I recently interviewed Lawrence Golbom, author of Not Safe As Prescribed.
Rosenberg: I found Not Safe as Prescribed to be a page turner. You captured the Pharma marketing apparatus from creating new “diseases,” bribing doctors and duping the FDA to phony patient groups, misleading research and the revolving doors between government officials and industry. You also really showed the connection to today’s heroin epidemic. Did you have to do a lot of research to get so many details right?
Golbom: Well, really the facts are out there. For seven and a half years I hosted a radio show called Prescription Addiction Radio and we had, as guests, Congressmen, medical experts, addiction experts, policy people, family members and affected patients who all exposed these practices. I am also a pharmacist by profession. In Not Safe as Prescribed, I simply tried to fill in what I imagined drug executives, the people behind these actions, were saying behind the scenes. I never dreamed I would write a book, but in the U.S. our growing drug culture for both legal and illegal drugs is affecting every community, person, family member or a friend. Everybody knows somebody struggling from too many drugs. That was my motivation.
Rosenberg: Not Safe as Prescribed is based on actual events that have helped Pharma establish its current dominating influence on Americans’ lives. As a reporter, I certainly knew about how the Sacklers, a New York family of physicians and philanthropists, parlayed their lucrative morphine franchise into OxyContin which they said they did not want to be “limited” to cancer pain. But the Sacklers, called the Mucklers in your book, also put benzodiazepines, notably Valium, on the map for Mr. and Mrs. Front Porch which I did not know.
Golbom: In Not Safe as Prescribed, Arturo learns the family’s new methods of marketing drugs from his father; in the case of the Sackler family, brothers Raymond and Mortimer learned from their older brother Arthur. He is credited with finding enough different uses for Valium to turn it into the first drug to make $100 million and creating tit-for-tat, reciprocity relationships with doctors, now the U.S. norm. The three Sackler brothers bought Purdue Pharma, who makes OxyContin, in the 1950s.
Rosenberg: Your book shows the insidious but successful transition in the 1960s of prescription drugs for a few to appropriate for everyone—because everyone has stress, frustration, blue days etc. In those days “housewives” and “businessmen” needed psychoactive drugs for their daily stresses. What I found chilling was how the same umbrella marketing has created the current opioid addiction epidemic.
Golbom: Yes. Soon after the launch of OxyContin in 1996, Pharma was able to have pain designated as the “fifth vital sign” to be monitored just like blood pressure. Suddenly almost everyone had pain and the new, field of “pain medicine” staffed by “pain management doctors” was born and monetized. We know what happened then. Estimates say more than 91 people a day are dying from opioids or the heroin they turn to when they can’t get opioid drugs. A part of my book highlights the sad state of the treatment of our veterans from the VA. Last estimates were 22 veterans a day were committing suicide. In my opinion, a direct result of the VA’s penchant for prescribing too many pills.
Rosenberg: After pain became a “vital sign,” the field of “addiction medicine” was born.
Golbom: The drugs to treat OxyContin addiction like buprenorphine, sold as Suboxone, are opioid derivatives that are 10 to 20 times stronger than OxyContin. After 8 hours of training, addiction specialists have a wonderful revenue stream. MAT—medication-assisted treatment—has doubled Pharma’s revenue.
OxyContin addiction also drives other drug sales. To quote the medical director behind the Muckler opioid marketing in my book, “People are hooked on OxyXR and the psychiatrists are diagnosing them as either depressed or bi-polar. If I took an OxyXR for a month I’d be depressed too. With the diagnosis of addiction as a disease, psychiatrists salivate knowing a five minute office call every month is in the future.”
Very early in its marketing of OxyXR, the Mucklers draw a line in the sand between “used as prescribed” and “abuse” to insulate the company from the growing thousands of deaths. By dismissing the overdose casualties and addicts as “abusers,” they are able to maintain that OxyXR is the leading “pain reliever” with no safety issues if used as prescribed.
Golbom: I think the older generation is pretty hopeless. They have been duped into our present drug culture. The baby boomers have bought into the powerful “drugs for everyone” Pharma message whether it’s the use of statins and GERD medicines, mood drugs or opioid-based pain pills. But I hope the younger generation can escape our present day drug culture.
For example, the long-term effects of the ADHD drugs millions of children are prescribed are dangerous and starting to emerge. One promoter of ADHD meds recently developed atrial fibrillation, a possible side effect from the powerful amphetamines parents pour down their children’s throats. The effects of the SSRI depressants millions are on are also shocking—they are linked to bizarre homicides and suicides, including among young people in the military. In the last decades, people addicted to drugs no longer go to mental health facilities which have been shut down—they increasingly go to prison.
We are also experiencing a huge autism epidemic which clearly has outside factors since I doubt our gene pool has changed.
Rosenberg: The character development in Not Safe as Prescribed is interesting as so much money is made. Some of Muckler’s operatives are without conscience or able to rationalize their deeds. Jeremy, the protagonist of the book, was unable to rationalize his job once his cousin dies from opioids. Early in the book, a skeptic about OxyXR’s safety who the company felt could do harm to its sales is literally killed. Jeremy ends up facing the same risks.
Golbom: Yes there is moral tension in the book and a shocking ending that people will enjoy. But sadly Pharma has money on its side because there is no money in prevention and education. As the kingpin OxyXR marketer, Auturo Muckler sums it up in the book, “I love drugs. Whether you take them, make them, use them, sell them, grow them, arrest people who have them, sentence people who got caught with them or run the jail houses, everyone makes money.” I think I left out the undertaker.
Not Safe As Prescribed can be found here.