Phew! I'm glad that's finished...

But now the real work begins

Over the last three months I have been really distracted. I have been working on what I hope will prove to be a significant and impactful research monograph investigating how Australia and New Zealand were misled into believing there was a huge opioid crisis that needed large sums of research money and a long sequence of unsuccessful regulatory responses.

Today I finally finished the first (rough) draft of that monograph and have shared it with a couple of senior academics to review and comment on. While they tear apart my work, check my working out and follow my references, I have to get back to matters Letby…

However, for today I am going to share with you an intentionally comical tongue-in-cheek summary of the entire 100+ page book that someone asked me to write a few weeks back.

Enjoy!

Once upon a time there were three research labs. Except they weren’t three research labs. There was a single amorphous research lab masquerading as three separate research labs spread across two universities. These three research labs evolved out of the work of three senior academics. And where it was useful, they drew in other established academics. They also spawned a couple of sub-project offices and became involved with national NGOs, one in particular that has become very well known in the addiction space in Australia that we will come back to later. These researchers realised that the traditional Triple Helix model of knowledge transfer between University, Industry and Government could be exploited - and so, ostensibly, that seems to be what they set out to do. 

In the early 2000s they realised that if you could hyperbolically exaggerate the problems of drug addiction, there was plenty of public money to be had. They positioned themselves in key groups, attended the right government meetings, and started beating the right drums. They made very loud music - that music started to bring in the money... but they needed a more targeted need because everyone else was already going after the funds for studying the street drugs. So they did two things. First, they positioned themselves in organisations like the well-known NGO and second, they attended a National Drugs summit where one small key part of the discussion stood out - nobody knew how to quantify the use, potential harms or need for control of freely available weak opioids like low-dose low-strength codeine medications that were, at the time, available in supermarkets. They saw that countries like South Africa were considering making these drugs pharmacy or prescription only on the basis of some pretty weak studies of coded hospital admissions data, and set about creating that body of research for Australia. Over the first couple of years they managed to create enough noise to get some small grants and help create an upswelling for making OTC codeine products pharmacist-only. Wow... they thought, that worked. What can we do next? 

They needed a new target because all the data they had showed that making OTC codeine pharmacist-only hadn’t done anything at all to change the (then, and still now) small percentage of opioid drug addicts. So they re-focused their efforts on blaming OTC codeine yet again, except this time they said it wasn’t enough to have made it pharmacist-only. Now, it needed to be made prescription only. At around the same time and still sporting their black eye in Australia for several dodgy practices, Reckitt Benckiser (manufacturer of Nurofen Plus and several of the opioid-naloxone tablets and wafers) realised that there was more profit to be made from getting their OTC products off the shelves because they were no longer in patent and had gone generic, and RB was no longer making increasing profits from them. They decided to fund studies by academics who were going to try and get these OTC codeine generic products restricted, because they saw that the way to make money was to get more people who would otherwise self-treat with weak OTC codeine to go to the doctor and get a prescription for oxy-naloxone or buprenorphine or something else that at the time was still under patent, but was also on the PBS. Win-win right? Our researchers get to keep the money coming in, and the pharma companies get to make profit by diverting customers (I mean, patients) away from generic OTC meds and onto expensive, publicly funded, stronger prescription opioids. 

By 2015/16 our little group of researchers had amassed a small army of research assistants and were at a minimum 60-strong. They had published hundreds of papers with, similar to the South African studies, poorly framed and heavily biased data and conclusions that exaggerated the scale and scope of the so-called “opioid epidemic” in Australia. They were bringing in between AU$20-150mil per year in research grants from both the government research funding bodies, and the pharma companies. They were also either on the board of, or working as research assistants for the NGO. One of our academics had supplanted the Executive Director of the NGO as that person went off to run a new NGO. The NGO was getting tens-of-millions of dollars each year to run unproven so-called education programs in schools and treatment programs for drug and alcohol addicted people (and sex addicts and internet addicts and porn addicts and... you get the idea). Most of the addicts the NGO were treating were alcohol addicts, but the NGO had a vested interest in helping to exaggerate the opioid epidemic tag line. The NGO wrote press releases that were quoted almost verbatim by politicians and the money was rolling in. Much of that money the NGO directed towards the three-but-really-one research groups. Other pharma companies like Seqirus had come on board and were paying our academic researchers to produce research that made patented medication like Tapentadol look like the wonder-drug of opioids. They buried the bad news and created research results that mirrored the Oxycontin scandal of America. Tapentadol was the safest drug that caused almost no adverse effects and was less addictive than anything else that had ever come before. Except that, when you looked underneath the lie to the data, what you find is Tapentadol has an addiction and adverse event profile very similar to Oxycontin. But let’s not dwell on the negative. 

To top it off, their second ‘research focus’ was coming to fruition. In 2018 OTC codeine products were made prescription-only. This would hopefully mean more patients getting more prescriptions rather than self-treating with those pesky generic OTC codeine preparations... right? Maybe. However, the so-called opioid epidemic needed a new ‘victim’ in order to keep the cash rolling in. Our little group of researchers switched gears a third time and shifted the narrative to prescription opioids (PO), and the need to reduce prescribing and supply to all of them. All except Tapentadol manufactured by the CSL company still funding much of the non-govt research grants coming in - Seqirus; and Buprenorphine, manufactured by their other sponsor - Indivior. And let us not forget Naloxone from Mundipharma, which has become the latest research-funding in return for favourable research output pharmaceutical manufacturer. While they published a small group of papers proclaiming that their OTC codeine up-scheduling was an unrivalled success, they started publishing papers saying that prescribing of other out-of-patent opioids (Tramadol, full-strength codeine, morphine etc) was harming patients and they were now considered the cause of the trumped up, completely exaggerated ‘opioid epidemic’. As it stands, over the last 2 years Tapentadol is the ONLY remaining opioid with increasing prescriptions on the basis that it has been promoted to GPs as a wonder-opioid that, like Oxycontin, never or rarely produces addiction. Yet, and as we will see at the end of the story, according to our group of researchers the opioid epidemic is still here and getting worse. 

Our academic researchers and many of their former PhD students and research assistants have likely made considerable income from this enterprise. They were collecting their academic salaries from the universities, and very probably even higher secondary salaries from their roles within the NGO. Their conflict of interest admissions also suggest they have drawn income from presenting CPD training, speaking, consulting on behalf of the pharmaceutical companies who have been sponsoring their research. All the while, they have reshaped the market in favour of industry, made some politicians wealthy (the politician’s super fund owns a $600mil stake in Seqirus), and appear to have little consideration for the average Australian who, well at least 98% of whom based on these researchers own data, were using OTC codeine appropriately when in pain and for whom now OTC codeine and other low-dose low-strength pain relief are unavailable. What some research now shows is increased use in unregulated, less safe home-lab-made street opioids (heroin, cocaine etc.). Australia has effectively been brought full circle and some people may have been pushed back to the more dangerous end of the opioid spectrum.

But to our little group of opioid researchers we say...

Well done You!

I expect to have 3 or 4 academic papers prepared and submitted from or relating to the manuscript content by the new year. After that, I intend to self-publish the entire work as a research monograph.

Stay tuned!