Roger Hanson: The problem with opioid painkillers

Prescription painkillers can cause big problems.
AFR

Prescription painkillers can cause big problems.

OPINION: The United States is in the grip of the worst drug addiction epidemic in its history. The main contributor to this epidemic is not the wayward youth one might imagine, but older people addicted to opioid prescription drugs used for pain relief.

In a recent Al Jazeera documentary, film maker Sebastian Walker investigated the scale and causes of this epidemic.

The figures are stunning. 17,000 people per year in the US are killed by overdosing on prescription drugs, that is one person every 30 minutes. The main culprits are the opioid drugs, oxycodone and hydrocodone.

An opioid is a drug, such as morphine, that resembles an opiate. Opiates are naturally occurring pain relieving chemicals which are the products of the opium poppy. In the words of Dr David Tauben of the University of Washington, the United States has been conducting a "population wide experiment" on the use of opioid drugs in chronic pain relief.

Dr Michael von Korff, a medical researcher, was the first to study the opioid drug problem and uncover the relationship between the drug companies and the Food and Drug Administration (FDA) whose job it is to approve drugs for the market.

Opioid drugs are big business for the drug companies, so the incentive to bring them to market is huge. At the same time the FDA is motivated to take action by the increasing number of people suffering from chronic pain, people of all ages involved in industrial accidents, road accidents and so on, but also from the growing demographic of the ageing population for whom chronic pain dominates their lives.

The high street physician, writing the prescriptions, is sandwiched between these two groups. Unfortunately the link between, the drug company, the FDA, the physician and the patient has proved to be unhealthy when it comes to opioid drugs. This is because these drugs are highly addictive and in many cases the prescribed doses have been inappropriate, excessive, and have led to addiction.

The US now has the disturbing situation where people far removed from the image of the stereotypical drug addict have become addicts. These people, unable to function without opioids, and forced to seek cheaper alternatives, by-pass the prescription system and go directly to the heroin dealers. Ambulance crews turning up to answer emergency calls in such cases often find a bag of heroin next to the body of the deceased patient.

Dr Gary Franklin of the Department of Labour and Industries in Washington State, was the first to raise the alarm over opioid drug prescriptions and was a key figure in demanding more stringent requirements on prescriptions.

As a result, the number of deaths in Washington State have decreased by 25 per cent since these stricter conditions were imposed.

The story became murkier when in October 2013 the FDA approved a much more powerful opioid drug, zohydro.

What makes this look decidedly questionable is that the decision to approve this drug was made despite the FDA's drug advisory committee strongly rejecting it. The drug companies were keen to portray the issue not as a prescription problem but as a medical issue associated with the individual patient.

Sebastian Walker points out in his documentary that since zohydro was approved in the US, 28 state attorneys have asked the FDA to reverse its decision and all six governors of the New England states where the problem is most acute, have asked for zohydra to be blocked.

Prescription opioid drugs are a worldwide problem with similar experiences as the US being reported in Canada, Australia and New Zealand.

Best Practice Journal (BPJ) NZ has published statistics that show the dispensing rate of oxycodone in this country has increased by 249 per cent between 2007 and 2011.

A survey of general practitioners, as  reported by BPJ, revealed that 72 per cent of the prescriptions for oxycodone issued in New Zealand were for secondary care, that is for the treatment of patients dealing with withdrawal from oxycodone after leaving hospital.

In the US, Dr Gary Franklin says he was first alerted to the problem when he noticed that many deaths were being reported in people whose medical records showed nothing more serious than lower back pain. It turned out that opioid drugs were being prescribed for minor ailments. Many of these patients were dead within three years due to overdoses.

The tragedy is that bad decisions on the dosage and applicability of  powerful opioid drugs, decisions made by the pharmaceutical companies, governments and doctors, have already led to many lives ruined by drug dependency.

 - Stuff

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