Opioid industry targets countries like Brazil, says researcher

The synthetic opioid industry has been striving to increase the market for these drugs in developing countries, such as Brazil, says physician Adriane Fugh-Berman, professor in the department of pharmacology and physiology at Georgetown University in Washington, DC.

To that end, companies have used strategies similar to those that led the United States to face the biggest epidemic of drug users in its history, says she, who researches conflicts of interest between the drug industry and the medical profession.

According to the doctor, among the strategies is the emphasis on the need for opioids in end-of-life care, a real and often neglected need in developing countries. In addition, there is the speech of making the US an atypical point.

“The line is, yes, the US has an opioid overdose epidemic, but that’s not going to happen here. [no país em questão]”, she says, in an interview with Sheet.

Fugh-Berman cites a number of industry tactics that preceded the U.S. opioid epidemic that could be used in other countries, such as declaring that there is an epidemic of untreated pain, positioning opioids as the best drugs for chronic pain, ensuring doctors that screening and monitoring will prevent addiction and convince them to keep patients on opioids, even when they are ineffective.

The aggressive promotion of highly addictive pain relievers since the mid-1990s is considered by many to be the trigger for the opioid crisis, which has led to more than 500,000 overdose deaths in the last 20 years in the United States.

As they became addicted to these prescription opiates, many patients later began using powerful illicit derivatives such as heroin or fentanyl, the cause of many overdoses.

Last year, Johnson & Johnson and three US drug distributors accused of fueling the opioid epidemic said they were willing to pay $26 billion to settle thousands of lawsuits. Last month, drugstore chain CVS also struck a $484 million settlement to settle opioid lawsuits.

Other large labs, such as Purdue — maker of the drug OxyContin, which many consider to be one of the first responsible for the epidemic — Teva, Allergan and Endo, are also targets of lawsuits.

To prevent Brazil from facing a similar situation, Fugh-Berman recommends that the country study and discuss what happened in the US. “Fight any perception that there is an epidemic of pain and that the risks of opioids are exaggerated. Refuse any drug-funded education. Doctors need to lead the fight against this.”

According to her, medical advice needs to warn professionals about the risks. “New prescriptions for opioids should be limited to three days. No one should prescribe more than 90 mme (milligram equivalent of morphine) of opioids per day, except for addicted patients, who must be weaned slowly.”​

According to Brazilian doctors, the country is in a situation where it is possible to prevent a situation like the current one in the USA. But for that, it needs to invest in information aimed at the lay population and doctors about the correct ways to manage pain.

Brazil, at the same time that it sees the numbers of consumption of opioid drugs rise, it also faces another opposite reality: the undertreatment of pain. This makes patients who need these stronger medications often delay accessing them for fear of addiction on the part of both the doctor and the patient.

According to the International Narcotics Control Board, the consumption of morphine and its derivatives in Brazil is very low when compared to countries regarded as international models in palliative care, such as England and Germany. It would be 3 mg per capita in Brazil, against around 20 mg in these countries.

For anesthesiologist Silvia Tahamtani, a specialist in pain and palliative care at ICESP (São Paulo State Cancer Institute), there is a lack of medical knowledge about pain control. “There are two things we have to deal with: opiophobia, the fear of prescribing opioids and the patient becoming addicted, and opioignorance, the person who does not know how to properly use that medication.”

There are questionnaires that stratify the risk of dependence whenever a patient has an indication for opiates. Among the questions are whether he has family members with some type of addiction (alcohol, cigarettes and other drugs) or a history of abuse in pre-teens. Both are situations that predispose the patient to addiction.

For doctor Angela Sousa, also an anesthesiologist and pain specialist at ICESP, the lack of care in the pre-administration of opioids is the main factor that leads to dependence. “If the patient is at risk of addiction, I need to look at him even more closely. He needs to know that we are going to stay on top and that this is for his protection.”

Understand what opioids are and the risks

• Medicines derived from the poppy — a plant that is also the basis for the production of opium. They stimulate receptors in the brain and provide powerful pain relief.
• In addition, they reduce the anxiety and depression that often accompany episodes of intense pain.
• They also produce a feeling of euphoria, are highly addictive and can lead to overdose deaths and other harm. Therefore, there is a danger that they will be used irregularly.