The U.S. Postal Service has taken a sudden interest in the treatment of cancer pain, judging by a disclosure in Cephalon (CEPH)'s annual report. The USPS's Office of the Inspector General sent the company a subpoena in January for documents regarding Fentora, its powerful opioid painkiller. The company disclosed no further details about what the postal service and the Philadelphia U.S. Attorneys' office might be after, but there are a few clues we can look at to figure out what might be going on.
In 2008, Cephalon paid $425 million to settle charges that it promoted Actiq, a product similar to Fentora, for unapproved "off-label" purposes. Both drugs contain fentanyl, the morphine-like painkiller. That settlement carried a five-year agreement with the feds not to cross the line in the promotion of Actiq. Both Actiq and Fentora are only approved for cancer pain. Yet Cephalon's sales staff had been pushing Actiq to non-cancer doctors as "an ER on a stick" with the mantra, "pain is pain."
The problem with Fentora, Actiq and other fentanyl-based products is that they aren't just addictive -- they're crazy out-of-control addictive. Addicts will dig through medical waste or try any of these weird cooking methods to get it. Take too much, and you die. Yet at one point, 80 percent of Cephalon's Actiq sales were off-label, as addicts found sleazy doctors to write them questionable prescriptions.
In the 2008 settlement, Cephalon was found to be promoting Actiq "for such maladies as migraines, sickle-cell pain crises, injuries, and in anticipation of changing wound dressings or radiation therapy," the DOJ said. Injuries and migraines sound a lot more like the kind of maladies that postal workers would suffer from than cancer. For mail carriers, routine hazards of the job include trips, falls, and herniated discs from trying to lift awkward bags and packages.
If 80 percent of Actiq's sales didn't involve cancer pain, it's a good bet that Fentora's sales also included off-label prescriptions. Could it be that Cephalon promoted Fentora the same way it did Actiq? That might explain why the subpoena seeks documents related to "Postal Service employees' workers' compensation claims," which tend to be paid out for job-related injuries -- and not cancer.
- "Pain Is Pain": Cephalon's Marketing Comes Under DOJ Control
- Fire-Eaters and Booze: What It Takes to Persuade Docs to Prescribe Painkillers
- Lethally Addictive Painkiller Recalled 7 Times While FDA Twiddles Its Thumbs
- Cephalon's Lollipops of Death: 56 Patients at One Clinic Die of Off-Label Painkiller Use