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Similarly, Andrew Kolodny, chair of the psychiatry department at Maimonides Medical Center and member of a group called Physicians for Responsible Opioid Prescribing, says cracking down on drug-dealing doctors and addicts who manipulate the system is necessary, but it doesn't get at the core problem.
"There has to be effective treatment," he says, pointing out that doctors are well-reimbursed for prescribing the pills but not so well-reimbursed for providing treatment for addiction. "What's more urgent is preventing new people from becoming addicted. The real problem is the well-meaning doctor who has been told for a decade that he needs to treat pain with opioids if he is going to be a compassionate doctor."
Kolodny's group joined several dozen doctors, researchers, and public health officials, including city health commissioner Thomas Farley, in petitioning the FDA to change the wording on opioid labels to make it harder for the drug to be marketed to patients with chronic pain not caused by cancer. They argue the labels allowing use for moderate to severe pain are too broad and leave a massive gray area that leads to overprescribing and abuse. "The labeling gives drug companies a license to promote opioids as safe and effective," he says.
A Purdue Pharma spokesman signaled that the company would resist a labeling change. He said the FDA believes current labels are "appropriate."
Organizations such as the American Academy of Pain Medicine and the American Pain Society also object to the label change. "We have serious concerns about the petition and believe the rationale is seriously flawed, potentially harmful to patients, and without substantive scientific foundation," AAPM president Martin Grabois wrote the FDA in August.
The FDA has yet to respond. In July, it overrode the proposals of an expert panel and opted not to require doctors to take special training before they would be allowed to prescribe painkillers. The American Medical Association also objected to mandatory training.Meanwhile, the pharmaceutical companies are said to be developing even more potent painkillers.