Wed, 17 Jul 2019

Another Way In Which Patents Contributed To The Opioid Crisis: Hospitals Ordered Not To Use Better, Less Problematic Medicines

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Two years ago, we wrote about a stunning (and horrifying) study that explained how patents deeply contributed to the opioid crisis. It described the lengths that drug companies -- including OxyContin maker Purdue Pharma -- went through to block any and all generic competition. It was quite a story.However, on a recent episode of Terry Gross's "Fresh Air" she interviewed medical bioethicist Travis Rieder about his new book, In Pain. It tells the story of how, even as a "medical bioethicist," Rieder himself got addicted to opioids after being in a severe motorcycle accident -- and then was shocked to find that none of his doctors either knew how or cared enough to help him get off the painkillers. The story is fascinating -- and harrowing.Deep into the discussion, however, one part caught my attention. Rieder tells a story about how, rather than putting him on opioids, they could have just given him acetaminophen:

GROSS: One of the pain killers that you were given when you were in the hospital was intravenous acetaminophen. And you thought that that was really, surprisingly effective as a painkiller, but you were only given a few doses, even though you kind of begged for more more because it was effective and not habit-forming. So why couldn't you get more of it?RIEDER: Yeah, this is such a wild story. I didn't know for a long time, and so all I had was this immediate experience where, after that fifth surgery, when I was really behind the pain, the pain management team upped all of the doses of everything I was on, but then also gave me three doses over 24 hours of IV acetaminophen. And for me, the way I described it at the time, it was as good as morphine in the short term, but it didn't knock me out. It didn't sedate me. I didn't have to worry about my breathing. And so I really liked it for that reason, and I asked for more.And I remember one of the residents being kind of hesitant - you know, one of these young doctors in training - and kind of mumbling something about, I don't think you can have more because of your liver, or something. I didn't question it.

Months later, I'm an invited speaker at an anesthesiology conference, and I'm hanging out with some of the docs over a coffee break. And I'm telling them the story because I'm like, hey, I've got these, you know, really smart people. I'm going to pick their brains. And I get to the point where the resident mumbles this excuse to me, and they all chuckle. And I look at them, and I say, what? Is that not the reason? And I can tell in that moment that they all know something and that they all know that they all know. And one of them looks up at me and says, they're not giving it to you because it's too expensive.(Laughter) And my mind was blown. I was like, wait a minute - what do you mean it's too expensive? It's just Tylenol, right? They said, yeah, but the IV form is still on patent. And so once it goes off patent, it'll be standard of care because it works great. But, you know, for now, it's too expensive, so most of us have hospital orders not to use it.

I think what it started for me was a dive down the rabbit hole of, how does money play a role in how we treat pain and how we overutilize opioids for pain, right? Because what it made really clear is that opioids are dirt-cheap because a bunch of them have been off patent for decades, and that these other sorts of therapies can be really expensive.

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