, communication barriers, or something else?3 Keith Wailoo comments:
In the 1990s, the new question was how these issues of identity could drive overtreatment for some and undertreatment for others. The answer was that minority people in pain and women in pain...were subject to an extra level of surveillance, because to provide pain relief was still, as it was in the nineteenth century, an act of policing boundaries of acceptable behavior and identity.4
Limbaugh saw himself as the victim of the manufacturers and of an over-reaching government, and an intended victim of the liberal conspiracy. The state governments had violated his privacy rights by accessing his medical records. His addiction was not, could not be, a problem beyond his own strength. He resumed his radio career after a stint in rehab.5
Senate hearings in 2012 revealed that Purdue Pharma and other pharmaceutical firms had provided large amounts of financial support for pain advocacy groups and other groups involved in medical care for pain, including the American Pain Society, the American Pain Foundation, the American Academy of Pain Medicine, the Federation of State Medical Boards, the University of Wisconsin's Pain and Policy Study Group, and the Joint Commission on Accreditation of Healthcare Organizations. Committe members charged these groups with using this support to disseminate materials that exaggerated benefits and minimized risks of narcotics use for pain management.6