I should give a little context: I rarely prescribe opioids to opioid-naive patients — a more common scenario is patients who are already on a regimen that I then continue when they come into the hospital. And certainly not all opioids are the same, and some have less abuse potential, etc.
But it’s a good question. I feel the miscreance is often unrelated to whether there is value, simply because of the widespread nature of miscreance in drug and device marketing. And I do think the drugs in question have some value. I don’t know about Subsys in particular, but its FDA-approved indication, breakthrough cancer pain, is unfortunately quite real and quite horrible, and not fully understood as to why it doesn’t act like “normal” pain and respond to “normal” therapy the same way.
I think the challenge (and the concern) for me is that — in the U.S. at least — the drug you take, the artificial knee you have implanted, even the suture you get stitched up with — these are all sold to doctors with varying levels of aggression on the part of the manufacturers, because the doctor is the decision-maker and his/her buy-in is worth everything. (Thus, “Ask your doctor about...”) It doesn’t necessarily mean the drugs or devices or therapies aren’t the right choice... it just means doctors have this bizarre other force (money) to contend with in our decision-making. And subconsciously or consciously or (worst of all!) in bad conscience, as in this article, doctors choose the drugs they prescribe because they’ve been marketed to.
But it’s a good question. I feel the miscreance is often unrelated to whether there is value, simply because of the widespread nature of miscreance in drug and device marketing. And I do think the drugs in question have some value. I don’t know about Subsys in particular, but its FDA-approved indication, breakthrough cancer pain, is unfortunately quite real and quite horrible, and not fully understood as to why it doesn’t act like “normal” pain and respond to “normal” therapy the same way.
I think the challenge (and the concern) for me is that — in the U.S. at least — the drug you take, the artificial knee you have implanted, even the suture you get stitched up with — these are all sold to doctors with varying levels of aggression on the part of the manufacturers, because the doctor is the decision-maker and his/her buy-in is worth everything. (Thus, “Ask your doctor about...”) It doesn’t necessarily mean the drugs or devices or therapies aren’t the right choice... it just means doctors have this bizarre other force (money) to contend with in our decision-making. And subconsciously or consciously or (worst of all!) in bad conscience, as in this article, doctors choose the drugs they prescribe because they’ve been marketed to.