Fentanyl Salesmen Arrested for Kickback to Doctors

An aspect of the prescription opioid epidemic that is often ignored is the role of pharmaceutical salesmen. These are people who are employed by pharmaceutical companies to travel around the country enticing doctors to prescribe their medical product. Now, it stands to reason that a physician's willingness to prescribe a drug should be based off of the drug's effectiveness at treating a specific condition—and in a perfect world that may be the case. However, doctors are often times given huge incentives to prescribe one medication over another, a practice which surely had a hand in the rampant over prescribing of drugs like OxyContin (oxycodone).

In the wake of the beloved pop star Prince’s death, attention has been redirected back to the powerful opioid analgesic fentanyl. Many Americans may have never heard of fentanyl as the drug is not commonly used outside of hospital settings. Those who had heard of the drug before may have been unaware that fentanyl is 100 time more potent than morphine. Fentanyl, while fast acting and highly effective, can cause severe respiratory depression that can be fatal; this is why it should be scarcely used except under the close supervision of doctors and nurses.

In an attempt to stem the tide of irresponsible prescribing practices, law enforcement has begun to set their sights on pharmaceutical salesmen. Recently, two former pharmaceutical salesmen were arrested from charges stemming from paying doctors to prescribe a form of fentanyl, USA Today reports. The two salesmen, who worked for Insys Therapeutics, allegedly paid two doctors in the New York-area $259,000 in kickbacks to prescribe Subsys.

Most fentanyl prescribed for take home use comes in the form a transdermal patch. The patches are adhered to one’s skin—slowly releasing the drug throughout the course of the day. Subsys, on the other hand, is sprayed under the tongue, according to the article. The spray version of fentanyl works quickly, relieving pain in just five minutes.

"You have this hyper-powerful drug marketed intensely, aggressively and shamelessly without any sense of the addictive and lethal power of what is being sold," said Arthur Caplan, the director of medical ethics at NYU Langone Medical Center in New York.

We will continue to follow the fentanyl story. Stay tuned. 

Alternatives to Opioids (ALTO)

If you experience an injury that requires a trip to the local emergency room, there is a good chance that you will be prescribed an opioid narcotic for the pain and will be told to follow up with your primary care physician. If you are still experiencing pain when you see your family doctor, there is an even greater chance that you will be prescribed more painkillers. In fact, nearly half of all opioid prescriptions written in the United States come from primary care physicians. One does not have to take opioids for too long before dependence develops, a slippery slope towards addiction which began back at the emergency room. So, what would happen if emergency room doctors only prescribe opioids as a last resort?

At one emergency room in New Jersey, the chairman of emergency medicine has decided to answer that question. At St. Joseph's Regional Medical Center in Paterson, NJ, doctors have begun using opioid alternatives to treat pain, keeping opioids off to the side for last ditch treatment efforts only, the Associated Press reports. The program, Alternatives to Opiates (ALTO), has been used since January, and in the first two months 75 percent of the emergency rooms 300 patients did not receive prescription opioids.

This month, the Centers for Disease Control and Prevention (CDC) released new prescribing guidelines, calling on primary care physicians to only use prescription opioids when every other alternative proves ineffective. While the guidelines are not something the CDC is normally responsible for creating, due to the dire nature of this epidemic every health agency needs to work together to put a stop to prescribing opioids when they are unnecessary.

Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing points out that emergency rooms are the front lines of the opioid crisis we face, according to the article. He supports the doctors at St. Joseph's, utilizing alternative forms of pain management.

"In many cases, we're exposing people to opioids when we don't need to be," said Kolodny.