Free AMERICAN PAIN by John Temple

to OxyContin, even if they took heavy doses of it for a long period of time. This was no easy task, since it directly contradicted thousands of years of human experience with opiates.
    The company found and cultivated “key opinion leaders,” usually doctors who were already promoting the idea that pain was undertreated and that narcotics should be more liberally prescribed. Researchers like Dr. J. David Haddox, who helped coin the term “pseudoaddiction.” Pseudoaddicts, Haddox said, were pain patients who displayed common drug-seeking behaviors: demanding specific drugs, hoarding drugs, seeking early refills, taking higher doses than prescribed. Pseudoaddiction looked a lot like addiction, Haddox said, but it wasn’t addiction. Those patients simply needed more pills. The counterintuitive concept was based on a case study of a single cancer patient, and it hadn’t been backed up by rigorous studies. Nevertheless, Purdue seized upon the new word—pseudoaddiction—and liberally sprinkled it throughout educational materials. The company also hired Haddox and made him a top executive.
    Purdue poured millions of dollars into organizations like the American Academy of Pain Medicine, the American Pain Society, and the American Pain Foundation, and those organizations backed or promoted the work of pro-opioid researchers. Some researchers dug up obscure and largely inapplicable nuggets of scientific data that seemed to support a pro-opioid hypothesis, then published and republished that data. One Purdue-funded study claimed that “psychological dependence or addiction is low” for chronic pain patients on narcotics. The Purdue study cited a single article from the prestigious New England Journal of Medicine . It didn’t mention that the “article” was a letter to the editor, published in 1980, and that its conclusions were based on a simple review of the charts of hospitalized patients, not a scientific study of long-term narcotic use.
    But the idea was out there, published in a scientific journal: Fewer than 1 percent of pain patients would develop addictions.
    Armed with this seemingly legitimate number, Purdue got to work.

    Suddenly, in the late 1990s, news stories about pain began to appear. Profiles of chronic pain sufferers who couldn’t get narcotic prescriptions due to doctors’ fears of addiction. Trend pieces about the prevalence of pain and its undertreatment. Purdue officials themselves were rarely mentioned, but the stories were peppered with quotes from Purdue-backed consultants and researchers and doctors. The stories created the general impression that tens of millions of Americans were suffering in needless pain.
    Many of the stories were planted by groups like the American Pain Foundation. The foundation claimed to be a patient advocacy organization, but 90 percent of its money came from the drug industry, including big grants from Purdue. The foundation acted as a front for Purdue and other drugmakers, advancing pro-opioid policies in ways that the companies themselves could not. The foundation funded pain management web talk shows, published policy guides that plugged narcotics, and marshaled pain patients to send angry e-mails to reporters, prompting news stories about the stigma they had faced when seeking medication. It was a smart move, Golbom believed, because it created the impression that anyone who questioned the escalating use of prescription narcotics lacked empathy for people in pain. Only a heartless clod wanted to deny people in pain the medications they said they couldn’t live without.
    Similar stories originated from new “grassroots” regional pain advocacy organizations that had sprung up, such as the Appalachian Pain Foundation, based in Huntington, West Virginia, which received a $20,000 grant from Purdue shortly after it formed in 2000. * The foundation arranged a series of meetings in Kentucky and West Virginia to spread the word among local doctors that opioids were