The American Society of Addiction Medicine (ASAM) was founded in 1954 to study and improve the use of addictive substances in health care. In the half-century since, it has become a leading voice in the medical community with important reach into legislative and regulatory initiatives to abate the abuse of addictive drugs. Although it casts itself as an impartial organization, there are reasons to question whether the pharmaceutical industry has undue influence that may affect the organization’s advice.
In recent years, a former president and the current president of ASAM have come under scrutiny for ties to big pharma. Dr. Stuart Gitlow became president in 2013. At the time, he was simultaneously medical director of Orexo, a manufacturer of buprenorphine, a drug used to treat opioid addiction. In 2014, in a letter to Health and Human Services Secretary Sylvia Burwell, Gitlow recommended increasing the number of patients who should be given access to buprenorphine.
Red flags were raised almost immediately. Mark Willenbring, a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, asked, “How can someone who is employed by the drug company have any credibility when his financial interest is in selling the drug?”
It’s an important question, especially given that Gitlow also supported a decision by state Medicare programs to switch to the Orexo brand of buprenorphine products. The conflict of interest here is hard to ignore.
The connections to buprenorphine manufacturers did not end with Gitlow. Current president Dr. Kelly Clark is the chief medical officer for Clean Slate, a company that has been fined for the improper prescription of buprenorphine. To make matters worse, Clean Slate partners with Apple Tree Partners, which owns a pharmaceutical company and has funded an advocacy campaign that supported buprenorphine treatment.
In addition, Indivior, a major producer of buprenorphine, is a member and funder of ASAM. It contributes $100,000 a year to the organization. Indivior has faced legal issues regarding the prescription of buprenorphine. All of this suggests that a big-pharma fox is in the anti-addiction hen house. How can government officials or anyone know that their recommendations are targeted at saving lives, not making money?
Replacing One Drug For Another
Some think using opioids to treat opioid addiction may be an effective treatment that saves lives. Used for decades now in the form of methadone and buprenorphine, among other drugs, such treatments basically replace heroin with a safer drug prescribed by medical professionals. These treatments are controversial, as they do not end addiction so much as make addiction safer.
That ASAM would support drug replacement treatments is not in and of itself surprising or problematic. However, leaders of the organization having close monetary ties with the companies producing these drugs is a clear conflict of interest.
While it makes sense that medical professionals in a position to advise government on drug policies would have experience with the pharmaceutical industry, having presidents of ASAM actually employed by drug producers should give legislators and regulators pause when considering their advice. Even if well-intentioned, the possibility of bias when a head of ASAM is in a position to directly gain financially from the use of a drug treatment cannot help but lead to serious questions about the advice they give.
Crisis and Opportunity
The opioid addiction crisis in the United States has reached terrible proportions. With tens of thousands of deaths every year, it has become front and center for legislators. It is absolutely essential that lawmakers and other officialsget advice from the best possible sources, but it is equally important that advice is not tainted by pharmaceutical industry avarice.
This is a difficult balance to strike, but it is also essential. Part of the difficulty stems from the fact that those who advocate treatments that do not involve replacing one opioid with another are not selling a product, they are selling a treatment. This means that drug companies, with a vested interest in selling their drugs, have an arsenal of money and power that those who disagree with them simply cannot compete with.
It is absolutely key that organizations like ASAM operate so that those who favor non-drug-based solutions have an equal seat at the table. It strains credulity to imagine that this is the case when the presidents of the organization are accepting money from pharmaceutical companies.
As the nation comes tries to fight the opioid epidemic, we need clean actors in the advocacy space, not people on the big pharma payroll. ASAM needs to find a way to divorce itself from drug company paydays, or decision-makers need to look askance at the bought and paid for advice it provides. Unless and until that happens, dollars and cents may trump sound policy, and more Americans may suffer from the pain of opioid addiction.
