Just before President Jimmy Carter left office in January of 1980, a short letter to the editor appeared in the New England Journal of Medicine. Signed by Jane Porter and Dr. Hershel Jick of Boston University Medical Center, the last sentence of that letter contained what appeared to be reassurance: “We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”
At that time, there were no serious reactions or responses to the letter, which simply passed on the doctor's observations, based on clinical records. According to those observations, very few who had no previous history of addiction (four individuals out of the nearly 12,000 such patients reviewed) developed addiction issues from opioid analgesics.
Dr. Jick never implied that the danger didn't exist. Nonetheless, over the ensuing years, Big Pharma latched on to that letter, using it as an endorsement to support its claims that people could take opioids without having to worry about becoming addicts. Since the introduction of Oxycontin in 1995, the “Jick Letter” has been cited more than 600 times – and 70% of those references were used in marketing promotions, claiming low addiction risk for opioid use.
Big Pharma has its own modern version of 19th-Century traveling “medicine shows” and snake oil salesmen. For years, drug makers have been recruiting shills from the medical profession to travel the country in order to convince the medical profession of the safety and efficacy of opioid pain meds. Euphemistically referred to as “Key Opinion Leaders,” or KOLs,” these doctors, recruited from top medical facilities, receive healthy compensation for their services.
One such physician, anesthesiologist Dr. Russel Portenoy, has received payments from numerous pharmaceutical companies over the past several years, including Purdue Pharma, Mallinckrodt and Pfizer. He has appeared in major magazines and on television, having been dubbed the “King of Pain.” Although he had an apparent change of heart in 2012, admitting that he may have “overstated” the benefits of opioids while minimizing the risks, he is still invited to make presentations at medical conventions and meetings.
Another industry “biostitute” was Dr. Lynn Webster, who co-founded the Lifetree Clinical Research pain clinic in Salt Lake City, and has been investigated by the Drug Enforcement Agency. Dr. Webster, who has seen over 20 of his patients die of opioid overdoses, was paid nearly $100,000 by ten different pharmaceutical companies in 2015 alone – more than twice as much as he received the previous year.
Big Pharma's recruitment efforts have extended beyond the medical profession. In 2002, Purdue Pharma, one of the major defendants in ongoing opioid litigation, hired former NYC mayor Rudy Giuliani to help with the company's public image and reputation among officials. Then of course, there is the veritable army of low-level sales representatives, whose job it is to hold closed-door meetings with doctors and hospital staff members all over the US, giving thoroughly rehearsed product pitches and assorted gifts.
Despite these revelations and ongoing legal actions from state and local governments, opioids continue to be big moneymakers for the industry, generating hundreds of billions of dollars in revenue.
It is still unknown whether legal action will be successful in attempting to hold Big Pharma accountable for its role in the current opioid addiction crisis. However, Sam Quinones, author of Dreamland: The True Tale of America's Opioid Epidemic, is optimistic that a day of reckoning is coming. He says, “These lawsuits are a way of forcing the price of these pills to accurately reflect their true social cost on the communities where they are oversold and overprescribed.”