New York (AFP)
In 2002, Andrew Kolodny, an intern in psychiatry, attended a training session on pain management in Philadelphia. Seventeen years later, he still has not recovered from the enthusiasm of the speaker, a leader, for opiates.
"He told us that it was perfectly normal to prescribe opioids aggressively and that the risk of addiction was low," recalls Kolodny.
Dr. Thomas McLellan, a renowned expert in the treatment of pain, had exposed, with a small film, a case study: a patient suffering from back pain.
The patient, he told the doctors present, had received a high dose of OxyContin, a pain reliever manufactured by Purdue Pharma. But he asked for more because the pain was atrocious.
When the film stopped, Mr. McLellan asked them for their diagnosis. "For me and for many others in the room, it was obvious that the patient had become dependent," recalls Mr. Kolodny, who is now head of the opiate research center at Brandeis University. Boston.
"But to my surprise, the speaker told us that it was not really addiction but a + pseudo-addiction + and that we were supposed to give him more opiates." He used the concept of + pseudo -addiction + that Purdue Pharma and other laboratories put forward to promote opiates ".
Recommendations from prominent doctors paid by Purdue Pharma, misleading marketing, controversial business practices: OxyContin, an analgesic drug similar to morphine, was launched in the US market in 1996 with a promotional campaign sweeping away years of caution against opiates, previously reserved for serious diseases because of their addictive nature.
It is because of the unprecedented promotion of this prescription-only drug that Purdue and the Sackler family, the lab's owner, now face more than 2,300 complaints in the United States, accused of helping to trigger the American crisis of opiates.
A crisis that has made more than 300,000 deaths by overdoses since 2000, according to figures released in October, and more than 130 deaths a day still today.
- FDA disputed green light
The origins of OxyContin, which generated more than $ 35 billion in sales for Purdue, date back to 1990: the Connecticut-based lab is looking for a successor to its successful pain reliever, MS Contin, a drug-based drug. morphine used primarily in diseases such as cancer, but under increasing competition from generics.
Purdue then develops a painkiller from oxycodone, a semi-synthetic opioid first developed in Germany in 1916, with effects comparable to MS Contin.
Purdue's main argument against the risk of dependence already known opiates: the beneficial effects of the new drug would last 12 hours, double the other drugs of the same type, limiting the intake of tablets and the risk of dependence.
Yet, prior to commercialization, tests had shown that the effects were shorter, revealed in 2016 a survey of the Los Angeles Times.
In December 1995, the US Drug Certification Agency, the Food and Drug Administration (FDA), authorizes the commercialization of OxyContin for the treatment of moderate and severe pain, well beyond cancer or other serious diseases .
"At the time of approval, the FDA was of the view that the controlled formulation of OxyContin would lead to fewer potential abuses because the drug was expected to be slowly absorbed and there would be no immediate euphoria" , justified an FDA spokesperson at AFP.
The green light from the FDA will be further criticized as Dr. Curtis Wright, who oversaw the committee that authorized OxyContin, joined Purdue's board in 1998.
Another troubling development: once the drug is marketed and promoted, OxyContin will generate a black market that Purdue is accused of ignoring or minimizing for a long time.
Quickly, quantities of pills are diverted and powdered, inhaled to multiply the euphoric effect, according to a confidential report of the Ministry of Justice quoted by the New York Times in 2018. Pills are stolen in pharmacy, doctors prosecuted to have "sold" prescriptions of the drug.
The 80 mg tablets, the most common, are trading between $ 65 and $ 80 on the black market, against $ 6 in pharmacy, according to several doctors interviewed by AFP.
- Explosion of sales
Despite these warning signals, Purdue will continue to present OxyContin as a less addictive opioid than others.
The budget for newspaper campaigns has increased from $ 187,500 in 1996 to $ 4 million in 2001, according to internal documents.
Purdue also opens a consulting "office" of high-paying, well-known doctors to tout the "miracles" of opiates.
And sales are exploding. For the year 1997, Purdue was expecting sales of nearly $ 80 million, according to an internal document. In 2001, they reached 2.1 billion.
Purdue has also enrolled the American Academy of Pain Medicine (AAPM) and the American Pain Society (APS), two organizations specializing in the treatment of pain and composed of health professionals, in its opiate destigmatization campaign.
Both organizations were funded by Purdue, and several of their members were working as consultants for the laboratory. Evidence of close ties between them, Dr. David Haddox, who chaired an APS committee that validated increased opioid use, was hired by Purdue in 1999, and was still working there in the spring of 2019.
While Purdue's promotional efforts appealed to doctors, Gregory Terman, director of the pain center at the University of Washington, who presided over the APS from 2015 to 2017, said it was partly because of the lack of importance that health officials at the time gave to pain.
"Until the opiate crisis, the NIH (National Institutes of Health) had never spent more than 1% of its budget on pain, yet one of the main reasons people go to the doctor, not to mention chronic pain that affects more than 100 million Americans, "says Dr. Terman.
Prosecuted for its role in the promotion of opiates, the APS filed for bankruptcy in late June, strangled by legal fees.
Keith Humphreys, professor of psychiatry at Stanford, adds: "GPs have minimal training on addiction or pain, so many of them believed in Purdue's promises."
- Judicial trouble starts
In 2006, the medical profession awakened to the dangers of OxyContin, after the publication of an article by Dr. Leonard Paulozzi of Centers for Disease Control and Prevention (CDC), reporting a 91% explosion of deaths related to opioid pain medication between 1999 and 2002.
In 2007, for the first time, Purdue Pharma and three of its executives pleaded guilty in Virginia to cheating doctors, patients and regulators of the risks of OxyContin addiction and abuse, and agree to pay a total of $ 635 million in fines.
If Purdue then sees its legal troubles in the United States multiply and OxyContin sales fall in the country from 2010, the company, through its international subsidiary Mundipharma, then turns to other parts of the world.
In Europe, where the legislation prohibits all advertising for medicines aimed at the general public, Mundipharma has broadcast in Spain, from 2013, a commercial spot drawing the public's attention to chronic pain, encouraging them to consult and ask for information. treatments.
Questioned, Mundipharma assured "no longer conduct this type of activity today," according to a spokesman.
The group funded opiate promotion seminars with doctors in other countries, including Brazil and China, revealed the late Los Angeles Times in late 2016.
Joseph Pergolizzi, a Florida doctor quoted by the newspaper as having intervened on behalf of Mundipharma in 2016 in Brazil, nevertheless rejected any misleading marketing charge.
"I was invited to a conference on the treatment of severe pain related to cancer (...) and my intervention was about the different options that patients have," he told AFP, adding cut the bridges with Mundipharma two years ago.
- Purdue in bankruptcy
Contacted by AFP, Purdue Pharma did not wish to comment. The lab regularly reiterates that Oxycontin is just one of the many opioid drugs on the market, and is now actively fighting against the misuse of OxyContin and all similar drugs.
Since mid-September, he has been under the protection of the US bankruptcy law and proposes to the states and local authorities who sue him to transform Purdue into a "trust", whose future revenues would go to finance the efforts to stop the opiate crisis.
The lab is proposing to eventually transfer to the plaintiffs the equivalent of $ 10 billion to $ 12 billion - including $ 3 to $ 4 billion from the Sackler family, according to the Wall Street Journal - by dropping all lawsuits against him.
But nearly 25 states, including New York, have so far rejected this proposal, saying the offer insufficient to deal with the "ravages inflicted on the American people," said in September Letitia James, attorney general of the State of New York.
© 2019 AFP