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Testimony in the state of West Virginia’s trial against opioid manufacturers continued Tuesday with a pain medicine specialist detailing how opioid marketing changed the landscape of prescribing.

The trial, which started in Charleston earlier this month, is for West Virginia’s claims against opioid manufacturers Teva Pharmaceutical and Allergan, which West Virginia Attorney General Patrick Morrisey accuses of fueling the opioid crisis by creating strategic campaigns to deceive prescribers by underplaying the risks opioids have on patients. The state settled with a third defendant, Johnson & Johnson subsidiary Janssen Pharmaceuticals, earlier this month.

Dr. Danesh Mazloomdoost, current medical director at Wellward Regenerative Medicine in Lexington, Kentucky, said he has been working for the past dozen years to reverse false education instilled in doctors by pharmaceutical companies about the psychology of pain and the effects opioids have on the body.

He said it’s about disease management as a whole, not pain management.

“By the time we see patients, they’ve already been exposed to opioids and it makes the challenges of resolving issues [more difficult],” he said.

As one of several indicators that opioid firms encouraged usage, he pointed to a presentation made at an Actiq national meeting that encouraged prescribing opioids based on pain being the fifth vital sign.

He said he has heard positive feedback from doctors to whom he has tried to teach the negative effects long-term opioid use can have. He said they have been trained to follow pain as the fifth vital sign, that opioids have little risk of addiction and more, all which do not fit the status quo in today’s medical society.

As bodies adapt to the presence of opioids over time, the drugs become less effective, meaning people need to take more to treat their pain, Mazloomdoost said.

He said that, once opioids are introduced to the system, there become two problems — the original pain and the change that happens neurologically because of the exposure. Mazloomdoost said it’s much easier to diagnose and treat the original pain, calling the body a “self-healing machine.”

“If all we do is numb the symptoms of the condition causing pain and ignore it, it is only going to get worse,” he said.

Mazloomdoost said he prescribes opioids only if the patient has acute pain, and he will give them only for a short time. He also prescribes them when someone has a fatal disease. He said he prefers to exhaust all other options, such as physical therapy, before writing such prescriptions.

With the other options, you can always reduce the amount of services if they are not needed or working, he said. It’s much harder to cut back on opioid use than the alternatives. After three days of use, the risk of opioid addiction increases. After 30 days of use, nearly 30% of opioid users will remain on them for a long period of time, he said.

Opioids can create mood changes, depression, anxiety and weight gain, among other things, because of long-term use, he added. He said he has seen a patient with a dozen medications, all prescribed to treat the effects opioids have had on their body.

He said most chronic pain evolves from mismanaged acute pain. He compared it to a person’s eyes adjusting when entering a bright room from a dark one. It takes time for your body to adjust when coming off the drug because of homeostasis. He said people often mistake withdrawal pain as pain caused by their initial injury.

Mazloomdoost pointed to booklets presented to doctors that cited what he called inaccurate studies about the effects opioids could have on pain management, stating the drug was reliable, efficient and safe when taken appropriately, with which he does not agree.

Opioids are not effective for long-term care, once homeostasis hits, Mazloomdoost said. He said negative studies rarely made it out to the public years ago because they often were funded by those with a stake in opioid companies. He said that makes it difficult for physicians to know the true effects of opioids.

Studies done by the U.S. Centers for Disease Control and Prevention and other reputable organizations differ from those backed by private company funding, Mazloomdoost said, alerting doctors to the questionable nature of prescribing opioids. He said industry highly affects opioid marketing, bending studies to favor themselves, rather than using unbiased studies. He called them an “echo chamber” of false information.

A defense attorney said not everyone who takes an opioid suffers opioid use disorder, but Mazloomdoost said that oversimplification of the subject gives a false sense of security for people who prescribe them.

In an attempt to counter Mazloomdoost’s testimony, the defense attorney said several government-backed organizations, including the CDC and World Health Organization, had backed the use of opioids to treat pain.

The attorney countered with several peer-reviewed articles in which doctors agreed that opioids were positive for pain management; however, Mazloomdoost said they were part of the “echo chamber” affected by marketing.

“It’s easy to start falling under the influence of [that] messaging and believing our beliefs are real,” he said.

Another attorney pointed to a label for Kadian in which the FDC said dosage should be increased as needed.

The trial wrapped up Tuesday with two taped depositions being played in court. The trial will continue Wednesday morning in Charleston.

Follow reporter Courtney Hessler at and via Twitter @HesslerHD.

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