PBS高端访谈:奥施康定制造商普度将停止向医生推销阿片类药物（在线收听）

Hari Sreenivasan: This week, the maker of Oxycontin, announced it is ending its marketing operation for the powerful opioid. Purdue Pharma is not giving up selling the highly profitable drug, but it will stop sending reps to doctors offices to drive sales of the addictive painkiller. Back in 2007, Purdue pleaded guilty to criminal charges of misleading the public about Oxycontin's addictive qualities and agreed to a civil penalty of nearly $635 million. This week's decision comes as Purdue and other opioid manufacturers are facing lawsuits from some 400 cities and states alleging they fueled addiction by misrepresenting the risks. Could Purdue's move change the course of America's opioid crisis? Lev Facher is a reporter with STAT News and joins me from Washington, D.C. tell me how significant this is?

Lev Facher: Symbolically this is huge. This is the company that really changed the paradigm for opioid use in the 1990s by aggressively marketing it to prescribers. The fact that Purdue has decided it's no longer going to go into doctor's offices an push this drug is really symbolic of where the country currently is in terms of considering the opioid epidemic a public health crisis and in terms of recognizing the potential harmful characteristics of drugs like Oxycontin.

Sreenivasan: What is the correlation between marketing them less and less of them being available on the street?

Lev Facher: Obviously, marketing drugs less should correspond to fewer sales. That said, this is not really a preemptive move. This is after years of declining Oxycontin sales. The Centers for Disease Control and Prevention issued recently new and much stricter guidelines for opiod prescription, so prescriptions are down, public awareness of the addictive qualities of these drugs is way up. And while there's still legitimate medical need and while prescriptions are going to continue, this is a move that more corresponds to a decline in sales than one that should fuel one.

Hari Sreenivasan: What are the factors that can actually decrease opioid consumption overall, or over prescription? It seems there is a tremendous amount of power in the hands of the insurance companies that choose to say that it's okay to prescribe these and that we'll pay for them.

Lev Facher: Yeah, and both insurance companies and public health providers like medicaid and medicare have taken steps, a variety of steps recently to reduce prescriptions and increase incentives to prescribe nonopioid, non-addictive pain killers. But again the marketing, I think, is less of something that is going to drive fewer prescriptions and more on Purdue's front on something that is meant to really change the narrative. They've been taking out full page ads in newspapers. They have been really trying to get out in front of the fact that they are increasingly viewed as a culprit. You mentioned the settlement in 2007. They are in talks to settle many of those other lawsuits from states and municipalities that you mentioned. So in terms of marketing, it's unclear of what level of impact that's going to have on prescription levels. But this comes amid really a sea change in the way physicians are prescribing opioids to begin with. And that has been happening over the last several years along with actions from the drug enforcement agency. A lot of different government agencies that are really taking steps to make sure that these drugs are used much less liberally.

Hari Sreenivasan: All right, Lev Facher of STAT News joining us from washington, thanks so much.

Lev Facher: Thanks, Hari.

哈里·斯瑞尼瓦桑：本周，奥施康定制药商宣布，由于阿片药效强劲，该公司将停止对本药进行市场营销。普度制药公司不是要放弃如此高盈利的药物，但它将停止向医生办公室派送医药代表，推销这种致瘾止痛药。2007年，普度制药承认，其在奥施康定的致瘾性上误导了公众，并接受了高达63,500万美元的民事罚款。本周此项决定的公布，正值普度及其他阿片制造商面临诉讼之时，大约400个城市及州份宣称这些公司故意误传该药物的成瘾风险，从而加剧了人们对它的药物依赖。普度此举可以改变美国的阿片危机进程吗？来自华盛顿特区STAT News的列弗·法彻，请告诉我此事有什么重要意义？

列弗·法彻：此举颇具象征意义。普度制药，通过大力进行市场推销，让医生开出处方，真的改变了上世纪90年代阿片的使用模式。对于近前正在经历公共健康危机，阿片类药物流行的美国，以及认识到像奥施康定这样药物的潜在伤害特性的美国而言，普度制药决定不再进入医生办公室推销该药品的这一举措，真的极具象征意义。

斯瑞尼瓦桑：营销的减少与市面上人们使用量的降低之间存在怎样的关系？

列弗·法彻：很明显，药品营销的减少应该对应销量的降低。这就是说，这并非一项先发制人的举措。奥施康定的销量将在此后数年内下滑。疾病控制与预防中心最近发布了新的更为严苛的阿片类处方指南，因此处方量下来了，公众对于这些药物致瘾效果的认识增强了。而对于此药，合法的医疗需求仍然存在，处方仍要继续开下去，此举更符合降低销量的需求。

哈里·斯瑞尼瓦桑：什么因素能真正促使阿片整体销量或处方的降低呢？似乎看起来，保险公司手中握有巨大的权力，这些权力让它们能够选择说“开出这些药品是可以的，我们会付钱给他们”。

列弗·法彻：是的，保险公司和公共卫生服务提供者，譬如医疗补助和医疗保险，近期都实施了举措，各种举措，来降低处方量，加大刺激（医生）开取非阿片类，非致瘾性止痛药。但是，还是营销，我认为，它不太像是要去减少处方量，而更多的是普度方面要去改变事态的手段。他们一直在报纸上打着整版广告。面对这种越发被视为罪人的局面，他们一直尝试摆脱。你提到了2007年的解决办法。他们积极斡旋，以摆平你刚提到来自各州及自治市的诉讼。所以就营销而言，它将在多大程度上影响处方量尚不清楚。但这是医生在开阿片类药物处方方面巨大改变的开始。伴随药品执行机构采取种种措施，这一改变在过去几年一直在发生。很多不同政府机构真的在采取措施，确保这些药物的用量真正锐减。

斯瑞尼瓦桑：好的，做客节目的是来自华盛顿特区STAT News的列弗·法彻，非常感谢。

列弗·法彻：谢谢，哈里。