For a city ravaged by deaths from prescription painkiller abuse and drug overdoses, a proposal to scrutinize how pharma companies promote their drugs to doctors in Philadelphia seemed like the right thing to do.
Still, sponsors Bill Greenlee and Cindy Bass pulled their bill from City Council consideration last week, after it ran into what Health Department spokesperson James Garrow called “intense lobbying” from unexpected opponents in the city’s tourism industry, in addition to aggrieved drugmakers.
It had been “an anticipated up-or-down vote” on bill 180888, but the sponsors backed off after “last-minute public comments,” says Christopher Molineaux, chief executive of Life Sciences Pennsylvania, an industry lobby.
Council stepped back “amid furious lobbying by opponents,” including hotel and restaurant operators scared they will lose doctors' and drugmakers' convention business, correspondent Ed Silverman wrote in Stat, the Boston-based life sciences news site.
The law would limit drug reps from giving gifts to doctors, which Philadelphia’s teaching hospitals already ban. It would also require sales reps to buy licenses, ban drug discount coupons, and force the reps to drop off copies of their sales materials with the health department for review and criticism — though the city would lack the power to force changes in those materials, sponsor Greenlee pointed out afterwards.
The bill, which passed the public-health subcommittee Nov. 30, was up for a full Council vote on the last legislative day of the year before its sponsors backed off in the face of hostile fire.
Later, Mayor Kenney defended the proposal as “one component of our citywide response to hundreds of deaths” from prescription-drug overdoses in recent years, and called for “a right-size legislative solution," a sign the liberal Democratic administration may agree to more changes but will still push a bill next year.
Molineaux said his members look forward to further discussions with the city administration on ways to meet what he said was their shared goal of limiting drug abuse.
"This bill doesn’t go after just the opioid manufacturer, it includes every pharmaceutical company,” and that threatens to drive drug and medical conventions away from Philadelphia, complained Melissa Bova of the Pennsylvania Restaurant and Lodging Association at the hearing, according to Stat’s account.
Philadelphia has been a medical center since Colonial times, though drugmakers like GlaxoSmithKline have mostly moved their operations to the suburbs, especially the U.S. Route 202 corridor in Montgomery and Chester Counties, Pa., and New Castle County, Del., as well as along U.S. Route 1 and in the leafy suburbs north of Princeton.
The city has joined other states and local governments suing opioid drugmakers (including units of Stamford, Conn.-based Perdue Pharmaceuticals, New Jersey-based Johnson & Johnson, and Chester County-based Endo Pharmaceuticals, among others) and drug distributors (such as Chesterbrook-based AmerisourceBergen) in hopes of proving damages and winning fat legal settlements to help defray the costs of treating and burying many thousands of prescription-drug abusers.
As if forgetting the wave of addiction and deaths that followed the earlier adoption of Percodan and other opium-based painkillers in the 1960s and 1970s, drugmakers like Endo, J&J, and Perdue Pharmaceuticals, aided by Wall Street investment bankers eager to finance aggressive new painkiller sales forces, began urging doctors to prescribe a new wave of powerful and heavily addictive painkillers such as Oxycontin and Opana, starting in the 1990s.
Soon doctors were prescribing addictive medicines for routine back, dental, and sports-injury-related pain, among other conditions. Some users became addicted; others who never received legal prescriptions became adept at accessing the legally-obtained pills from corrupt doctors, pharmacists, friends, and family members, and specialized dealers who sold prescription pills, along with dangerous synthetic substitutes such as China-made fentanyl.
After thousands of fatal overdoses, as public-health professionals and the Drug Enforcement Agency and police reported the resurgent problem, the FDA belatedly began tightening painkiller guidelines. Doctor groups, drug distributors, and manufacturers blamed each other and those addicted to drugs for the problem.
The government says fewer opioid prescriptions have been written in recent years. But Philadelphia officials say they don’t trust the FDA or drugmakers to protect city residents from the next round of destructive medicine over-promotion.
“The thing we just wanted to keep emphasizing is this is not just about the opioid crisis,” Greenlee told me. “The bill is to get ahead of the next over-addiction crisis, or the one after that.”
I understand why you don’t trust drug companies, medical providers or the federal government to do the right thing, I told him. But can Philadelphia really expect registration and review policies to reduce drug abuse? And don’t lawmakers believe hotel and restaurant owners when they say they are worried that they will lose a lot of business when the medical industry sees the city as unfriendly?
“The threats, I don’t know if they are real or not,” Greenlee said. And, the bill has already been amended to ensure conventioneers won’t be forced to register, even if they sell drugs back home. The continued threats “bother me. It says they are trying to hold us hostage.” Which would more or less describe how both sides claim to feel.
He added that representatives of the Temple, Penn, and Jefferson medical schools had all expressed support for provisions of the bill, though the Philadelphia County Medical Society — the doctors’ leadership group — has weighed in against it.