The DPF rally at Brandeis calls into question Dr. Kolodny's role in the opioid epidemic
An investigation into the nuances behind the opioid crisis and the DPF's history reveals a complex web of perspectives.
The Doctor Patient Forum, an organization that raises awareness for chronic pain patients who cannot access pain medication, hosted a protest in front of the University on Oct. 25 to call for the immediate dismissal of Dr. Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management. The protestors presented three major claims: that Kolodny is profiting from his advocacy to limit opioid prescriptions, that chronic pain patients who cannot access painkillers are increasingly taking their own lives, and that opioid overdoses increased because of Kolodny’s advocacy to limit opioid prescriptions.
In an Oct. 25 interview with the Justice, Claudia Merandi, the executive director and president of the DPF, claimed that Dr. Kolodny and the other members of PROP are spreading “misinformation against opioids” that has made accessing pain treatment difficult.
The DPF’s website claims that an estimated 40 million Americans experience severe chronic pain, approximately 5 to 8 million patients are on daily opioid therapy for pain, and 40% of doctors refuse to accept new chronic pain patients on daily opioid medication.
The Center for Disease Control and Prevention reports that “in the United States, annual opioid prescribing rates increased from 72.4 to 81.2 prescriptions per 100 persons from 2006 to 2010, were constant from 2010 to 2012, and then decreased by 13.1% to 70.6 per 100 persons from 2012 to 2015.”
“Except for maybe COVID, the opioid addiction epidemic is the most urgent, worst public health crisis we’ve faced in the past 100 years,” said Kolodny in an Oct. 28 interview with the Justice. “What drug companies did that caused an epidemic of opioid addiction in the United States is they promoted opioids to be used in the highest possible doses for the longest possible duration.” According to the National Institutes of Health, three million U.S. citizens and another 16 million individuals worldwide had or currently suffer from opioid use disorder.
Kolodny claimed that the reason “is that the medical community was responding to a brilliant, multifaceted campaign launched by companies making opioids like Purdue [Pharma].” The campaign disguised the marketing of drugs as education and advocacy that would help patients suffering from chronic pain.
According to the National Institutes of Health, the shift in discourse from “opiophobia” to “inappropriate prescribing” illuminates the tensions between the important issue of chronic pain, the lesser-known role of the pharmaceutical industry in pain-management training, and the moral conflict that physicians faced between offering their patients relief with opioids and preventing addiction.
Since 2010, Kolodny has been the president of Physicians for Responsible Opioid Prescribing, an organization dedicated to promoting cautious opioid prescribing practices in an effort to reduce opioid addiction and overdoses.
“Not treating pain with opioids has been an abject failure in the United States,” Merandi said. “Unfortunately, overdoses will only continue to increase because people are hitting the streets now for pain relief.” She claimed that overdoses have increased by 600% because of Kolodny’s involvement in the opioid crisis.
Merandi herself is a chronic pain patient with Crohn’s Disease. She is dependent on two forms of chemotherapy and receives medication through a port. “When I come out of remission, I have terrible, terrible pain. Opioids help me with that pain. While I don’t need to take them every day, when I need them, I should be able to have them,” she said.
During the DPF demonstration, Merandi and the other protestors claimed that the government and the CDC contracted and paid Koldony to advocate against opioid prescriptions. One of the signs they held read, “Andrew Koldony is making a fortune off the pain of sick and disabled patients.”
Merandi also stated that Kolodny was paid as a consultant for opioid-related series such as “Dopesick” on Hulu and “Painkillers” on Netflix.
“He’s basically addicted to two things: lying and money,” Merandi said.
When asked to verify the claims about how he makes his money, Kolodny explained that he has worked with several states since 2019 to sue the opioid industry for causing the opioid crisis. “I’m very proud of that work,” he said. He hopes that his work will cause billions of dollars to come into the States over the next decade to “help clean up the mess that these companies caused through their greed.” Kolodny emphasized that the effort is a work in progress to ensure that states do not misuse the earnings from the lawsuit. He confirmed that he is paid as a medical witness.
In a previous testimony against Johnson & Johnson, Kolodny said that the state paid him $725 an hour to assist Oklahoma attorneys in preparing their case and to appear as an expert witness. According to his estimates, he received $300,000 to $500,000 at the time of his pretrial deposition.
Kolodny also confirmed to the Justice that he was a medical advisor for Dopesick to make sure the scripts were medically and historically accurate. “I don’t have some cut or share in it, but I was involved in producing it. And I am extremely proud of my role. I was not a big fan of the Netflix show ‘Painkiller.’ I think it’s too sensationalized, not historically accurate enough, overly dramatized. But ‘Dopesick’ is something that I think everyone should watch.”
He stated that he was paid “a modest amount of money,” estimating a few hundred dollars for reading each script.
“Dopesick” focuses on the conflicts of interest between Purdue Pharma and various government agencies such as the Food and Drug Administration and the United States Department of Justice as well as the legal case against Purdue Pharma and their development, testing, and marketing of the drug OxyContin.
Purdue Pharma is owned by the Sackler family, who have faced multiple lawsuits regarding the overprescription of addictive pharmaceutical drugs, especially OxyContin. For their role in the opioid epidemic in the United States, the Sacklers have been referred to as “the most evil family in America” and “the worst drug dealers in history.”
On the DPF's X account and TikTok account, Merandi has posted multiple tweets and TikToks defending the Sackler family as the “scapegoats” for the opioid epidemic and claiming that “the truth will prevail” to clear their name.
Kolodny believes that the danger of opioid prescription lies in patients becoming tolerant to the pain relief effect. The NIH reports that the more regularly a patient takes opioids, the more reduced the response will be, leading doctors to consistently increase doses to achieve the desired effect.
“If you take an opioid every day, you become dependent on it, meaning you’re going to feel sick when you try to come off. And the longer you’re on it, and the higher the dose, the harder it is to ever come off,” Koldony said. “Many doctors don’t appreciate how hard it is for patients to come off [opioids].”
During an Oct. 28 interview with the Justice, Dr. David Juurlink, a hospital-based specialist in internal medicine and toxicology and long-time member of PROP, addressed the DPF’s claim that opioid-related overdoses have increased: “It’s true that overdoses have increased. It’s not true that those increased because of changes in prescribing. It’s a very easy mistake to make and even some doctors have made [it]. The overdoses have risen because the nature of the illicit drug supply has become much more toxic courtesy of the profusion of fentanyl and other compounds in the drug supply.”
“What we would like to see happen nowadays is that opioids be used much more sparingly and mainly for short-term,” Juurlink stated. “In a way, the chronic pain patients have a valid point which is that they shouldn’t have these medicines taken away from them.”
Following the DPF’s protest, Juurlink shared a thread on X in support of Kolodny and his work.
Doctors can turn to alternative and effective pain medications that are not opioids and do not require increased doses, such as nonsteroidal anti-inflammatory drugs. Over-the-counter NSAIDs include ibuprofen and naproxen. According to Kolodny, studies have shown that even for the most excruciating types of pain, such as kidney stone pain — medically known as renal colic — an injection of an NSAID such as ketorolac can relieve the pain just as effectively as morphine, an opioid, without any of the side effects like nausea and severe constipation.
“NSAIDs would generally be much better. They relieve severe pain, and they don’t have … the side effect of addiction, which is a game changer. When that happens to somebody, it can really ruin their life or their family’s life,” Kolodny stated.
However, with these benefits have notable risks as well. The British Journal of General Practice cautions that NSAIDs increase the risk of gastrointestinal bleeding, myocardial infarction, and stroke. “All NSAIDs increase both bleeding and cardiovascular disease risk” with a considerable increase in risk in older individuals. The same article estimates that NSAID use in patients above the age of 65 “more than doubles the risk of acute kidney injury in the next 30 days.”
Harvard Health Publishing writes that NSAIDs can be dangerous because they function by blocking proteins called COX enzymes, which results in the reduction of prostaglandins. These prostaglandins also play a key role in pain and inflammation. Furthermore, there are two types of NSAIDs: nonselective and COX-2 selective NSAIDs.
The British Journal of General Practice specified that non-selective NSAIDs “increase the risk of a [gastrointestinal] bleed four-fold, whereas COX-2 inhibitors increase this risk 3-fold.”
Although most of these concerns are comorbid with age, it is important to note that many individuals who qualify for long-term opioid use are close to 65, explaining the growing wariness for NSAID side effects in older age groups. The study found that of long term opioid users in 2005, the average ages for women and men were about 56 and 53, respectively.
In an interview with the New York Times in 2016, Kolodny explained that racial stereotypes protect minority populations from being prescribed opioids as pain killers because doctors worry they might sell them or become addicted.
However, many Black and Latinx communities still disproportionately suffer from drug abuse due to the 1970s heroin epidemic and the crack cocaine epidemic in the late ’80s and early ’90s. These communities are “also getting hit very hard by fentanyl,” Kolodny told the Justice.
The final claim of the DPF was that patients are increasingly committing suicide due to a lack of relief from their chronic pain. In a press release shared with the Justice on Oct. 25, the DPF cited more than 80 suicides associated with the reduction of opioid prescriptions, documented from 2016 to 2022 by the National Pain Council.
“On the one hand, they have a point, and everyone in PROP would agree with that point, which is that [chronic pain patients] should not have their meds summarily taken away because that can be harmful. [Kolodny] knows this. [He] has said this publicly,” Juurlink said. “What they don’t seem to accept … is the notion that they’re going into opioid withdrawal.”
Kolodny stated that increased sensitivity is a common effect of opioid withdrawal that can convince patients that the opioids were helping them instead of harming them.
Juurlink suggested that the DPF may receive financial support from the pharmaceutical industry. He added an addendum to this thread on X that one of the executives of the U.S. Pain Foundation, Cindy Steinberg, appeared at the rally at Brandeis. The U.S. Senate Committee on Homeland Security and Governmental Affairs released a report that provides evidence that the U.S. Pain Foundation received nearly $3 million from Purdue and other drug companies that produce opioids. The former Founder and CEO of the U.S. Pain Foundation Paul Gileno was also arrested for embezzling $1.5 million from the foundation.
Merandi said that claims that the DPF receive funding by pharmaceutical companies are false and that they exclusively rely on donations. She confirmed in an Oct. 28 email to the Justice that the DPF is a nonprofit organization.
Tax-exempt organizations that have gross receipts of at least $200,000 or assets worth at least $500,000 must file Form 990 on an annual basis. As of press time, the Justice could not find a copy of the DPF's tax returns on ProPublica’s Nonprofit Explorer to verify claims as to whether or not they receive funding from pharmaceuticals. This is most likely because the DPF makes less than $50,000 in gross receipts and is not included in ProPublica’s data. However, Merandi claimed that the DPF has a membership of 30,000 and chapters in all 50 states as well as one in Australia, Canada, and the U.K., suggesting that the DPF has a significant support base.
In September 2020, Merandi teamed up with Dr. Arnold Feldman, a retired anesthesiologist, to raise money for a possible class action lawsuit against Kolodny for “us[ing] his position to destroy the lives of millions of Americans all the while profiting personally.”
Feldman has been charged with seven counts of negligence and unprofessional conduct. He allowed an unlicensed and unsupervised employee to insert an IV into a patient, causing the patient to go into cardiac arrest. Feldman was unable to revive him.
Although Feldman fought against the suspension of his medical license in 2016 in Louisiana, the state medical board accused Feldman of a coverup. They stated he gave investigators false records and testimony.
“Dr. Feldman failed to adequately monitor the patient, exercised poor management or care of the patient after complications arose, and all of his resuscitation attempts were contributing factors to the patient’s death,” the board said in its ruling.
The GoFundMe that Feldman and Merandi started has raised over $20,000 to sue Kolodny. Why the lawsuit has not yet happened and where the donations will be directed is unknown as of press time.