Opioids, pain and the power of marketing

I have a love-hate relationship with Big Pharma, as I am sure many other health professionals do. Pharmaceutical companies develop, manufacture and distribute important medications that have been beneficial for thousands of people globally.

But these companies also profit from their billion-dollar industry.  And some have dodgy work practices particularly in terms of burying clinical evidence and downplaying their profits. The cost of medicine is high – to patients, taxpayers and health systems.  Big Pharma defends the prices as necessary to underwrite the research and development (R&D) costs of new products. But this argument has been debunked by economist Mariana Mazzucato.*

Empire of Pain by Patrick Radden Keefe is more than an exposé of one such company, Purdue Pharma.  It is the story of a family that grew extremely rich primarily due to one prescription medicine, the opioid OxyContin.  This book is well-written in a narrative format that made me go ‘wow’ every so often.  The scale of the opioid crisis is described in vivid detail.  

I have prescribed opioids and I have been prescribed them post-operatively. Opioids have a role in treating acute pain and cancer pain, but we now know that they are unsuitable for the management of most chronic non-cancer pain.  The Sackler family was instrumental in pushing (and I deliberately use this word) for opioids to be prescribed for chronic pain – a large market in the United States for which there was a lack of effective medication.  

The company’s sales pitch was that an opioid prescribed by a doctor to a person in pain was not addictive, even in the large doses the company recommended. And the doses were large.  Sales representatives were given bonuses based on the volume of medicine they manipulated doctors into prescribing.  But some doctors were also culpable and did not monitor patients for poor outcomes.  If the patient did become addicted, it was the patient’s fault because of an addictive personality. Overdoses? Blame the patient. OxyContin being sold on the street? All the addicts’ fault. 

Purdue Pharma did not base its claims of non-addiction with medicinal use on any evidence from clinical research. The Sacklers, even on their downfall just a few years ago, have never admitted any guilt for the misery they caused worldwide. 

The stigma of the drug-seeking opioid user has been pervasive.  It can be difficult for a health professional to trust any person asking for opioids.  It is hard to be compassionate even when that patient may have become dependent because of a first prescription issued in good faith. 

We now refer to dependence instead of addiction to reduce emotive language.  Much more is known about the adverse effects of opioids and many countries are monitoring their use more extensively. 

I was part of a team that worked on this video for consumers developed by NPS MedicineWise and the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (ANZCA). It provides information to people who may be considering taking opioids for chronic (ongoing) non-cancer pain.


Empire of Pain by Patrick Radden Keefe, Picador, 2021

* The value of everything by Mariana Mazzucato, Allen Lane, 2018

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