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Opioid evangelist switches sides in pharma case

A doctor who was an early evangelist for increased use of highly addictive opioids like OxyContin to treat chronic pain — and who was paid to promote the idea — has switched sides and now says drug makers helped to create a U.S. epidemic by failing to acknowledge the risks of abuse.

Dr. Russell Portenoy, a medical-school professor who studied pain for more than 30 years, has agreed to testify against the industry in trials of lawsuits brought by local governments seeking billions in social costs associated with addiction, according to unsealed court filings. In a sworn statement, he said drug makers were too aggressive in promoting opioids for all kinds of ailments.

“The opioid manufacturers should have tempered their positive messaging about opioids with a greater focus on risk, particularly as early signals of opioid risk emerged,” Portenoy said in his court declaration. Drug makers also “should have responded as evidence of increasing adverse effects mounted” to increased awareness and “reduce inappropriate or risky prescribing,” he said.

Portenoy switched sides last year after U.S. cities and counties agreed to drop their lawsuits against him in exchange for his cooperation, the court records show. A settlement was reached, and he provided documents and testimony that could be used in the lawsuits against opioid manufacturers including Purdue Pharma, Johnson & Johnson’s Janssen unit and Teva Pharmaceutical Industries Ltd.

According to a 2017 investigation conducted by then Missouri Sen. Claire McCaskill, more than 50,000 Americans died from drug overdoses in 2015, with a third of those deaths caused by prescription opioids including Purdue Pharma LP’ OxyContin and Insys Therapeutics Inc.’s Subsys.

Recognized as one of the leading U.S. experts on pain treatment and a “key opinion leader,’’ Portenoy will testify that companies “overstated the benefits of chronic-opioid therapy’’ and “understated the risks of opioids, particularly the risk of abuse, addiction and overdose,’’ according to the federal-court filing.

That backs up the contention of local governments that illegal marketing by opioid makers fueled a public-health crisis that consumed billions of tax dollars. The plaintiffs say those misleading sales tactics created a “public nuisance’’ that puts the companies on the hook for social costs tied to the epidemic.

Robert Josephson, Purdue’s spokesman, declined to comment on Portenoy’s defection.

Portenoy’s 36-page declaration about his change of heart was made public Friday as part a pre-trial ruling in a consolidation of more than 1,600 suits filed by public entities before a federal judge in Cleveland. The doctor didn’t immediately respond to an interview request Monday.

A special master overseeing discovery in test trials set for October is recommending that Portenoy be barred from testifying because plaintiffs’ lawyers didn’t notify the companies of the doctor’s settlement until months after it was signed. Portenoy would be free to testify in future opioid cases if U.S. Judge Dan Polster signs off on the recommendation.

Portenoy, a professor of medicine at New York-based Albert Einstein College of Medicine at Yeshiva University who oversees hospice care at Memorial Sloane-Kettering Cancer Center, was an early adopter of the idea that opioids used mostly to treat cancer patients could be safely and effectively used for chronic pain from arthritis and bad backs.

Government regulators generally limited prescription opioids — some of which are 1,000-times more powerful than morphine. While doctors have wide discretion to prescribe medicines beyond what they’ve been approved to treat, drug makers can only market their products for ailments approved by regulators.

Portenoy’s assertion that opioid therapy is effective and safe for non-cancer pain was used in doctor-training videos backed by opioid makers and in the companies’ marketing brochures, he said. Portenoy said he was hired as a consultant by several drug makers. He has been identified in court filings as a “spokesman” for Purdue and an expert who provided “a critical component” of drug-marketing efforts.

Changed Views

But Portenoy now says he’s changed his view. After more than 20 years of experience with opioids, he has determined that the drugs should not be prescribed widely, and instead should only be targeted to patients who don’t have a high risk of addiction, according to the declaration.

The pain doctor said opioid makers selectively cited his work to market their products in an “unbalanced’’ way that contributed to physicians prescribing the painkillers inappropriately. During that period, he was receiving compensation from pharmaceutical companies for speeches, research and consulting. He didn’t say how much he was paid in total, but cited examples of almost $80,000 from 2006 to 2011, as well as a $500-an-hour consulting contract in 2008 with Insys, court filings show.

Those kind of prescribing habits — influenced by opioid makers’ relentless marketing of their painkillers — “contributed to rising incidences of drug addiction and overdoses,’’ Portenoy said in his declaration.

Not all the plaintiffs’ lawyers are impressed with Portenoy’s change of heart.

“Although it’s nice that Dr. Portenoy has changed his view on the use of opioids, it doesn’t help the millions who have died and become addicted over the years while he was a shill for Purdue, J&J and the rest of the opioid industry,” Hunter Shkolnik, an attorney for some cities and counties, said in an emailed statement.

The case is In Re National Prescription Opioid Litigation, 17-md-2804, U.S. District Court, Northern District of Ohio (Cleveland).

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