Getting Tough on Opioid Marketing

Chicago sets stage for stricter standards
By Scott Warner

In what could serve as a model for other drug makers, Pfizer, the world’s second-largest drug company, has agreed to a written code of conduct in Chicago for the marketing of opioids. On July 6, Mayor Rahm Emanuel announced the breakthrough agreement with the pharmaceutical giant that will commit the company to strict standards for the marketing and promotion of prescription opioids, and ideally help curb the use of these addictive painkillers.

By way of background, in June 2014, the City of Chicago filed a lawsuit against five pharmaceutical manufacturers for misrepresenting the benefits of opioids and concealing the serious health risks associated with these drugs. In the lawsuit, the city claimed that in 2009, approximately 1,100 emergency room visits were due to opioid overdose or misuse. The city also contends it paid out more than $12 million in insurance claims for painkiller prescriptions between 2008 and 2015. And in 2015, Chicago had 84 fatal overdoses due to prescription opioid painkillers.

OxyContin Manufacturer Targeted

The lawsuit sought to end deceptive marketing so that patients and physicians are able to make informed decisions about when and how to use these highly addictive drugs. While the original lawsuit was dismissed last year, the city filed an amended complaint this past fall that gave 326 pages of specifics about Chicago’s costs related to painkiller abuse, and the drug companies’ marketing practices. Among the targets of Chicago’s lawsuit was Purdue Pharma, manufacturer of OxyContin, a painkiller that was touted to reduce the risk of addiction and abuse. Years earlier, Purdue pleaded guilty to criminal charges of making misleading statements to regulators, the public and physicians about the drug’s addictive qualities.

Pfizer, which was not named in the lawsuit, has cooperated with the city’s investigation and litigation, providing documents and other evidence relevant to the city’s claims against other manufacturers of opioids. According to Stephen Patton, Chicago’s corporation counsel, Pfizer is “a company that has agreed to embrace what we think are the common-sense proscriptions that we are seeking as part of our lawsuit.” Patton also says that Pfizer’s action sets it apart from companies that have been accused of fueling an epidemic of opioid misuse through aggressive marketing of their products.

Was Agreement a Breakthrough?

Patton maintains that some opioid manufacturers are still using deceptive tactics and are spreading their message more subtly, and often through third parties. However, the city’s recent agreement with Pfizer hopes to curtail such practices.

While the Mayor’s office hailed the agreement as a breakthrough, some industry experts are saying that Pfizer is already bound to these practices that are part of existing regulations and laws that currently govern drug marketing. Pfizer is currently working with Eli Lilly on the development of a possible safer alternative to opioids, an injectable painkiller that would be administered every eight weeks. Now in late-stage testing, the injectable drug would be used to treat chronic pain resulting from a range of conditions such as osteoarthritis and cancer. Pfizer is seeking regulatory approval for the injectable drug by 2018.

Currently, the Chicago Department of Public Health (CDPH), is relying on Pfizer to assist the city in educational efforts about opioids and the proper disposal of unused opioid prescriptions. “Opioids have caused a public health epidemic that has affected patients, their families and entire communities, and education is key to preventing other forms of abuse,” said CDPH Commissioner Julie Morita, MD. “We look forward to working with Pfizer to help keep residents of Chicago fully informed about the risks associated with the use of these painkillers.”

From Opioid to Heroin

Health officials further point out that many patients who receive a valid prescription for an opioid painkiller not only become addicted, but may also turn to heroin because it is cheaper and easier to access. A recent study found that heroin use among those who misuse or abuse opioid painkillers has increased, with many people reporting abuse or misuse of these drugs before starting heroin.

By dramatically increasing the market for opioids, drug companies have also created a supply of drugs that are diverted to people to whom they are not prescribed. In fact, more than three out of four people who misuse prescription painkillers use drugs prescribed to someone else.

Nationwide, nearly 165,000 people have died from overdoses of prescription narcotics since the year 2000, according to the Centers for Disease Control and Prevention. The CDC estimates that 2.1 million people are addicted to prescription painkillers. “We are waking up as a society to the fact that these are dangerous drugs,” CDC Director Tom Frieden, MD, said in an interview. “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.”