AMERICAN PAIN by John Temple

the drug did addict someone, and they began taking too much of it, or hoarding it to take all at once, or trying to obtain multiple prescriptions or early refills—then, that person was no longer taking it as prescribed . That person became one of the outcasts, an addict, and therefore the “safe when taken as prescribed” dictum remained valid. Purdue seemed to regard those folks as a tragedy of their own making. But the company affirmed that its responsibility was not to addicts who were abusing the drug, but to the untold millions of pain sufferers who needed it.
    Golbom wondered how many addicts had begun taking OxyContin under the care of a doctor. He came to realize that there was very little difference between heroin and opioid narcotics. Heroin had been stigmatized as a bottom-of-the-barrel drug, the destination of the dirtiest of street junkies. Whereas, “pain pills” had been systematically sanitized in the public’s mind. Even in the flood of news stories about oxycodone deaths, reporters and experts referred to prescription narcotics as if they were, at worst, a gateway to the hard stuff. As a pharmacist, Golbom could determine only two clear advantages OxyContin had over heroin as a recreational drug. One, OxyContin was legal. Two, it was pharmaceutical-grade—you knew exactly what was in it, unlike a bag of heroin bought on the street. Other than that, oxycodone addiction and heroin addiction were the same thing .
    Nevertheless, Purdue had inflated the market for opioids, and other pharmaceutical companies rushed to meet the demand. They copied Purdue’s OxyContin marketing techniques. They re-educated doctors about narcotics, hired “key opinion leaders” to promote the drugs, funded pro-opioid medical education courses, funneled money to seemingly independent patient advocacy groups, and professional societies. And the companies developed one new opioid narcotic after another, hailing each as a breakthrough.
    Cephalon promoted its berry-flavored narcotic lollipop Actiq for migraines, sickle-cell pain, and injuries, despite the fact that the FDA had approved its use only for cancer pain.
    Janssen Pharmaceuticals, Inc. promoted the narcotic Ultracet for everyday chronic pain, distributing posters to doctor’s offices that showed people in active professions with the breezy tagline “Pain doesn’t fit into their schedules.”
    Endo, maker of Opana, Percocet, and Percodan, distributed a patient education publication that said withdrawal symptoms and increased tolerance to narcotics are not the same as addiction. “Addicts take opioids for other reasons, such as unbearable emotional problems.” *
    The overall impact of the lollipops and posters and authoritative assurances was to create the impression that prescription opioids were like any other class of drugs—a life-enhancer like the erectile dysfunction pills or acid reflux tablets advertised on TV.
    The tactic of distinguishing between addiction and physical dependence was key to many of the feel-good campaigns. On their drug labels, the companies were required by the FDA to acknowledge that opioids are addictive narcotics that could kill. But the companies often left that information out of patient education materials. Brochures and websites often mentioned only the least scary side effects of the drugs, usually leading with constipation, which no doubt seemed a small price to pay for pain relief. The drug companies also highlighted drowsiness, confusion, nausea, and dizziness, among other mild complaints. And the side effects would probably go away in a couple of days, they assured.
    Janssen sponsored a multimedia patient education campaign called “Let’s Talk Pain,” which warned that strict regulatory control had made doctors fearful to prescribe opioids, leaving patients to suffer in pain: “This prescribing environment is one of many barriers that may contribute to the under treatment of pain, a serious problem in the United