Pharma, Hospitals

Might opioid addiction be a symptom of our broken primary care system?

Investigative journalism lives in some unlikely places, such as on HBO’s “Last Week Tonight with John Oliver.” This week, host John Oliver — you know, a comedian by trade — took a deep look at the opioid epidemic in America.

John Oliver opioids

Despite the fact that our presidential campaign has turned into a tabloidesque reality show, some people are still out there digging for real news — and no, I don’t mean embarrassing old videos of Donald Trump or Hillary Clinton.

These days, investigative journalism lives in some unlikely places, such as on HBO’s “Last Week Tonight with John Oliver.” This week, host John Oliver — you know, a comedian by trade — took a deep look at the opioid epidemic in America.

The 19-minute segment got this healthcare reporter thinking about how opioid overprescription might have had its roots in the broken mess known as fee-for-service primary care. Insurance fraud also seems to be at play here.

Predictably, Oliver started out by pointing fingers at Big Pharma, particularly OxyContin manufacturer Purdue Pharma. Purdue was rather masterful in the 1990s in marketing OxyContin as a way for people to reclaim their lives from chronic pain, he explained.

The company also was relying on rather dubious science, according to Oliver. He debunked a 1999 Purdue claim that less than 1 percent of people who take opioids become addicted by noting that the statistic came from a letter to the editor in the New England Journal of Medicine.

“It wasn’t peer-reviewed and it was only about short-term use of opioids in hospitals, but it became the main source for that 1 percent claim,” Oliver said.

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Prescriptions for OxyContin soared around the turn of the millennium, perhaps in part because some physicians didn’t have the time to investigate the drug’s safety for themselves.

“Purdue’s overall message of a quick, easy cure for pain was very appealing, especially for primary care doctors who might only have 15 minutes to treat a patient,” Oliver said about 11 minutes into the segment.

In the early 2000s, it became apparent that a 1998 claim by a physician on the Purdue payroll that people may have been suffering from “pseudo-addiction” was dubious. Now we know that oxycodone — the active ingredient in OxyContin — and other opioid painkillers can be highly addictive.

Oliver didn’t put all of the blame on Purdue, though. He mentioned federal investigations of opioid makers Cephalon (now owned by Teva Pharmaceutical Industries) and Insys Therapeutics.

At least one Insys sales representative pleaded guilty to criminal fraud charges earlier this year for arranging kickbacks to physicians who prescribed Subsys, an Insys drug containing the fentanyl, the same opioid linked to the deaths of musicians Michael Jackson and Prince.

Subsys had been approved for use in cancer patients only, but Oliver showed a telling video interview from the Fusion cable network. In that interview, a former Insys employee talked about a sneaky way of convincing insurance companies to pay for the drug for people who didn’t have cancer.

“They would always ask, ‘Does the patient have cancer?'” the interviewee said. “‘Uh huh.’ That’s what we would say.” The former employee noted that she was careful not to say, “Yes.” (Oliver had fun with that little feat of verbal gymnastics.)

Lack of access to physical therapy in rural areas is another culprit in the opioid crisis, Oliver suggested. Even when alternative treatments might be available, insurance won’t always cover them.

There are a couple of parts of this video that might be NSFW, but if you’ve got headphones, you should be just fine.