by Charles Ornstein and Tracy Weber

A version of this story was published in The Washington Post.

As the U.S. Senate Finance Committee launched an investigation Tuesday into makers of narcotic painkillers and groups that champion them, a leading pain advocacy organization said it was dissolving “due to irreparable economic circumstances.”

The American Pain Foundation, which described itself as the nation’s largest organization for pain patients, was the focus of a December investigation by ProPublica in The Washington Post that detailed its close ties to drugmakers.

The group received 90 percent of its $5 million in funding in 2010 from the drug and medical-device industry, ProPublica found, and its guides for patients, journalists and policymakers had played down the risks associated with opioid painkillers while exaggerating the benefits.

It is unclear whether the group’s announcement Tuesday evening — that it would “cease to exist, effective immediately” — was related to letters sent earlier in the day from Sens. Max Baucus, D-Mont., the finance panel chairman, and Charles Grassley, R-Iowa, to the foundation, drug companies and others.

In the letters, the senators cited an “an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers,” including popular brand names like Oxycontin, Vicodin and Opana.

The American Pain Foundation’s website carried a statement Tuesday night saying its board had voted May 3 to dissolve the organization because it couldn’t stay “operational.” The foundation did not respond to requests for comment Tuesday.

The senators are targeting a who’s who of the pain industry, seeking extensive records and correspondence documenting the links, financial and otherwise, between them and the makers of the top-prescribed narcotic painkillers.

Letters went to three pharmaceutical companies, Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson, as well as five groups that support pain patients, physicians or research: the American Pain Foundation, American Academy of Pain Medicine, American Pain Society, Wisconsin Pain & Policy Studies Group, and the Center for Practical Bioethics.

The Federation of State Medical Boards, the trade group for agencies that license doctors, received a letter, as did The Joint Commission, an independent nonprofit that accredits hospitals nationwide and made pain management a national priority in 2001.

A report by the U.S. Government Accountability Office in 2003 noted that the commission partnered with Purdue Pharma, the maker of Oxycontin, to distribute pain educational materials nationwide. The committee’s letter to Purdue noted that the company pleaded guilty in 2007 to federal criminal charges that it misled regulators, physicians and consumers about Oxycontin’s risk of addiction.

The senators requested payment information since 1997 to 10 groups and eight people, including two doctors featured in ProPublica’s December report.

They asked about any influence the companies had on a 2004 pain guide for physicians that was distributed by the Federation of State Medical Boards; on the American Pain Society’s guidelines; and on the American Pain Foundation’s Military/Veterans Pain Initiative.

In addition to citing ProPublica’s work, the letters also mention the reporting of the Milwaukee Journal Sentinel and MedPage Today.

Patients in serious pain need access to opioids, the senators wrote, but drugmakers and health-care groups “must distribute accurate information about these drugs in order to prevent improper use and diversion to drug abusers.”

“The problem of opioid abuse is bad and getting worse,” Sen. Grassley said in a statement. “Something has to change.”

Earlier Coverage:

“When it comes to these highly addictive painkillers, improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk,” Baucus said in a prepared statement.

Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in Brooklyn, N.Y., and president of Physicians for Responsible Opioid Prescribing, applauded the investigation.

“These groups, these pain organizations … helped usher in an epidemic that’s killed 100,000 people by promoting aggressive use of opioids,” Kolodny said. “What makes this especially disturbing is that despite overwhelming evidence that their effort created a public health crisis, they’re continuing to minimize the risk of addiction.”

Concerns about the overuse and abuse of painkillers have intensified in recent years. As sales of the powerful drugs have boomed — rising 300 percent since 1999 — so, too, have overdose deaths.

Opioids were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined, according to the U.S. Centers for Disease Control and Prevention.

In 2009, the use and misuse of the drugs were cited in more than 475,000 emergency department visits, nearly doubling the 2004 number, the CDC said.

Pain doctors and patient groups say that while drug overdoses are a legitimate concern, only a small percentage of deaths involves patients who receive them from their doctors. Most deaths involve illicitly obtained drugs, statistics show.

The groups also say that patients’ risk is low if they do not have addictive personalities, and that any restrictions should not punish patients who suffer from serious pain.

In recent weeks, two articles in medical journals have documented different aspects of abuse.

According to a paper published online this week by the Archives of Pediatrics & Adolescent Medicine, one of every eight high school seniors surveyed said they had used prescription opioids for nonmedical reasons.

A paper released last month by The Journal of the American Medical Association found that the rate of newborns diagnosed with drug withdrawal jumped threefold from 2000 to 2009.

And the rate of mothers using opioids at the time of delivery was five times higher in 2009. (Not all babies born to mothers using the drugs exhibit signs of withdrawal.)

Janssen Pharmaceuticals, a Johnson & Johnson subsidiary that makes the painkiller Nucynta, said in a statement that it “is committed to the responsible prescribing and appropriate use of opioid pain medications” and has supported educational websites about safe use.

The company is reviewing the senators’ letter and “will work with them to fulfill their request for information,” spokesman Mark Wolfe said via email.

Purdue Pharma acknowledged in a statement that it had received the letter, was reviewing it and looked forward to “cooperating with the committee on this matter.”

Endo did not return a request for comment. A spokeswoman for The Joint Commission said the group had just received the senators’ letter and had no comment yet. The Federation of State Medical Boards responded but did not offer immediate comment.

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The company issued the recall after receiving complaints from consumers who reported difficulty using the Infants’ Tylenol  SimpleMeasure dosing system.

SimpleMeasure includes a dosing syringe, which a parent or caregiver inserts into a protective cover, or “flow restrictor,” at the top of the bottle to measure the proper dose.

In some cases, the flow restrictor was pushed into the bottle when inserting the syringe, the company said.

Consumers can continue to use Infants’ TYLENOL provided the flow restrictor at the top of the bottle remains in place, the company said.

If, however, the flow restrictor is pushed into the bottle, the parent or caregiver should not use the product, the company said.

The company has made a video on how to use the new dosing system - click on image to view.

No adverse events associated with this action have been reported to date and the risk of a serious adverse medical event is remote, the company said.

Consumers can request a refund by visiting www.tylenol.com or contacting McNeil at 1-888-222-6036 (Monday-Friday 8 a.m. to 8 p.m. Eastern Time; Saturday-Sunday 9 a.m. to 5 p.m. Eastern Time).

Parents and caregivers with any health questions or concerns should contact their healthcare provider and visit www.tylenol.com for additional information

By Bill Scott

After reading recent media reports such as The Seattle Times series, “Methadone and the politics of pain,” I’ve been saddened to learn of the overwhelming number of Washington residents living in chronic pain and/or addicted to painkillers. Also, the near universal frustration of both patients and providers for solutions is alarming.

I’m sure that all caring persons agree that no one should ever be left in agonizing pain, but is increasing dependence on painkillers the only answer?

For instance, why is this largely an American problem? With less than 5% of the world’s population, Americans consume 80% of painkillers sold. A recent comment on the Times website noted, “I just worked in Cuba. There (are) NO narcotics except for a couple of doses after major surgery. Tylenol is over the counter and ibuprofen by prescription. Somehow they manage and they have a lot less pain. Consider that paradox? They have no pain medicines and have less pain?”

According to recent news reports, I’ve been encouraged to hear that some patients are managing to get off painkillers, including Cynthia Toussaint. From an ABC NEWS report last June, she “was confined to her bed, writhing in pain from muscle spasms, unable to walk or to live a meaningful life.”

Yet, ten years later, after turning to a variety of integrative medicine treatments, she resumed her singing career. Toussaint noted, “There’s a whole range of under-appreciated non-traditional treatment options that are low-cost, effective and with no side effects.”

A recent article in The St. Petersburg Times explains how addiction to prescription painkillers nearly killed ex-NFL star Randy Grimes. Yet, at a point that Grimes describes as “a spiritual moment,” he began to regain control of his life, found renewed purpose and now works to help others to overcome the same addiction. Throughout my entire life, I’ve taken a spiritual approach to my own health and have experienced consistent, positive results.

It’s also encouraging to read reports on therapeutic approaches that focus on thought and the mind in reducing pain. Studies at Stanford, Duke and Wake Forrest Universities have proven many mind-body approaches to be effective in clinical trials.

One reason alternative therapies are not more commonly used by the public appears to be the lack of insurance coverage. According to The Seattle Times, Rep. Jim Moeller believes it is “unfortunate” that Medicaid covers narcotic painkillers but not alternative treatments.

However, there are signs this may be changing. From a recent press release, starting in July of 2012 the 13,000 employees of Maricopa County, Arizona will soon have the option of an integrative approach “that embodies the philosophy and practice of healing oriented medicine, addressing mind, body and spirit.”

Specialists who work with patients dealing with pain have told me they support expanding health coverage to include alternative therapies that are less obtrusive and generally more affordable.

On Dec. 16, the Obama administration surprised many by declaring that each state will now be allowed to have greater freedom in what their respective health exchanges will include.

This may be a unique opportunity to include alternative treatments, especially the treatments that already qualify as medical expense deductions for federal income tax purposes. Including alternative therapies in health insurance will make them more accessible to patients who may be struggling to find better ways to manage their pain.

This article first appeared on Blogcritics.

A retired architect, Bill Scott writes about spirituality and health for Blogcritics.org and also serves as the Christian Science Committee on Publication for Washington State.

In the series, the Times reported that in order to save money the state steers Medicaid patients, workers’ compensation recipients and state employers toward methadone, a long acting drug that costs less than a dollar a dose.

The drug’s effects, however, are unpredictable, increasing the risk of overdose, and the Times investigators found that since 2003 at least 2,173 people in Washington had died from unintentional overdoses linked to the drug.

In today’s article, the Times writes:

The health advisory marks the first public acknowledgment by a powerful state committee that methadone can be more unpredictable than other pain drugs, or opioids. State officials had previously resisted attempts to single out methadone for special treatment, insisting the drug was as safe and effective as any other narcotic pain drug.

To learn more:

• Read today’s article in the Seattle Times: State plans emergency warning on risks of methadone.

Read the Seattle Times series:

Part 1: Silent deaths

State pushes drug that saves money, costs lives

Timeline: State defends methadone as deaths rise

How we did it: our analysis

Part 2: Politics of pain

New law leaves patients in pain

Source documents

Part 3: A troubled clinic

In pain clinic’s wake: doubts, chaos, deaths

Source documents

Graphics

More deaths from methadone than other drugs

The paper argues drug is dangerously unpredictable and responsible for the deaths of hundreds, particularly among the poor.

At the same time, the state has adopted tough new prescription rules that are making it difficult for patients with chronic pain to find doctors willing to treat them, the paper reports.

The series is written by Seattle Times staff reporters Michael J. Berens and Ken Armstrong.

To learn more read the paper’s series: The Politics of Pain.

• State pushes drug that saves money, costs lives

To cut costs, Washington steers Medicaid patients to a narcotic painkiller that costs less than a dollar a dose. The state insists methadone is safe. But hundreds die each year — and more than anyone else, the poor pay the price.

• New state law leaves patients in pain

It was meant to curb rising overdose deaths. But Washington’s new pain-management law makes it so difficult for doctors to treat pain that many have stopped trying, leaving legions of patients without life-enabling medication.