Pandora's Lab: Seven Stories of Science Gone Wrong

by Paul A. Offit

On March 15, 2016, the Centers for Disease Control and Prevention (CDC) finally offered guidelines for the sensible use of prescription painkillers, stating that doctors should prescribe them: (1) only after nonprescription painkillers like ibuprofen and physical therapies had failed; (2) in quantities not to exceed a three-day supply for short-term pain and rarely longer than seven days (typically, patients are given two weeks or a month worth of pills); and (3) only when improvement was significant. The guidelines did not apply to patients who were receiving painkillers for cancer or end-of-life treatment. The American Academy of Pain Management—a group that receives funds from Purdue and Teva Pharmaceuticals—and the Washington Legal Foundation, which frequently represents pharmaceutical company interests in court, opposed the new guidelines. After all, painkillers were now a $9 billion a year industry. Robert Twillman, executive director of the academy, didn’t like the three- to seven-day dosing recommendation. “The numbers are still arbitrary,” he said. But Tom Frieden, director of the CDC, had had enough. “For the vast majority of patients with chronic pain,” he countered, “the known, serious, and far too often fatal risks far outweigh the transient benefits. We lose sight of the fact that prescription opioids are just as addictive as heroin.” Today, 80 percent of the world’s opioid prescriptions are written in the United States, even though only 5 percent of the worl...