The opioid industry's use of scientific evidence to advance claims about prescription opioid safety and effectiveness.

Health affairs scholar Pub Date : 2024-10-24 eCollection Date: 2024-10-01 DOI:10.1093/haschl/qxae119
Ravi Gupta, Jason Chernesky, Anna Lembke, David Michaels, Cecilia Tomori, Jeremy A Greene, G Caleb Alexander, Adam D Koon
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Abstract

It is widely recognized that pharmaceutical marketing contributed to the ongoing US opioid epidemic, but less is understood about how the opioid industry used scientific evidence to generate product demand, shape opioid regulation, and change clinician behavior. In this qualitative study, we characterize select scientific articles used by industry to support safety and effectiveness claims and use a novel database, the Opioid Industry Documents Archive, to determine notable elements of industry and non-industry documents citing the scientific articles to advance each claim. We found that 15 scientific articles were collectively mentioned in 3666 documents supporting 5 common, inaccurate claims: opioids are effective for treatment of chronic, non-cancer pain; opioids are "rarely" addictive; "pseudo-addiction" is due to inadequate pain management; no opioid dose is too high; and screening tools can identify those at risk of developing addiction. The articles contributed to the eventual normalization of these claims by symbolically associating the claims with scientific evidence, building credibility, expanding and diversifying audiences and the parties asserting the claims, and obfuscating conflicts of interest. These findings have implications for regulators of industry products and corporate activity and can inform efforts to prevent similar public health crises.

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阿片类药物行业利用科学证据来宣传处方阿片类药物的安全性和有效性。
人们普遍认为,药品营销是美国阿片类药物持续流行的原因之一,但人们对阿片类药物行业如何利用科学证据产生产品需求、制定阿片类药物法规以及改变临床医生行为的了解较少。在这项定性研究中,我们对阿片行业用于支持安全性和有效性声明的部分科学文章进行了描述,并使用一个新颖的数据库--阿片行业文件档案--来确定引用科学文章来推动每项声明的行业和非行业文件中的显著要素。我们发现,在 3666 份文件中总共提到了 15 篇科学文章,这些文章支持了 5 种常见的、不准确的说法:阿片类药物对治疗慢性非癌症疼痛有效;阿片类药物 "很少 "成瘾;"假性成瘾 "是由于疼痛管理不当造成的;阿片类药物剂量不会过高;筛查工具可以识别有成瘾风险的人群。这些文章将这些说法与科学证据象征性地联系在一起,建立了可信度,扩大了受众和主张这些说法的各方的范围并使其多样化,同时还掩盖了利益冲突,从而促使这些说法最终正常化。这些发现对行业产品和企业活动的监管者具有启示意义,并可为预防类似的公共卫生危机提供参考。
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