Congress Boosts Rehab but Gives Opioid Pushers a Pass

Lawmakers on Capitol Hill are proudly touting recently passed measures to address the nation’s growing heroin and opioid crisis, but the legislation may have handed the drug companies at the center of the epidemic a major victory.

The legislation focuses on treating addiction and does nothing to limit the role of pharmaceutical companies in fueling the opioid crisis. In fact, it instructs the federal government to review and potentially undo sweeping new guidelines that recommend less prescribing of highly addictive opioid painkillers such as OxyContin, Percocet, and Vicodin.

The review panel would be made up of a range of stakeholders including pain management groups, many of which are financially tied to the drug industry.

Four out of five people addicted to heroin began using it after trying prescription opioid painkillers, which provide a similar high. Investigations have found that drug companies orchestrated much of the epidemic by promoting claims that opioids are not addictive and by financing third-party groups that promote opioid painkillers for minor pains, such as toothaches.

Now the boldest effort to curb the flow of legal opioids may face a setback.

The Centers for Disease Control issued new guidelines in March to encourage doctors to prescribe opioids with low dosages, and only after other pain relief treatments, such as ibuprofen, have been tried. Since the voluntary guidelines were first leaked online last year, the drug industry has reacted furiously, even convening regularly in Washington to discuss how to derail the proposal. A legal group funded by the makers of OxyContin threatened the CDC with a lawsuit.

The legislation, which passed the House and Senate and is currently in conference committee, calls for the prescribing guidelines to be reviewed and potentially changed by a new panel made up of representatives from a range of stakeholders, and for the revisions to incorporate “pain management” expertise from the “private sector.” The legislation calls for the task force to be convened by the end of 2018, and for it to issue a report within 270 days.

“We must make sure that these guidelines are updated and reviewed regularly,” said Rep. Susan Brooks, R-Ind., who co-sponsored one of the House bills now being merged with the Senate version, which contains similar language instructing a new panel to review the guidelines.

The demand for pain advocacy and pain specialists to review the CDC guidelines comes as recent reports show that the leading societies for pain management have been funded and controlled by painkiller companies for years.

One leading pain advocacy group, the Pain Care Forum, is funded and largely controlled by Purdue Pharma, the makers of OxyContin. According to a report from the Associated Press, the Pain Care Forum organized a lobbying campaign last year to defeat the CDC guidelines.

A complaint filed by the city of Chicago found that Burt Rosen, the chief in-house lobbyist for Purdue Pharma, has used pain advocacy groups like the Pain Care Forum to advance his company’s agenda. The complaint alleges that Rosen instructs the Pain Care Forum on “what to do and how we do it.”

The American Pain Foundation, another leading pain advocacy organization, shut down after a ProPublica investigation found that the group received 90 percent of its funding from the drug and medical device industry, and had regularly advocated on behalf of painkiller companies.

The push for a panel to review and modify the CDC guidelines can also be traced to the drug industry.

Endo Pharmaceuticals, the makers of Percocet, retained registered lobbyists who have worked to influence Brooks’s legislation, which is co-sponsored by Rep. Joe Kennedy, D-Mass., according to disclosures.

Advocacy groups backed by the drug industry have also pushed against CDC guidelines.

“Rep. Susan Brooks’s bill would create a more transparent and inclusive process for the development of best practices in pain management and prescribing pain medications than the CDC used in formulating its opioid prescribing guidelines,” says Michael Barnes, the executive director of the Center for Lawful Access and Abuse Deterrence (CLAAD). Barnes is also the managing attorney at a D.C. law firm that specializes in helping drug companies with “legislative and regulatory strategies.”

Earlier this month, Barnes gave a presentation to state legislators in which he decried the CDC guidelines as “affiliated with anti-opioid activists” and praised Brooks’s legislation to create a new process. Barnes’s CLAAD has received funds from Purdue Pharma and Endo.

Dr. Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing, dismissed the arguments from CLAAD, calling it a “front group for pharma.” Kolodny said that industry-funded groups like CLAAD “argue that efforts for more cautious prescribing, such as the CDC guideline, are bad for patients with pain” but that “their real agenda is to continue reaping profits from aggressive prescribing.”

As the CDC has reported, 78 Americans die every day from opioid abuse, and the U.S. has become the center of the world opioid market. Despite the U.S. accounting for only about 5 percent of the global population, Americans consume almost all of hydrocodone products, such as Vicodin, and nearly 81 percent of global supply of oxycodone products, such as Percocet.