Academics Profit By Making the Case for Opioid Painkillers

Some say conflicts of interest may muddle the balance of benefit and risk.

ByABC News
April 2, 2011, 11:45 PM

April 4, 2011— -- As an epidemic of narcotic painkiller abuse raged across America in 2006, researchers at the U.S. Centers for Disease Control and Prevention issued a medical journal report connecting deaths from those drugs to up to a 500 percent increase in prescriptions.

In that same journal, a couple of officials with a little-known group at the University of Wisconsin School of Medicine and Public Health took issue with the paper, issuing their own warning against any attempt to increase regulation of the drugs.

But the article from the UW group did not disclose that over the last decade or so, as this group advocated for greater use of narcotic painkillers, it had received about $2.5 million from companies that make those drugs -- with most of that money paid before they published their arguments defending the use of opioids, as a Journal Sentinel/MedPage Today investigation found.

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Fueled by a continuous infusion of money from the manufacturers of drugs such as OxyContin, the UW Pain & Policy Studies Group has been a quiet force in the effort to liberalize the way those drugs are prescribed and viewed in the U.S.

UW says the money comes with no strings attached and that the group's goal is to improve pain care and access to opioids worldwide. It says its mission is to "balance" international, national, and state pain policies and to achieve availability of pain medications while minimizing diversion and abuse.

But doctors in the addiction and pain fields say the UW Pain Group pushed a pharmaceutical industry agenda not supported by rigorous science.

"They ... lend credence to positions that benefit pharmaceutical companies and harm the public health," said Andrew Kolodny, MD, an expert on opioid addiction. "The only rational explanation for their mission is that their bread is buttered by big pharma."

The efforts of the UW group helped create a climate that vastly expanded unproven medical use of the often abused drugs, said Kolodny, chairman of psychiatry at the Maimonides Medical Center in New York City.

In addition, a review of records revealed personal financial relationships between drugmakers and two officials with the UW Pain Group. Those include helping a drug company win Food and Drug Administration approval for a new narcotic painkiller and working as speakers or consultants.

The narcotic painkiller industry's funding of the UW Pain Group is a unique twist on the drug and medical device industry's use of medical schools to sell more of its products, sometimes at the expense of patients.

In the past, Journal Sentinel/MedPage Today stories have documented how dozens of UW doctors had hired themselves out as promotional speakers for drug companies or were enriched by lucrative royalty and consulting deals with medical device makers.

At the same time, the medical school itself has pulled in millions of dollars in pharmaceutical industry money to sponsor courses for doctors that critics say have questionable educational value.

On several occasions financial relationships between drug companies and the Group were not disclosed in medical articles co-authored by group scientists, the Journal Sentinel/MedPage Today found.

By far the biggest chunk of money the UW Pain Group got was from Purdue Pharma, which in 2007 was accused by the U.S. Department of Justice of misleading doctors with the fraudulent claim that its narcotic painkiller OxyContin was less addictive, less likely to cause withdrawal, and less subject to abuse than other pain medications. Those claims, the DOJ said, had no basis in proof.

At the time, scores of deaths and an even greater number of addictions were attributed to the drug. The company and three of its executives pleaded guilty to various charges. Fines and restitution payments totaling $635 million were imposed.

Between 2000 and 2010, Purdue paid the UW Pain Group about $1.6 million, according to university records obtained by the Journal Sentinel/MedPage Today through an open records request.

Indeed, the UW Pain Group appears to have played a critical role in rapid growth of Oxycontin.

In 1996, David Joranson, MSSW, who is listed as the founder and distinguished scientist of the group, was vice chairman and co-author of a consensus statement from the American Pain Society and the American Academy of Pain Medicine. The statement suggested that opioids were safe and effective for chronic, noncancer pain and that the risk of addiction was low.