What Might Unsealed Opioid Marketing Records Reveal?

Recently there’s been some insightful reporting by STAT (owned by Boston Globe Media) on marketing opioids.  In the true spirit of investigative journalism, they have filed to make public the testimony that a past president of Purdue Pharma had given to the Attorney General of Kentucky.  These records reveal could reveal how marketing practices contributed to the current epidemic of opioid dependence.  Purdue has appealed the decision to unseal the testimony, leaving observers to wonder what the deposition might contain that would be so damaging for the public to know about.  It could be many months before the contents emerge, if ever.

Shining a spotlight on marketing practices is a crucial step toward resolving the current opioid epidemic.  It might also reinforce the value of more socially responsible marketing in general.  Most attention is focused on the downstream consequences of accelerating opioid use- in terms of lives lost, and the role that physician-patient communication has played at facilitating substance dependence.  Upstream, manufacturer-physician communication is a key driver that has received comparatively less attention.  Purdue, in particular, spent heavily to promote oxycodone formulations for chronic, non-malignant pain. Therefore, it’s their marketing practices being singled out for public scrutiny.

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New Medical Guidelines for Treating Depression

Earlier this year, two leading physician organizations have published important recommendations for treating depression.

First, a guideline published in JAMA (Journal of the American Medical Association) recommends routine screening for depression among all adults who are seen in primary care settings. These findings are derived from a larger U.S. Preventive Services Task Force, a group of experts on prevention, evidence-based medicine and primary care.

Second, the American College of Physicians has issued guidelines (see video clip here) to help physicians and patients in selecting treatments for depression. These guidelines refer to cognitive behavioral therapy as a “reasonable first approach” that “should be considered as an alternative” for those individuals who are beginning treatment for depression.

These are important steps for a number of reasons.

One reason is that depression is often undetected. Although it is recognized as a widespread problem (with some estimates that more than 10% of US Americans are experiencing it at any time), the symptoms don’t just consist of feeling sad. It can be apparent as problems with concentrating, self-criticism, lack of fun, insomnia, physical complaints and other features. By identifying cases during routine healthcare visits it may be possible to help more people who are needlessly suffering. Read more…

Preventing Iatrogenic Addiction to Opioids Through Smarter Marketing

There’s been plenty of drama over the CDC guidelines on prescribing opioids for chronic non-malignant pain (CNMP). In the face of what has become an opioid epidemic, these are important steps for preventing abuse and addiction. However the proposed guidelines primarily focus on clinical encounters that are downstream of certain key influences that drive the opioid epidemic – ones that play out in how these products are marketed to physicians. There are critical antecedents upstream, found by examining the manufacturer-physician interaction. Smarter marketing might have averted this problem, and also enabled manufacturers to avoid the public quagmire they’re finding themselves in over their opioid products. It may also help to reduce abuse, addiction and overdoses.

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