Twenty years ago, the drug company, Purdue Pharma, introduced a prescription opioid it advertised as safe. It was Oxycontin. Opioid prescriptions given to elementary and high school students have been linked to an increased risk in illegal drug use among young adults, and overdose deaths have reached record highs every year for the last 15 years. There’s mounting support for a bill that would require parents be notified of the dangers of opioids before their kids are dosed. Dr. Andrew Kolodny is Chief Executive Medical Officer of New York based Addiction Treatment Center, Phoenix House.
Williams: What would the Parental Notification Act require of doctors and patients?
Kolodny: The law would require doctors to notify parents when prescribing an opioid, that they are prescribing an addictive drug.
Williams: You’re also the head of the Physicians for Responsible Opioid Prescribing. How would this bill prevent opioid abuse?
Kolodny: Well, I don’t know that it would prevent opioid abuse, what I believe it would prevent is opioid addiction. The United States is in the midst of a severe epidemic of opioid addiction, and people are developing opioid addiction sometimes through abuse or non-medical use, and sometimes through medical use. It’s repeated exposure that leads to addiction, and I believe if prescribers and parents and patients understood how addictive opioids are; prescribers would prescribe more caution, and the parents and patients would be better informed.
Williams: Aren’t the doctors already required to tell people what the side effects are of any drug?
Kolodny: Yeah. Well, doctors are expected to provide something that is called an informed consent when prescribing any kind of medication.
Williams: What’s different about this bill?
Kolodny: For a prescriber to give a patient informed consent. The prescribers themselves have to be well educated about the risks and benefits of the treatment that they are recommending. In the case of opioids for pain, we’re in a situation where the prescribers have very bad information. Prescribers are underestimating how risky these drugs are.
Kolodny: Well, a campaign was launched when Purdue introduced Oxycontin back in 1996. That minimized the risks of opioids and exaggerated the benefits, especially the benefits on prescribed long term. The campaign that they launched was multi-faceted so that doctors began to hear from many different sources. They heard from their medical societies, from their medical board, from their hospitals.
Williams: Twenty years ago, but they’ve gotten updated information since, clearly?
Kolodny: No, unfortunately. That campaign was launched 20 years ago, but for 15, 20 years the medical community continued to hear that the compassionate way to treat pain is with an aggressive opioid prescription and that the risk of addiction had been overblown, is what we were being taught.
Williams: In your work at Phoenix House can you tell us how long it takes for opioid use to become abuse, addiction?
Kolodny: It’s not opioid abuse that leads to addiction, its opioid use that leads to addiction. Now, the person could be using the pill because they’re taking them for fun, recreationally, that would be abused; but the use could also be as prescribed by a doctor. If you repeatedly take a highly addictive drug, you can become addicted. Young people seem to be especially susceptible to developing addiction.
Williams: Let’s talk about the bill that is in the General Assembly. The head of the health committee is Dr. Herb Conaway. He is resisting posting this bill because he says it will interfere with the doctor, patient relationship. What do you say to that argument?
Kolodny: That argument doesn’t make sense. There are many different situations where we require a doctor to inform the patient about the risk of a medication or a procedure. I think this would be a very good example of where we might want to make that required. I don’t believe that that’s the reason that Dr. Conaway is opposing the bill.
Williams: Dr. Conaway argues that this, and I’m going to read this, “may open the door to further legislators governing how doctors behave”.
Kolodny: Right. I think that what he might be suggesting is that this is a slippery slope, and that legislators shouldn’t be in the business of telling doctors what they should do with their patients. This is a feeling that many doctors have, and what we’re seeing around the country as state legislators propose bills to tackle a public health problem caused by the way in which doctors are prescribing. We’re hearing that response from some medical groups. Unfortunately, this is not the right way to be thinking about this.
Williams: Why do you think Conaway is blocking this?
Kolodny: I did have the opportunity to speak with his chief of staff this morning and I asked his chief of staff whether or not their office had been lobbied on this bill. And in fact they have been by a group called by the Cancer Action Network, which is a group that is blocking interventions to address the opioid crisis both on a federal level and on a state level. Any efforts that would really be effective at addressing the opioid crisis will generally result in reduced prescribing. The manufacturers of opioid painkillers don’t want to see their prescriptions go down, so they are blocking efforts to promote more cautious use.
Williams: That’s a serious charge.
Kolodny: It is, it is. I’d be happy to back that up. For example, the Cancer Action Network is receiving funding, hundreds of thousands of dollars from hundreds of opioid manufacturers, including Purdue Pharma, the maker of Oxycontin; Endo Pharma, the maker of opana; and on the federal level right now, they’re attempting to block the CDC from releasing a guideline that promotes more cautious opioid use for chronic pain.