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Dr. Marc Lévêque (Neurosurgery – Pain)
Just days after its launch on Netflix, the series Painkiller, which tells the true story of the opioid crisis in the United States, explodes records. This story resonates much more than you might think with the French situation. Dr. Marc Lévêque, neurosurgeon and pain specialist, answers our questions about drug addiction and its mechanism.
What is oxycidone, the scandalous drug in the Netflix series Painkiller?
Dr. Marc Leveque: “Oxycotin, or oxycodone, is the name of a derivative of morphine, more powerful than morphine, which promised at its launch to avoid addiction problems. This is what is told in the Netflix series. A drug originally touted by Purdue Pharma, which still operates in Europe under the name Mundipharma.
It is a product still sold in France currently, which is experiencing slippages as is currently the case in Aquitaine where prescriptions are soaring. And it is not the only painkiller that poses a problem: we also know that more and more French people are now dependent on Tramadol, another opioid which has the same active ingredients. The more you take to fight your pain, the more you are led to take more, without attacking the origin of the pain.
“Several mechanisms are put in place when taking oxycodone:
- On the one hand, a phenomenon of habituation: the more you take morphine, the more you need it;
- On the other hand, the longer you take morphine, the lower your pain threshold will be and the more sensitive you will be to it. The hyperanalgesia induced by opioids therefore paradoxically maintains the pain. It is a phenomenon that is becoming better and better informed, and which means that prescribing morphine for more than 3 months is not recommended.
Finally, there is a societal effect that will trigger a dramatic vicious circle: this chronic pain and this addiction make you quit your job, for example, prevent you from driving, isolate you… Which again maintains the pain.
“There has been deception in the United States. Purdue Pharma has touted a lower risk of addiction with Oxycotin. The painkiller was “supposed” to reduce cravings and resolve chronic pain without consequence. It was also aimed at chronic “non-cancerous” pain, therefore at people whose life expectancy was long. For this, the company engaged in significant lobbying, with very aggressive marketing, television clips intended for the general public… Today, we know that all the patients appearing in these clips died by overdose a few years later”.
Could such a crisis happen in France?
“To say that this American problem could not happen in France is false: French figures show that in 2015, nearly 10 million French people (i.e. 17.1% of the population) had already had a prescription for opioid analgesics, a figure that would be on the rise in recent years.Between 2006 and 2017, the prescription of strong opioids increased by around 150% according to the ANSM (oxycodone being the opioid analgesic with the most significant increase). And the prescription of oxycontin (another strong opioid) has increased by 25% in New Aquitaine in 5 years. Without real reflection, we are taking the same path as the United States”.
What are the measures that would prevent such a crisis in France?
“Admittedly, the marketing around opioids is not as aggressive in France (it is prohibited). But the problem is that we tend more and more to medicalize social problems, when there is no way out. : we will medicate back pain when we cannot affect working conditions for example. Same thing for chronic pain, because it causes problems of socialization, couple or family problems… (which will also do the pain medication).
Unfortunately, pain management centers are overcrowded, as is access to psychiatric care. Faced with patients who are in lasting pain, general practitioners have no choice but to use what they have on hand to relieve them, such as morphine, Tramadol or antidepressants. To put an end to this problem, it would be necessary to find more time with the patient, to take into account his fragilities, the context in which he evolves, and to question his way of life, the degree of social precariousness…”
Against chronic pain, are there alternatives to opioids?
“Yes there is. TENS, skin electrostimulation for example, works well, but it is more difficult to prescribe, because it can only be done by a qualified pain practitioner. Other non-drug alternatives are also possible like neuromodulation techniques, spinal cord stimulation, adapted physical activity, meditation, hypnosis, or even encouraging people to find an activity as soon as they can. But all this goes beyond treatment, c is a real policy of well-being that must be undertaken”.
Also read “Opioids: “Because of chronic pain, I took 6 times the allowed dose of morphine””