Jim Weinrebe
EVP, Health, MSLGroup

Initiatives to align prescription opioid use with appropriate patient medical needs are yielding progress, but substantive impact on saving lives won’t happen for years. Some of this progress is also creating backlash by delegitimizing patients with chronic pain for whom prescription opioids may be the best or only helpful treatment option, and choking off their access to these medicines.

This grim reality is partly fueled by patients and family members who inadvertently lapsed into dependence on prescription opioids, before falling prey to cheaper, more accessible heroin. The crisis has multiple origins, but manufacturers are increasingly deemed solely culpable, regardless of behavior. How can they responsibly participate in this therapeutic area?

Consider reshaping commercialization from a public health perspective. Integrate marketing with functions in public health and public affairs.

Under a public health umbrella, manufacturers would remove product-branded direct-to-patient and direct-to-consumer comms from the promotional mix. They would work more with public health authorities and advocacy groups to support non-branded public education about harm avoidance in households.

As data yields deeper insight into the epidemiology of prescription opioid dependence, manufacturers can better educate physicians about products. It’s neither ethical nor fiscally viable for manufacturers to run from patients for whom prescription opioids may be the only viable treatment option. It’s time to revisit education about pain.

 


 

Wendy Lund
CEO, GCI Health

The future of opioids marketing should be redefined as we try to find common ground where physicians fully address the safe and appropriate use of these medicines – as well as when they should consider an alternative therapy – and are comfortable prescribing them, while patients are able to trust in their physician’s decision to prescribe an opioid and learn how to use them without unreasonable fear of addiction.

The goal is to drive informed dialogue between prescriber and patients and their families about their specific pain needs, pain management, and all the appropriate treatments that exist to empower the prescriber to make the right determination. Too many physicians are reticent to prescribe opioids out of fear of potential consequences – abuse, misuse, diversion, liability – and need to regain the assurance to prescribe these drugs when appropriate.

We need a radical departure from past efforts that have grown the opioids market – whether by design or not – by making these medications the go-to for all types of pain, even when an opioid is not appropriate.

Future marketing must be ultra-responsible and focus on the safe and appropriate use of pain medications. Modern technologies of today, such as abuse deterrent formulations and Prodrug new molecular entities are available now to help discourage misuse and abuse.

Physician and patient education available today can help ensure appropriate prescribing with small numbers of pills, especially for acute pain treatment. Appropriate storage and disposal of unused medications are actions that can occur today to reduce diversion into the misuser orb. In short, the opioid marketing of tomorrow is available today – if all players are willing to change.

Efforts should be a partnership between industry, government, public health, and others to focus on key issues and create a paradigm shift in the way these medications are accessed. Balancing responsible prescribing with meeting the pain management needs of patients is a challenge, but given the life or death nature of addiction and chronic pain, we all have a stake in communicating in a new and different way.

 


 

John LaLota
CEO, Neura Therapeutik

In the midst of the U.S. opioid crisis, many stakeholders have a primary objective of simply reducing the number of prescriptions. However, millions of Americans suffer from chronic pain, and for many of these appropriate patients, opioid analgesics are the mainstays of therapy. Many of these patients have been denied access to opioid treatment and have suffered greatly as a result.

Several barriers exist to the responsible use, including the need for mandated physician education, inadequate access in certain demographics, and a lack of proper ongoing assessments by practitioners. Achieving a critical balance between adequate pain control and access, and minimizing the risk of abuse, misuse, and diversion, is crucial to foster better outcomes.

Opioid manufacturers have a responsibility to provide a forum that promotes networking between pain specialists, primary care, and addiction medicine physicians, which can be fostered at major national pain conferences, such as Pain Week, and can be continued throughout the year at various Pain Weekends. Partnering, through PR initiatives, with national pain organizations, patient advocacy groups, and law enforcement agencies to support public policy, with a patient-centric focus, is essential to achieve optimal treatment outcomes.

For their part, physicians must be knowledgeable on how to structure opioid therapy based on perceived risks and must adopt various proactive and reactive strategies, via a REMs structured educational mandate.

A recent survey, conducted by Pain Insights, characterized the recent dynamics in the treatment of chronic pain, identifying patients segments with varying perspectives on opioids.

The researchers found that ongoing patient assessment (via mobile devices, apps, etc.) utilizing risk-mitigation tools, such as the ORT and SOAPP, as well as a cohort of outcome-based identifiers, can lead to more effective communication of patient-centered opioid therapies and can provide feedback on issues that are most meaningful in achieving the aforementioned balance.

 


 

Bob Twillman
Executive director, Academy of Integrative Pain Management

First and foremost, pharmaceutical manufacturers need to market opioids in the proper context. Opioid monotherapy is almost never the right answer for people with chronic pain, and patients will do much better with an integrative multimodal approach to treatment.

Opioids will be most effective when they are combined with non-opioid medications and non-pharmacological interventions. Using this kind of treatment approach should maximize effectiveness while minimizing harms to patients. Manufacturers need to continue innovating with respect to abuse deterrence as well, making their products as safe as possible, even if most of the abuse that is deterred happens among non-patients.

As far as methods are concerned, I have two thoughts. It seems to be universally agreed that the marketing model used in the 1990s and early 2000s was extraordinarily effective at encouraging prescribing. If that is the case, then why not resurrect that model, which is essentially an academic detailing model, only with a focus on marketing effective pain management instead of just more opioids?

Additionally, there is a great need for effective marketing to patients, to help them understand the proper role of opioids in the larger scheme of a comprehensive integrative pain management plan. Patients are very important members of the care team, and they need to understand their role as such, and to understand that they will need to make an investment in their own care if they want to get the best possible results. Educational efforts aimed at patients, and, perhaps, at the general public as well, need to be prioritized.

 


 

Delia DeRiggi-Whitton
Nassau County Legislator, D-Glen Cove

Many people don’t know that the exploding heroin epidemic is due in large part to prescription painkillers being the road to addiction. Some move to heroin because it’s easier and cheaper to find and gives a “higher high.” Others overdose on painkillers without ever using heroin.

From the training sessions I’ve sponsored over the past few years on Narcan, which counteracts an opioid overdose, I’ve met parents whose children got hooked on painkillers from sports injuries. Years later, they’re still fighting a daily battle to stay clean.

To begin to make a real difference in opioid-related overdoses, marketing that speaks to the paths to addiction needs to be blunt and multi-targeted. Since addiction to opioid pills and heroin often starts innocently with prescriptions, patients and parents of minors must understand that opioids are very addictive. But doctors and pharmaceutical companies must also become part of the solution by counseling patients and developing less addictive substitutes, respectively.

The legislation my colleagues and I recently filed requiring signage in pharmacies warning patients about opioid addiction is a good first step. So is the national database that monitors opioid prescriptions per person. But they are both only small parts of a bigger puzzle. Everyone needs to understand how easy it is to become addicted to opioids and how painfully difficult it is to break the habit.

Every possible form of marketing should be used to warn patients, parents, educators, the medical industry, and pharmaceutical companies about how opioids are a major reason why the heroin epidemic is so out of control. The responsibility should mainly lie with pharmaceutical companies and their messaging should trickle down to doctors and hospitals, educators, and consumers.

 


 

Marsha Stanton
Independent consultant, medical affairs and program development/education

Those of us who have been involved in the pain management specialty, through both direct patient care and the pharma industry, have seen significant changes in how medications and devices are advertised, marketed, designed and indicated over the past 20-plus years.

We have encouraged new terms, such as breakthrough pain, pseudoaddiction, etc., and have learned to specify our efforts and financial support towards more definitive objectives. We are constantly under review for the most insignificant of wording in disseminating information to the community, which includes both clinicians and consumers.

The current media frenzy over opioids, has frequently tied our hands from accomplishing a clear and timely consumer education initiative or in providing clinicians the most critical information for use in their patient populations. Sensitivity in finding the right project, the right audience and the right structure is at the root of what we try to accomplish. The use of consumer organizations to encourage education, has proved almost impossible due to an overzealous negativity towards the pharma industry as a source of funding.

Additionally, professional organizations have become increasingly less apt to secure financial support from our industry due to the critical regard for our ultimate purpose. Medical education has undergone substantial changes, with a shift to independence rather than specific product information.

Alliances, collaboratives and/or partnerships and CME have been the cornerstone of the “new” model for transference of information. Organizations such as CLAAD (Center for Lawful Access and Abuse Deterrents), the National Family Partnership “Lock Your Meds program”, SaferLock equipment such as Locking Caps, The Abuse Deterrent Coalition, ASPMN (The American Society for Pain Management Nursing), AAPM (The American Academy of Pain Medicine), the AIPM (Academy of Integrative Pain Management), as well as others have provided an opportunity to support all audiences with impartial data.

The criticism directed at the use of KOLs for education or experiential learning has caused an uneasy relationship and unfortunately some have chosen to eliminate all association with the pharma industry. There is still a substantial need for the voice of both clinician and consumer, however, their messages may be less responsive and more refined. Caution is the overriding principle in all things pain-related.

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