(Prosecutor Brownlee testified two months later that the night before his office secured the guilty plea, he had received a call from then-chief of staff to the Deputy Attorney General Michael Elston, who reportedly told Brownlee to slow down. Brownlee settled the case anyway, and eight days later, his name appeared on a list compiled by Elston of prosecutors who should be fired.)
Purdue paid $470 million to various federal and state agencies, and $130 million to resolve civil disputes brought by pain patients claiming they became addicted to Oxy after it was prescribed to them. The FDA also mandated that Oxy come with a "black-box warning," or the strongest alert the FDA can require.
"I think the fact that Purdue concealed evidence and said OxyContin was not addictive was not that different from what the tobacco industry did," Ballantyne said.
Today, many doctors are wary of prescribing opioid-based painkillers, but few would advocate for banning their use altogether. There just aren't other drugs available that manage pain like opioids can.
That puts doctors and other prescribers in a delicate position. If a patient has already exhausted the traditional arsenal of pain-management tactics — physical therapy, spinal injections, acupuncture, massage, etc. — and the doctor is mandated to treat pain, opioid-based pharmaceuticals become the last resort.
"It's really hard to see a patient and tell them you don't want to prescribe opioids, and then they look at you like, 'Okay, what else are you going to give me?' " said Dr. Mark Drews, associate medical director at Whittier Street Health Center in Roxbury. "Most of the time, it looks completely legitimate and believable."
Drews said the time he spends on monitoring patients with chronic pain has increased exponentially. Not only is he trying to figure out if his patient is improving, he's also in the position of making sure they aren't getting addicted.
"It's a weird situation that we're in when you're a doctor and an advocate but you're also trying to figure out if your patient is lying to you," Drews said. "Sometimes it's really obvious, but sometimes it's not."
Drews said he regularly screens his patients with urine toxicity tests, which reveal whether or not they've been taking more medication than they've been prescribed. He also looks up the prescription history of any new patient to see whether or not they're being prescribed the same medication by other doctors, but that can only rout out certain types of abuse or diversion.
"It seems like I'm spending a huge amount of my day monitoring people who are taking narcotics," Drews said. It's a problem, he adds, that "definitely didn't exist 20 years ago."
There's at least a partial solution to Drews's dilemma: prescription drug monitoring programs, or PDMPs, which endeavor to track patients and prescriptions, prevent addicts from "doctor shopping" (or obtaining multiple prescriptions of the same drug from multiple doctors), and catch "pill mill" doctors. The PDMP bill just signed into law automatically registers prescribers in the system when they renew their professional license, and it requires them to use it when they first prescribe an opioid to a new patient.