On May 8, the Senate Finance Committee opened an investigation into financial and other connections between three opioid pharmaceutical manufacturers, medical groups and physicians who, according to a committee press release, had “advocated the increased use of narcotic painkillers, or opioids.” The committee issued letters requesting information from the three companies, Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson, and sent similar letters to seven medical organizations inquiring about their financial ties and collaborations with the pharmaceutical manufacturers. Responses to the letters were due by June 8.
Behind the committee’s action is what it calls in the letters, “an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers.” According to the press release, the committee is trying to establish whether the seven organizations “have promoted misleading information about the risks and benefits of opioids while receiving financial support from opioid manufacturers.”
Committee chairman Max Baucus (D-Mont.), one of two people who signed the letters, said in a statement: “When it comes to these highly addictive painkillers, improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk.” Co-signer and senior committee member Chuck Grassley (R-Iowa), said in a statement: “The problem of opioid abuse is bad and getting worse. Something has to change. A greater understanding of the extent to which drug makers underwrite literature on opioids is a good start.”
The medical groups that received letters from the Senate Finance Committee were the American Academy of Pain Medicine (AAPM), American Pain Foundation (APF), American Pain Society (APS), Center for Practical Bioethics, Federation of State Medical Boards (FSMB), Joint Commission and Pain & Policy Studies Group. In their letters to manufacturers, the senators asked about payments to these groups and to the Alliance of State Pain Initiatives, American Geriatrics Society and Beth Israel Medical Center, Department of Pain Medicine and Palliative Care.
Also under scrutiny were any payments from the manufacturers to the following individuals: bioethicist Myra Christopher as well as pain physicians Perry G. Fine, MD, Scott M. Fishman, MD, Rollin M. Gallagher, MD, MPH, Martin Grabois, MD,
Bill McCarberg, MD, Russell K. Portenoy, MD and Lynn R. Webster, MD. Additionally, the committee is seeking documentation about the development of various guidelines and other documents, including the book Responsible Opioid Prescribing: A Physician’s Guide, written by Dr. Fishman and distributed by the FSMB. None of the physicians were sent lettters and therefore are not expected to respond to the committee at this time.
The Alliance of State Pain Initiatives, AAPM, Beth Israel Medical Center’s Department of Pain Medicine and Palliative Care, Endo, Joint Commission, Pain & Policy Studies Group and Purdue Pharma did not respond to requests for comment.
According to a notice on its Web site, the board of directors of the APF voted to dissolve the organization on May 3, 2012, citing “irreparable economic circumstances,” just five days before the Senate Finance Committee’s letter was sent. The APF did not respond to email or phone inquiries.
In a statement, the APS said it would “cooperate fully with the members and staff of the U.S. Senate Finance Committee. … APS also looks forward to sharing with the Committee its strong advocacy for a sound policy approach to addressing the problem of abuse and diversion of prescription analgesic medications.”
John Carney, MEd, president and CEO, Center for Practical Bioethics, Kansas City, Mo., also said in a statement that his organization plans “to cooperate fully.” The American Geriatrics Society wrote: “The AGS does accept industry support for dissemination of our clinical recommendations and clinical guidelines and our policies and procedures for managing this support are robust.”
Humayun Chaudhry, DO, president and CEO of the FSMB, Euless, Texas, said in a statement: “We agree with the committee that the abuse and misuse of opioids is a serious national problem and will provide information requested by the committee as it addresses the issue.”
Jeff Christensen, manager of Product Communication, Janssen Pharmaceuticals, Inc., Raritan, N.J., a subsidiary of Johnson & Johnson, said in a statement: “Janssen Pharmaceuticals, Inc. is committed to the responsible prescribing and appropriate use of opioid pain medications.”
Steven D. Passik, PhD, professor of psychiatry and anesthesiology, Vanderbilt University Medical Center, Psychosomatic Medicine, Nashville, Tenn., who was not named in the investigation letters, commented by email: “The Senate Finance Committee is calling some prominent pain clinicians and researchers to task for their ties to opioid manufacturers. This is ironic given government’s ties to [political action committees] and industry. The doctors’ reputations will suffer by insinuation, even though they are researchers with high standards who took everyone else’s difficult patients when it would have been easier not to. Meanwhile, the legislators will enjoy the publicity they will get appearing to do something meaningful in the war on prescription drugs.”
Dr. Passik continued: “Lost in this climate are the pain patients. Exposure to opioids is necessary, but not sufficient, to cause addiction; also needed is a vulnerable person at a vulnerable time. With appropriate assessment, safer opioids, monitoring tools, and psychological and rehabilitative care, we can use opioids safely with many pain patients.”
Mr. Carney, Dr. Chaudhry, and Mr. Christensen reported no relevant financial conflicts of interest. Dr. Passik reported the following: Speaker: Cephalon, Janssen, Millennium Laboratories, Quest Diagnostics; consultant: Ameritox, Cephalon, Covidien, Endo, Janssen, Millennium Laboratories, Pfizer, Pharmacofore, Purdue Pharma, Quest Diagnostics; research funding: Covidien.
Drs. McCarberg, Passik and Portenoy are members of the Pain Medicine News editorial board.