With the ongoing opioid crisis killing over 1,200 Philadelphians last year, a look back at history portrays drug crises coming in waves. Can we learn our lesson and potentially prevent the next one? Or is history doomed to repeat itself?
No one can discount that our current opioid public health crisis happened in large part because pharmaceutical companies were prodding doctors to write prescriptions for opioid painkillers. The drug companies, through their sales representatives, told medical professionals that prescription painkillers were safe and the risk of addiction was negligible. We were lied to.
Doctors are partly responsible for current circumstances. Not wanting their patients to suffer unnecessarily from pain, many doctors responded to those sales reps and prescribed painkillers. From 1999 to 2010, opioid prescribing in this country quadrupled, reaching staggering levels. In Philadelphia, one in three adults received a prescription for opioids in the past 12 months, and one in seven – or about 168,000 adults – is currently taking the drugs.
As a family physician who also runs an office-based opioid treatment program, I share in the challenges of caring for patients with chronic pain. I feel like few options exist, but also see the hardships when patients become dependent on opioids, may transition to heroin, and have their lives overtaken by addiction.
I've always made the conscious choice to be a "pharma-free" physician. I do so because of the notable evidence on the impact of gifts from drug companies on physician prescribing. Undoubtedly, many doctors heard pitches on the efficacy and safety of opioid pain medicines over a lunch or a dinner sponsored by a drug company. Some may even say that the route to a doctor's prescription pad was through their stomach.
Under pressure from lawsuits by scores of states and cities (including Philadelphia), the pharma industry may soon be backing off on this technique for opioids. However, we must be cautious about other drugs that can lead to future public health problems. For example, Philadelphia is seeing worrisome increases in sales of amphetamine, a potentially addictive prescription drug.
Learning from history, Council members William Greenlee and Cindy Bass have introduced a bill that would put commonsense limits on what the pharma sales reps could do. Under the bill, tactics to promote prescribing in the form of gifts are not allowed; however, there is no moratorium on evidence-based conversations or information sharing. The sales reps would have to send copies of their educational materials to the health department to ensure the integrity of information. The sales reps could no longer give out discount coupons for potentially addictive drugs, a past practice perhaps akin to a dealer giving someone a first bag of heroin for free in the hopes of hooking a person for long-term use.
The largest health systems in Philadelphia – Jefferson, Temple, and the University of Pennsylvania – already have internal policies that are similar to these regulations. And leaders of all of these health systems have endorsed the bill.
Of course, the pharma industry is lobbying City Council against it. Drug companies are arguing that they are already regulated by the Food and Drug Administration, which is sufficient.
Yes, those previous practices have occurred under current FDA regulations, but are they really working? Does a city not have a duty to protect its citizens?
The regulations outlined in the proposed bill are neither onerous nor unreasonable as a mechanism to promote public safety. Furthermore, they uphold the integrity and principles of the medical profession. The pharmaceutical industry should embrace it. Current regulatory failures caused a disaster in Philadelphia, and we, as a society, have been left picking up the pieces. It is the responsible thing to do to for Philadelphia – the big city hit hardest by the opioid crisis — to step in to prevent future public health crises.
Across the country, doctors and public health officials have been too slow to recognize and respond to our drug crises. We can't change that history, but we can put in place components of a preventive strategy to avoid the next one. This bill gives me hope that we as a society are learning our lesson for a healthier future for Philadelphia.