Russell Portenoy, MD, Switches Sides

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www.bloomberg.com

Opioid Evangelist Switches Sides in Case Alleging Pharma Abuse

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.
www.bloomberg.com www.bloomberg.com

"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."
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That dude right there has an immense amount of blood on his hands.
 
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SommeRiver said:
That dude right there has an immense amount of blood on his hands.
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not so fast...i was taught by one of his fellows. what Portenoy originally said was to adjust opioids until pain was diminished then leave the patient at that dose. if the pain increased on the same dose, the patient was a poor candidate for chronic opioids and was to be tapered off. now if you can find evidence he changed his thinking on this then perhaps i would agree with you. But i never read that. i do remember a whole lot of other academics telling me things that they had no evidence for, and when i called them on it, they agreed there was no evidence, just a lot of theoretical BS. But methinks they came after Portenoy.
 
willabeast said:
not so fast...i was taught by one of his fellows. what Portenoy originally said was to adjust opioids until pain was diminished then leave the patient at that dose. if the pain increased on the same dose, the patient was a poor candidate for chronic opioids and was to be tapered off. now if you can find evidence he changed his thinking on this then perhaps i would agree with you. But i never read that. i do remember a whole lot of other academics telling me things that they had no evidence for, and when i called them on it, they agreed there was no evidence, just a lot of theoretical BS. But methinks they came after Portenoy.
Click to expand...

What Portenoy said was that it is "uncommon" to have to escalate dosage in pts with nonmalignant pain. That and a million other things.
 

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willabeast said:
not so fast...i was taught by one of his fellows. what Portenoy originally said was to adjust opioids until pain was diminished then leave the patient at that dose. if the pain increased on the same dose, the patient was a poor candidate for chronic opioids and was to be tapered off. now if you can find evidence he changed his thinking on this then perhaps i would agree with you. But i never read that. i do remember a whole lot of other academics telling me things that they had no evidence for, and when i called them on it, they agreed there was no evidence, just a lot of theoretical BS. But methinks they came after Portenoy.
Click to expand...

Meanwhile, public IRS tax documents show Kalodny was making $463,000 per year working for a "non-profit" addiction center. That's good work if you can get it!

www.acsh.org

Andrew Kolodny Says Chronic Pain Patients Are PR Pawns for Big Pharma

Dr. Kolodny (1) has a long history of spreading misinformation about the opioid crisis; (2) insults chronic pain patients; (3) profits handsomely from doing so; and (4) calls everyone who disagrees with him an industry shill. The good doctor's version of compassion actually comes with poor...
www.acsh.org www.acsh.org

"Oh, he wants to talk about money? Let's talk about money. In 2016, while working for Phoenix House, Kolodny made $463,000 denying opioids to chronic pain patients. (That doesn't include his Brandeis University salary.) It's safe to say he makes well over half a million dollars per year, which is more than half of ACSH's entire budget."
 
SommeRiver said:
What Portenoy said was that it is "uncommon" to have to escalate dosage in pts with nonmalignant pain.
Click to expand...
exactly. Portenoy's big "contribution" was that nonmalignant pain patients seldom developed tolerance to opioids if they were given around the clock. But he always added that the patients that do develop tolerance are poor candidates and should be tapered off. So IF everyone had done exactly what Portenoy had advocated, most of the opioid crisis could have been avoided AND opioids would probably still be an option for non malignant pain. But a bunch of docs took the ball and ran out of the park with it. Well meaning docs. Who often got paid to speak. And i would listen. And go up after the talks and ask where is the evidence for what you are saying. And to a man they said there was none. The lesson here is that people advocate all the time for things they have no proof for, and the media gets hold of it and pretty soon one is an oddball for questioning the status quo. I would launch into a critique of the Democrats at this point but common sense dictates i crawl back into my corner.
 
willabeast said:
exactly. Portenoy's big "contribution" was that nonmalignant pain patients seldom developed tolerance to opioids if they were given around the clock. But he always added that the patients that do develop tolerance are poor candidates and should be tapered off. So IF everyone had done exactly what Portenoy had advocated, most of the opioid crisis could have been avoided AND opioids would probably still be an option for non malignant pain. But a bunch of docs took the ball and ran out of the park with it. Well meaning docs. Who often got paid to speak. And i would listen. And go up after the talks and ask where is the evidence for what you are saying. And to a man they said there was none. The lesson here is that people advocate all the time for things they have no proof for, and the media gets hold of it and pretty soon one is an oddball for questioning the status quo. I would launch into a critique of the Democrats at this point but common sense dictates i crawl back into my corner.
Click to expand...

Portenoy, for many years, was vocal about using opiates for nonmalignant pain. His approach was the same for malignant pain - Dose the pt until the pain goes away, and don't worry bc the pt won't develop tolerance or require dose escalation. That is absolutely the recipe for all of the bad things that come with opiate use. Just keep increasing the dose until the pain is gone. What self respecting doctor who has nothing financial to disclose would ever Rx opiates like that?

"Did I teach about pain management, specifically about opioid therapy in a way that reflects misinformation? Well, against the standards of 2012, I guess I did...We didn't know then what we know now."

Lie - He knew very well what was happening with addiction and misuse of opiates, OD deaths, etc.

"I gave innumerable lectures about opiates and addiction in the late 80s and 1990s that simply weren't true."

Portenoy is the past president of the APS. To say he didn't play a role in the problem is ludicrous.
 
He switching sides to save face, money, and possibly jail time. There is a word for a person like that -- a *****
 
SSdoc33 said:
He switching sides to save face, money, and possibly jail time. There is a word for a person like that -- a *****
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I cant say the wh- word that rhymes with door? Damn you studentdoctor upgrade
 
"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."

He sees the writing on the wall and is trying to get out while he's still wealthy and not behind bars bc HE KNOWS he intentionally lied and misled everyone. I wonder if he still feels pain is the 5th vital sign?
 
SommeRiver said:
Portenoy, for many years, was vocal about using opiates for nonmalignant pain. His approach was the same for malignant pain - Dose the pt until the pain goes away, and don't worry bc the pt won't develop tolerance or require dose escalation. That is absolutely the recipe for all of the bad things that come with opiate use. Just keep increasing the dose until the pain is gone. What self respecting doctor who has nothing financial to disclose would ever Rx opiates like that?

"Did I teach about pain management, specifically about opioid therapy in a way that reflects misinformation? Well, against the standards of 2012, I guess I did...We didn't know then what we know now."

Lie - He knew very well what was happening with addiction and misuse of opiates, OD deaths, etc.

"I gave innumerable lectures about opiates and addiction in the late 80s and 1990s that simply weren't true."

Portenoy is the past president of the APS. To say he didn't play a role in the problem is ludicrous.
Click to expand...
What Portenoy originally was saying when i did my fellowship in 1994 would not have brought on the opioid epidemic. He may have changed his spiel later on, and i probably missed it if he did, but i have yet to see any evidence that he advocated steadily increasing opioids in the face of tolerance, which was IMHO what sank the whole concept.
 
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willa, I think that seems revisionist history. his role goes deeper than dose adjustment.

if pourtenoy had not advocated for chronic opioid use for non-malignant cancer patients, widespread use would at least have been more delayed than how it occurred, which might have provided time to find greater clinical evidence confirming the believed risks of chronic opioid therapy.

yes, in a vacuum with him alone, rampant opioid prescribing might not have occurred.

but with concurrent voices - all conveniently funded by Purdue et all - of Fine, Fishbain, Passik, Webster, Tennant, it became a tidal wave, and his voice was noted based on his positions as a pain leader.
 
They tried to throw out 5,000 years of known human knowledge about human nature, mother nature, opiates and the poppy plant, and decided they knew better.
 
Ducttape said:
willa, I think that seems revisionist history. his role goes deeper than dose adjustment.

if pourtenoy had not advocated for chronic opioid use for non-malignant cancer patients, widespread use would at least have been more delayed than how it occurred, which might have provided time to find greater clinical evidence confirming the believed risks of chronic opioid therapy.

yes, in a vacuum with him alone, rampant opioid prescribing might not have occurred.

but with concurrent voices - all conveniently funded by Purdue et all - of Fine, Fishbain, Passik, Webster, Tennant, it became a tidal wave, and his voice was noted based on his positions as a pain leader.
Click to expand...
//Fine, Fishbain, Passik, Webster, Tennant, // They published after my fellowship, and being mostly interventional, i never read anything they wrote. But IMHO blaming Portenoy for the opioid crisis is like blaming the Wright brothers for airplane disasters. And i still feel that if opioids were prescribed the way Portenoy originally advocated they would still be a good option for many patients (and still are although the pendulum has swung again to the point where even terminal cancer patients are being denied opiates) - clear signs that the much of the USA is delusional, *****ic without logic or common sense and ruled by emotion rather than reason. It is scary to think just how stupid things have become on a national level. Many of you will wait for CNN to exonerate Portenoy before you do. Whatever...
 
emd123 said:
They tried to throw out 5,000 years of known human knowledge about human nature, mother nature, opiates and the poppy plant, and decided they knew better.
Click to expand...

exactly
first time I heard my attending talk about pseudoaddiction I chuckled because I thought he was kidding and it sounded ludicrous to me. I was not a popular fellow after that...
 
willabeast said:
//Fine, Fishbain, Passik, Webster, Tennant, // They published after my fellowship, and being mostly interventional, i never read anything they wrote. But IMHO blaming Portenoy for the opioid crisis is like blaming the Wright brothers for airplane disasters. And i still feel that if opioids were prescribed the way Portenoy originally advocated they would still be a good option for many patients (and still are although the pendulum has swung again to the point where even terminal cancer patients are being denied opiates) - clear signs that the much of the USA is delusional, *****ic without logic or common sense and ruled by emotion rather than reason. It is scary to think just how stupid things have become on a national level. Many of you will wait for CNN to exonerate Portenoy before you do. Whatever...
Click to expand...

I don't think anyone...blames him...I think we all feel he played a huge role though. Like I said earlier, he was the APS president at one point. He was paid by multiple pharmaceutical companies to say lukewarm things about chronic opiate use. Things that he knew wasn't true.
 
He taught physicians and fellows that high dose opiates were safe for a host of indications.

Portenoy’s high doses pale in comparison to when you and I talk about high doses.

he was not holding the matches but he told people that it would be safe to play with fire.
 
Notice that no one blames the drug addicts that lie to their doctors, cheat and steal to get medications?
 
emd123 said:
Notice that no one blames the drug addicts that lie to their doctors, cheat and steal to get medications?
Click to expand...

Hallmark of addiction is loss of control. It is the doctors fault for not doing their due diligence in assessing for the disease when the situation presents. Now blaming the DM for the BS>500 might be the same thing....donut holes in the pockets of one of my nurses....
 
lobelsteve said:
Hallmark of addiction is loss of control.
Click to expand...
Still no excuse from stealing from grandma to pay for your pills. Still no excuse for lying to your doctor to get pills so you can inject half and sell the other half at the High School Prom. Still not excuse for drinking and driving and killing a family of 4. Sorry, but the diseaseification of addiction has limits. One still has responsibility for their disease, it's treatment and it's effect on others. Just like someone with seizures is prohibited by law from driving for 6 months after a seizure, doing so and creating havoc "because you have a disease" is no excuse. I'm not sure normalizing addiction to reduce stigma and encourage treatment, as we have over the past 25 years, has the greatest track record. If anything it's made the problem worse. I see a helluva lot more people dying from drugs than I see dying from stigma.

lobelsteve said:
blaming the DM for the BS>500 might be the same thing....
Click to expand...
It's not the diabetic's fault he has the disease, but it is his responsibility to take his insulin.
 
Last edited:
lobelsteve said:
Hallmark of addiction is loss of control. It is the doctors fault for not doing their due diligence in assessing for the disease when the situation presents. Now blaming the DM for the BS>500 might be the same thing....donut holes in the pockets of one of my nurses....
Click to expand...
Depends, is that diabetic's glucose that high because their PCP is only giving them metformin despite an A1c of 12 or is it because they keep eating a dozen donuts for breakfast every morning?
 
emd123 said:
Still no excuse from stealing from grandma to pay for your pills. Still no excuse for lying to your doctor to get pills so you can inject half and sell the other half at the High School Prom. Still not excuse for drinking and driving and killing a family of 4. Sorry, but the diseaseification of addiction has limits. One still has responsibility for their disease, it's treatment and it's effect on others. Just like someone with seizures is prohibited by law from driving for 6 months after a seizure, doing so and creating havoc "because you have a disease" is no excuse. I'm not sure normalizing addiction to reduce stigma and encourage treatment, as we have over the past 25 years, has the greatest track record. If anything it's made the problem worse. I see a helluva lot more people dying from drugs than I see dying from stigma.

It's not the diabetic's fault he has the disease, but it is his responsibility to take his insulin.
Click to expand...
The 1970s called. They want their drug policy back.
 
er, no.

you make $50 a day, working 8+ hours minimum wage.

so... $25 for the insulin. $13 for 20 needles, and at 2 times a day, that will last 10 days. in a month, depending on how much insulin you use, that will run roughly $120-400 per month. no testing... guessing unless you include test strips, which increases cost ($10 for 50 at cheapest).

for someone making minimum wage (fed rates), that's 10% of your total salary.
 
Umm, no.

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100 syringes for $20.

If you're using 70/30 its BID dosing, to that is good for 50 days. Let's call it $12 for the month.

Most of my 70/30 patients are using roughly 50 units per day. So a vial will last 20 days. So let's say $40 for the month for insulin.

Most of my folks on 70/30 don't test routinely - if they aren't going to adjust their insulin its not needed.

So we're at $52 for the month. Or less than half of your minimum number.

Beyond that, if you're making minimum wage you easily qualify for free insulin through patient assistance programs run by the drug companies.
 
www.cnn.com

Americans borrow $88 billion annually to pay for health care, survey finds

Americans borrowed a staggering $88 billion in the past year to pay for health care, a new survey finds.
www.cnn.com www.cnn.com


btw, 100 syringes - need to include needle. $20 for the needles. makes it $40 for roughly 100. so $40 for insulin for 30 days using your estimate, add $20 for syringes, $20 for needles for 25 days. +/- $25 for test strips. cheapest is $88/month with no testing.

ill split the difference between your number and my higher number.



fwiw, the $120-400 per month is from a quoted JAMA study.


Lawmakers in Both Parties Vow to Rein In Insulin Costs
 
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I just saw that posted elsewhere earlier today. I find it a bit odd as most hospitals I've ever worked for or gotten care from will let you set up a payment plan with them. Why take out a loan, presumably with interest, if the hospital will let you pay your bill of over time without interest?

Do people just not know that this is an option or is this actually something fairly rare outside of my geographic area?
 
about 15% of my patients are on financial assistance (different from a bank loan). they know about it, and some use it. obviously, one has to qualify for it.

in terms of loans, however....

money.cnn.com

Hospitals are offering bank loans, but patients need to think twice

Hospitals are teaming up with lenders to offer low- or no-interest loans to patients. But health experts say promoting bank loans at hospitals and, particularly, in emergency departments, raises concerns.
money.cnn.com
 
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