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This story is a collaboration between STAT and ProPublica.

In May 1997, the year after Purdue Pharma launched OxyContin, its head of sales and marketing sought input on a key decision from Dr. Richard Sackler, a member of the billionaire family that founded and controls the company. Michael Friedman told Sackler that he didn’t want to correct the false impression among doctors that OxyContin was weaker than morphine, because the myth was boosting prescriptions — and sales.

“It would be extremely dangerous at this early stage in the life of the product,” Friedman wrote to Sackler, “to make physicians think the drug is stronger or equal to morphine. … We are well aware of the view held by many physicians that oxycodone [the active ingredient in OxyContin] is weaker than morphine. I do not plan to do anything about that.”

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“I agree with you,” Sackler responded. “Is there a general agreement, or are there some holdouts?”

Ten years later, Purdue pleaded guilty in federal court to understating the risk of addiction to OxyContin, including failing to alert doctors that it was a stronger painkiller than morphine, and agreed to pay $600 million in fines and penalties. But Sackler’s support of the decision to conceal OxyContin’s strength from doctors — in email exchanges both with Friedman and another company executive — was not made public.

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The email threads were divulged in a sealed court document that ProPublica has obtained: an Aug. 28, 2015, deposition of Richard Sackler. Taken as part of a lawsuit by the state of Kentucky against Purdue, the deposition is believed to be the only time a member of the Sackler family has been questioned under oath about the illegal marketing of OxyContin and what family members knew about it. Purdue has fought a three-year legal battle to keep the deposition and hundreds of other documents secret, in a case brought by STAT; the matter is currently before the Kentucky Supreme Court.

READ THE SACKLER DEPOSITION

Meanwhile, interest in the deposition’s contents has intensified, as hundreds of cities, counties, states and tribes have sued Purdue and other opioid manufacturers and distributors. A House committee requested the document from Purdue last summer as part of an investigation of drug company marketing practices.

In a statement, Purdue stood behind Sackler’s testimony in the deposition. Sackler, it said, “supports that the company accurately disclosed the potency of OxyContin to healthcare providers.” He “takes great care to explain” that the drug’s label “made clear that OxyContin is twice as potent as morphine,” Purdue said.

Still, Purdue acknowledged, it had made a “determination to avoid emphasizing OxyContin as a powerful cancer pain drug,” out of “a concern that non-cancer patients would be reluctant to take a cancer drug.”

The company, which said it was also speaking on behalf of Sackler, deplored what it called the “intentional leak of the deposition” to ProPublica, calling it “a clear violation of the court’s order” and “regrettable.”

Much of the questioning of Sackler in the 337-page deposition focused on Purdue’s marketing of OxyContin, especially in the first five years after the drug’s 1996 launch. Aggressive marketing of OxyContin is blamed by some analysts for fostering a national crisis that has resulted in 200,000 overdose deaths related to prescription opioids since 1999.

Clip from a 1998 Purdue Pharma marketing video that was sent to doctors’ offices across the U.S., featuring a paid consultant, Dr. Alan Spanos.

Taken together with a Massachusetts complaint made public last month against Purdue and eight Sacklers, including Richard, the deposition underscores the pivotal role of the Sackler family in developing the business strategy for OxyContin and directing the hiring of an expanded sales force to implement a plan to sell the drug at ever-higher doses. Documents show that Richard Sackler was especially involved in the company’s efforts to market the drug, and that he pushed staff to pursue OxyContin’s deregulation in Germany. The son of a Purdue co-founder, he began working at Purdue in 1971 and has been at various times the company’s president and co-chairman of its board.

In a 1996 email introduced during the deposition, Sackler expressed delight at the early success of OxyContin. “Clearly this strategy has outperformed our expectations, market research and fondest dreams,” he wrote. Three years later, he wrote to a Purdue executive, “You won’t believe how committed I am to make OxyContin a huge success. It is almost that I dedicated my life to it. After the initial launch phase, I will have to catch up with my private life again.”

During his deposition, Sackler defended the company’s marketing strategies — including some Purdue had previously acknowledged were improper — and offered benign interpretations of emails that appeared to show Purdue executives or sales representatives minimizing the risks of OxyContin and its euphoric effects. He denied that there was any effort to deceive doctors about the potency of OxyContin and argued that lawyers for Kentucky were misconstruing words such as “stronger” and “weaker” used in email threads.

Sackler depo Quote 1
Alex Hogan/STAT

The term “stronger” in Friedman’s email, Sackler said, “meant more threatening, more frightening. There is no way that this intended or had the effect of causing physicians to overlook the fact that it was twice as potent.”

Emails introduced in the deposition show Sackler’s hidden role in key aspects of the 2007 federal case in which Purdue pleaded guilty. A 19-page statement of facts that Purdue admitted to as part of the plea deal, and which prosecutors said contained the “main violations of law revealed by the government’s criminal investigation,” referred to Friedman’s May 1997 email to Sackler about letting the doctors’ misimpression stand. It did not identify either man by name, attributing the statements to “certain Purdue supervisors and employees.”

Friedman, who by then had risen to chief executive officer, was one of three Purdue executives who pleaded guilty to a misdemeanor of “misbranding” OxyContin. No members of the Sackler family were charged or named as part of the plea agreement. The Massachusetts lawsuit alleges that the Sackler-controlled Purdue board voted that the three executives, but no family members, should plead guilty as individuals. After the case concluded, the Sacklers were concerned about maintaining the allegiance of Friedman and another of the executives, according to the Massachusetts lawsuit. To protect the family, Purdue paid the two executives at least $8 million, that lawsuit alleges.

“The Sacklers spent millions to keep the loyalty of people who knew the truth,” the complaint filed by the Massachusetts attorney general alleges.

Clip from a 1998 Purdue Pharma marketing video intended for doctors to show their patients.

The Kentucky deposition’s contents will likely fuel the growing protests against the Sacklers, including pressure to strip the family’s name from cultural and educational institutions to which it has donated. The family has been active in philanthropy for decades, giving away hundreds of millions of dollars. But the source of its wealth received little attention until recent years, in part due to a lack of public information about what the family knew about Purdue’s improper marketing of OxyContin and false claims about the drug’s addictive nature.

Although Purdue has been sued hundreds of times over OxyContin’s marketing, the company has settled many of these cases, and almost never gone to trial. As a condition of settlement, Purdue has often required a confidentiality agreement, shielding millions of records from public view.

That is what happened in Kentucky. In December 2015, the state settled its lawsuit against Purdue, alleging that the company created a “public nuisance” by improperly marketing OxyContin, for $24 million. The settlement required the state attorney general to “completely destroy” documents in its possession from Purdue. But that condition did not apply to records sealed in the circuit court where the case was filed.

In March 2016, STAT filed a motion to make those documents public, including Sackler’s deposition. The Kentucky Court of Appeals last year upheld a lower court ruling ordering the deposition and other sealed documents be made public. Purdue asked the state Supreme Court to review the decision, and both sides recently filed briefs. Protesters outside Kentucky’s Capitol last week waved placards urging the court to release the deposition.

Sackler family members have long constituted the majority of Purdue’s board, and company profits flow to trusts that benefit the extended family. During his deposition, which took place over 11 hours in a law office in Louisville, Ky., Richard Sackler said “I don’t know” more than 100 times, including when he was asked how much his family had made from OxyContin sales. He acknowledged it was more than $1 billion, but when asked if they had made more than $5 billion, he said, “I don’t know.” Asked if it was more than $10 billion, he replied, “I don’t think so.”

By 2006, OxyContin’s “profit contribution” to Purdue was $4.7 billion, according to a document read at the deposition. From 2007 to 2018, the Sackler family received more than $4 billion in payouts from Purdue, according to the Massachusetts lawsuit.

During the deposition, Sackler was confronted with his email exchanges with company executives about Purdue’s decision not to correct the misperception among many doctors that OxyContin was weaker than morphine. The company viewed this as good news because the softer image of the drug was helping drive sales in the lucrative market for treating conditions like back pain and arthritis, records produced at the deposition show.

Sackler depo Quote 2
Alex Hogan/STAT

Designed to gradually release medicine into the bloodstream, OxyContin allows patients to take fewer pills than they would with other, quicker-acting pain medicines, and its effect lasts longer. But to accomplish these goals, more narcotic is packed into an OxyContin pill than competing products. Abusers quickly figured out how to crush the pills and extract the large amount of narcotic. They would typically snort it or dissolve it into liquid form to inject.

The pending Massachusetts lawsuit against Purdue accuses Sackler and other company executives of determining that “doctors had the crucial misconception that OxyContin was weaker than morphine, which led them to prescribe OxyContin much more often.” It also says that Sackler “directed Purdue staff not to tell doctors the truth,” for fear of reducing sales. But it doesn’t reveal the contents of the email exchange with Friedman, the link between that conversation and the 2007 plea agreement, and the back-and-forth in the deposition.

A few days after the email exchange with Friedman in 1997, Sackler had an email conversation with another company official, Michael Cullen, according to the deposition. “Since oxycodone is perceived as being a weaker opioid than morphine, it has resulted in OxyContin being used much earlier for non-cancer pain,” Cullen wrote to Sackler. “Physicians are positioning this product where Percocet, hydrocodone and Tylenol with codeine have been traditionally used.” Cullen then added, “It is important that we be careful not to change the perception of physicians toward oxycodone when developing promotional pieces, symposia, review articles, studies, et cetera.”

“I think that you have this issue well in hand,” Sackler responded.

Friedman and Cullen could not be reached for comment.

Asked at his deposition about the exchanges with Friedman and Cullen, Sackler didn’t dispute the authenticity of the emails. He said the company was concerned that OxyContin would be stigmatized like morphine, which he said was viewed only as an “end of life” drug that was frightening to people.

“Within this time it appears that people had fallen into a habit of signifying less frightening, less threatening, more patient acceptable as under the rubric of weaker or more frightening, more — less acceptable and less desirable under the rubric or word ‘stronger,’” Sackler said at his deposition. “But we knew that the word ‘weaker’ did not mean less potent. We knew that the word ‘stronger’ did not mean more potent.” He called the use of those words “very unfortunate.” He said Purdue didn’t want OxyContin “to be polluted by all of the bad associations that patients and healthcare givers had with morphine.”

In his deposition, Sackler also defended sales representatives who, according to the statement of facts in the 2007 plea agreement, falsely told doctors during the 1996-2001 period that OxyContin did not cause euphoria or that it was less likely to do so than other opioids. This euphoric effect experienced by some patients is part of what can make OxyContin addictive. Yet, asked about a 1998 note written by a Purdue salesman, who indicated that he “talked of less euphoria” when promoting OxyContin to a doctor, Sackler argued it wasn’t necessarily improper.

“This was 1998, long before there was an Agreed Statement of Facts,” he said.

The lawyer for the state asked Sackler: “What difference does that make? If it’s improper in 2007, wouldn’t it be improper in 1998?”

“Not necessarily,” Sackler replied.

Sackler depo Quote 3
Alex Hogan/STAT

Shown another sales memo, in which a Purdue representative reported telling a doctor that “there may be less euphoria” with OxyContin, Sackler responded, “We really don’t know what was said.” After further questioning, Sackler said the claim that there may be less euphoria “could be true, and I don’t see the harm.”

The same issue came up regarding a note written by a Purdue sales representative about one doctor: “Got to convince him to counsel patients that they won’t get buzzed as they will with short-acting” opioid painkillers. Sackler defended these comments as well. “Well, what it says here is that they won’t get a buzz. And I don’t think that telling a patient ‘I don’t think you’ll get a buzz’ is harmful,” he said.

Sackler added that the comments from the representative to the doctor “actually could be helpful, because many patients won’t get a buzz, and if he would like to know if they do, he might have had a good medical reason for wanting to know that.”

Sackler said he didn’t believe any of the company sales people working in Kentucky engaged in the improper conduct described in the federal plea deal. “I don’t have any facts to inform me otherwise,” he said.

Purdue said that Sackler’s statements in his deposition “fully acknowledge the wrongful actions taken by some of Purdue’s employees prior to 2002,” as laid out in the 2007 plea agreement. Both the company and Sackler “fully agree” with the facts laid out in that case, Purdue said.

The deposition also reveals that Sackler pushed company officials to find out if German officials could be persuaded to loosen restrictions on the selling of OxyContin. In most countries, narcotic pain relievers are regulated as “controlled” substances because of the potential for abuse. Sackler and other Purdue executives discussed the possibility of persuading German officials to classify OxyContin as an uncontrolled drug, which would likely allow doctors to prescribe the drug more readily — for instance, without seeing a patient. Fewer rules were expected to translate into more sales, according to company documents disclosed at the deposition.

One Purdue official warned Sackler and others that it was a bad idea. Robert Kaiko, who developed OxyContin for Purdue, wrote to Sackler, “If OxyContin is uncontrolled in Germany, it is highly likely that it will eventually be abused there and then controlled.”

Nevertheless, Sackler asked a Purdue executive in Germany for projections of sales with and without controls. He also wondered whether, if one country in the European Union relaxed controls on the drug, others might do the same. When finally informed that German officials had decided the drug would be controlled like other narcotics, Sackler asked in an email if the company could appeal. Told that wasn’t possible, he wrote back to an executive in Germany, “When we are next together we should talk about how this idea was raised and why it failed to be realized. I thought that it was a good idea if it could be done.”

Asked at the deposition about that comment, Sackler responded, “That’s what I said, but I didn’t mean it. I just wanted to be encouraging.” He said he really “was not in favor of” loosening OxyContin regulation and was simply being “polite” and “solicitous” of his own employee.

Near the end of the deposition — after showing Sackler dozens of emails, memos and other records regarding the marketing of OxyContin — a lawyer for Kentucky posed a fundamental question.

“Sitting here today, after all you’ve come to learn as a witness, do you believe Purdue’s conduct in marketing and promoting OxyContin in Kentucky caused any of the prescription drug addiction problems now plaguing the Commonwealth?” he asked.

Sackler replied, “I don’t believe so.”

David Armstrong is a senior reporter for ProPublica and was formerly STAT’s senior enterprise reporter.

  • 22 years out and still there is no treament available for people with addiction. This artcile points to the deceptive marketing by Perdue, yet nothing has been done to stop any of it. The US is experiencing an Epidemic of Despair, and virtually nothing hasbeen done about any of that. They are making billions from the so called opiate epidemic, so as cheap Fentanyl and Meth replace Oxycontin, and people die, lets all pretend the regulatory agencies that lied to Americans are doing something beneficial. We stll have the head of the CDC peddling misinformation and creating demand for fentanyl laced illegal drugs, while people with pain commit suicide.

  • I’m seeing this more and more as a shakedown of Perdue Pharmaceuticals by various state governments to get all the money they can before they bleed both the company and the Sackler family dry. I’m saying this not as a defender of the company or family; clearly both over promoted OxyContin, minimized its adverse consequences and otherwise stretched the truth.

    My issue is with the legal system, aka all the lawyers involved, which is in essence treating the etiology of the opoid crisis( or whatever other moniker one chooses to use) as solely the machinations of one company and its controlling family. The etiology is far more complicated and include: a collapsing economy and culture, particularly, in the Midwest, the ready availability of potent heroin from Mexico(interestingly, concurrent with the rise in illegal immigration), pressure on physicians to treat pain( also, concurrent with insurance companies refusal to cover non medication approaches to treating chronic pain) and a growing population of people particularly susceptible to the allure of drugs as an escape from their troubled lives.( I’ve observed that most heroin addicts appear to come from broken homes and many are victims of a variety of abuses)

    My point is not to defend the company or the Sackler family. Rather, my fear is that the legal system will get it’s pound of flesh from both, use the money for various political purposes and personal gain and leave little to actually treat those afflicted with the addiction. Just remember the tobacco settlements.

  • having been through 25 major surgeries and over 20 procedures I was taking Oxycontin at the request of my pain management doctor. I know for a fact if he would have known the strength of Oxycontin but he never would have prescribed it for me. those Executives from Purdue knew exactly what they were doing and knew the high degree of addiction that would occur from their drug! They made billions of dollars for the founding fathers of Purdue and they tried everything they could to sell more and more of the drug. with unlimited funds they will pay penalties but none will be put in jail where they all should be. Each one of the cases this allows any use of the information they get against the founding fathers of the company and they could pay any amount required to not have jail time.

  • It gives me pain to read the name of my graduate alma mater used in the name of this sleazy pharma company. I hope all readers know that the university has absolutely nothing to do with these a**h**es. The shortening of the pharma company name is convenient, but I wish all writers would use the complete name of the company instead.

  • I WILL NOT EVEN ATTEMPT TO WRITE MORE THAN FIFTEEN WORDS AS SUCH . ONE MORE EXAMPLE OF THE DISASTER AND THE EMPIRE OF MONEY IN THE SO CALLED HEALTH CARE SYSTEM IN THE U.S.A . NOT WITHSTANDING THE NEW YORK TIMES AND THE LIBERALS RADICALS OF ELITES CONSTANTLY WRITE .SHOUT AND WITH SO MUCH PASSIONS OF DECEPTIONS SAY .JUST PUT OR PLACE TRILLIONS OF TRILLIONS DOLLARS IN THIS HEALTH CARE CRIMINALITY SO THAT EVERY ONE WILL HAS AND OR BEING IN HOLD OF HEALTH CARE . THEREBY , WE WILL REMAIN HEALTHY AND LIVE FOR EVER .ONLY A FEW DAYS AGO THIS NEW YORK TIMES EDITORIAL WROTE A FULL PAGE ARTICLE ABOUT THIS . MORE TO COME .TREVOR MERCHANT . THURSDAY . FEBRUARY . 21 2019

  • As appalling as this story is, it assumes that doctors were willing pawns in Purdue’s evil scheme. They were not – well nearly all were not. Hydrocodone was not sham aspirin as the story seems to suggest. Physicians know their opioids. While they might have viewed OxyContin as less potent than morphine, they were often correct in so far as the dose levels they prescribed were lower in morphine-equivalence. Keep in mind that the climate at the time was that doctors were under-medicating pain – they still are by recent accounts.

    In essence, Sackler elected to do nothing when it was their impression that some doctors (how many?) might think Oxy was less addicting. If this was a widespread failing, then where was AMA and where was FDA? Apparently, those organizations did not see the same confusion some Purdue salesman did.

    Finally, a smoking gun is not necessarily the murder weapon. It is worth keeping in mind that the opioid overdose crisis is very likely due to a variety of factors such as economic despair (Case & Deaton (2015, 2017) and victim chronic health problems rather than immoral Big Pharma or reckless physician behaviors. As papers by Michael Schatman and Steven Karch have often pointed out, the cause of opioid overdose death cannot be reliably attributed to Purdue’s product line. In the vast majority of cases, post-mortem blood tests show heroin, fentanyl, hydrocodone, and other drugs that can trigger fatal symptoms, making it impossible to validly ascribe the cause of death to a single drug. Add to that the sad fact that our Center for Disease Control has no enforceable standards for reporting cause of death across our 50 states.

    • Thank you Thomas. That was very well said and I think describes the true situation here. I believe that chronic pain patients are the ones suffering the most with this media blitz. Most doctors are now afraid to help anyone in constant pain. How can one not feel oppressed and depressed when they’re the ones in pain and can’t find anyone LEGALLY willing to help? If one calls around, they’d find that most doctors refuse to accept chronic pain patients.

    • A few points:
      1) Dr. Hilton states: “In the vast majority of cases, post-mortem blood tests show heroin, fentanyl, hydrocodone, and other drugs that can trigger fatal symptoms, making it impossible to validly ascribe the cause of death to a single drug.” Nice obfuscation. The main issue here isn’t fatal overdoses of OxyContin itself, it’s the increase in the number of people who became addicted to opioids as a result of the deceptive marketing and over-prescribing of OxyContin and then – as a result of their addiction – turned to cheaper and more readily available illegal opioids sold on the street, such as heroin and fentanyl. So, while OxyContin may not be present in the bloodstream when the fatal overdose occurs, it was – in many thousands of cases – the ONLY opioid in the bloodstream as the original addiction took hold. Surely Dr. Hilton is aware of this.
      2) Dr. Hilton writes: “In essence, Sackler elected to do nothing when it was their impression that some doctors (how many?) might think Oxy was less addicting.” Unfortunately, this is, in fact (or should I say “in essence?”), but one of many things that Sackler and Purdue knowingly did – or, in this case, didn’t do – that led straight to the current opioid crisis. Read the Massachusetts complaint (linked above) and then re-read this claim by Dr. Hilton. I’ll wait. Thank you.
      3) The points raised by Dr. Hilton are awfully consistent with the PR strategy that that the Sacklers and Purdue have followed (again, see the Massachusetts complaint for detail) in trying to obscure their very active role in creating a health crisis that now claims more American lives each year than car accidents. In fact, a more cynical person than I might consider the possibility that “Dr. Hilton’s” comment is actually another example of that effort to shift the focus elsewhere.

    • Disagree. The efforts (guided, misguided?) on the part of Purdue to sell as much as possible as quickly and profitably as possible had the effect of dumping vast amounts of “oxy” on communities (some with the elements of SDOH mentioned above). Our community, 76K pop. at the time, early 2000’s experienced 19 deaths in a little over a year and a half, 14 OD’s and 5 suicides of oxy/heroin addicted young, 17-27 years. The unfortunate combination of the American propensity for youth binge drinking and the pharmaceutical action of oxycontin, the pills were everywhere, and were, over and over again, fatal. We are still experiencing the aftershocks.

      Was this the fault of these young people or was the candy like distribution of a powerful narcotic to blame? Restricting access through the pharmacies was a first step at control (“This pharmacy does not carry oxycontin” signs). Re-educating physicians, remember that Purdue cleverly bought its way into at least one local area medical school, one with a “Sackler” building, and was involved in medical education, has been a long, arduous, and continuing process. The fifty thousand dollar Purdue Pharma feel good ads in the New York Times could have been much more effectively spent on public apology and physician re-education – and good luck with that!

      Does any of this restrict good medical practice? No, if physicians have been able to exercise reasonable restraint and develop appropriate protocols over the use of other opiates, why the fuss implying, wrongly, the loss of a useful pharmaceutical tool when the only request from the long suffering public was/is that it be treated in the same fashion – intelligently and compassionately. There is no loss of a useful drug, merely an unwillingness to assume the responsibility implied by “First, do no harm.”

    • Agreed. Another factor I would mention is, in the 1990s,the Joint Commission on Accreditation of Healthcare Organizations(JCAHO) proclaimed that “pain is the 5th vital sign.” This meant not only doctors but nurses and other employees in a health care organization were involved in maintaining this “culture” of vigorously inquiring about pain and aggressively “treating” it. Some hospitals would get cited for undermanagement of pain. So, there was a structural incentive in place to keeping people “pain free” whatever the means. So everyone in the business of healthcare including regulators were party to this racket.

  • 22 years later, and the CDC, FDA, and our media, is still misreporting the Facts. They failed to explain any of this to the public, they are still misleading the public as people die from illegal fentanyl pills. The CDC in order to please Pharma is still conflating illegal, deadly Fentanyl pills with prescription medications. The death rate looks like it is rising, as the same marketers are in control of drug policy. The so called opiate epidemic has been a great marketing tool.

    https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

    • I agree with Sam Gur on this point of view. I am a retired nurse from a 50 year career in nursing. I am experienced in all levels of care from OB to ER to Acute Cardiac care, plus. I totally agree that pain as a 5th vital sign is a nice thought. The translation was that patients received many narcotics because in the patients judgment the pain was overwhelming. So meds were given in some increase due to patients who caught on quickly, that the number meant more than the observation skills of the nurse provider. Pain contol was usually very necessary for 2- 3 days post a procedure or a trauma. The pain scale should be pegged to a number the patient assigned, a number that the nurse assigns, and the followup on the pain control with meds vs. means to control the pain. In essence relieve the fecal impaction, address the discharge concerns, increase patient activity which does help pain, and just talk to the patient about medication or addiction issues. In other words think of what this patient will do at home with narcotics, talk to the patient the patient about pain control measures that do not involve narcotics but sometimes lesser meds. Everyone wants an instant cure for pain, chronic mostly and chronic pain does not go away at times. Use showers, use exercise if possible. Some patients who go to physical therapists for therapy about joint replacement are aware that actual therapy helps them. Taking narcotics for 6 months after joint replacement does not address the pain focus. Medical providers are busy, but the patient should be the focus and getting better should be the focus for diagnoses of temporary pain and some chronic pain etiologies. The pain should not be the main focus, the rehab from the cause of the pain should be the focus. It really pains me to say this but the medical profession needs to decide if the people giving the pain meds are just quieting the patient or helping the patient to discharge in better condition. The people actually administering the meds need to challenge the patient to do other modes of pain control, they need to facilitate and spend time with a patient. They also need to challenge depression, lack of interest and make the patient believe that their pain control is not all about medication intake. Also discharge planning is not all about who is at home, who will assume care, who will fix meals. It should be about followup on medications that are used for pain control. How many new prescriptions are written for pain control without any thought about challenging the patients reliance on the narcotic. Sorry, this is about caring for a patient in a hospital setting that need to resume their life without narcotics. If chronic pain is involved, treating depression, with appropriate followup is just as important as treating the pain. If a patient has a fairly immediate terminal diagnosis that is another approach completely with pain control. People that encourage narcotic control to the extent implied in this acticle should have to pay for the rehab costs, the counseling and the followups involved if at all possible. Insurance companies will not, patients need to be convinced that there is still a life to lead, and PCPs need to deal with a chronic vs a temporary pain control as an actual diagnosis. Sharing of potential narcotic abuse information should be a national requirement and resource. Sorry. If the addicted person cant help themselves, then the PCP has to stop it and tell the addicted person in the presence of a caregiver why narcotics, alcohol, non compliance with recovery measures has to stop. A very tall order all of this. I enjoyed patient care more when it is approached by an honest attitude. I also did not fear losing my job, wonder why and I felt better when a provider can be honest when talking to a patient with an addiction or any abuse. Sorry for the long post, when what fired me up was the pain scale and the financial repercussions.

  • Why isn’t the judge who signed off on sealing the deposition named, and why isn’t his/her rationale outlined?

    Looking at court documents linked three stories back, it looks like it’s an agreed qualified protective order but there’s no discussion of how that came to be, if it’s proper, if the judge should have or even had to allow it and if the documents sealed in it should have been there or if this is a normal or abused practice.

  • I am quite vexed with the sensationalism and liability issues dominating the discussion. Let’s solve the real problems. Starting with I need a better option than the opioids that are the best choice in my case!

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