Ethicists don’t necessarily know what they’re talking about

Purdue Pharma is currently running trials of the opioid painkiller OxyContin on 150 patients aged 6 to 16, after previously discontinuing expensive youth trials in order to redirect their resources to developing an abuse-resistant form of the drug. All of these children were already on other opioid painkillers to manage pain from cancer, severe burns and sickle cell anemia.  Doctors have already been prescribing OxyContin, but without the benefit of any studies showing its effects on children specifically, and the FDA’s offer of a six-month patent extension on the drug in exchange for conducting trials on children was enough to get Purdue to resume testing.

Ethicist Dr. Arthur Caplan has a problem with this:

“It looks to me like a raw, crass, last-gasp exploitation of a drug that has been synonymous with misuse, abuse and harm to patients,” said Dr. Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center.

Putting aside Purdue’s possible motives, I’m not sure why OxyContin should necessarily be considered uniquely “synonymous with misuse, abuse and harm to patients”, or why this is a reason not to acquire data about its possible effects in children who would already be taking other opioid painkillers anyway. Does OxyContin possess some property which presents a much higher risk of addiction than all other opioids in common use as painkillers? When used properly, is it still more harmful than other opioid painkillers? Are these same objections somehow inapplicable to other opioids, which also pose a risk of addiction and can be harmful when abused?

Or does Dr. Caplan believe that OxyContin itself now inherently possesses some kind of Aura of Badness just because of the widespread trend of people abusing it? If OxyContin did pose any sort of elevated risk to people beyond that of any other opioids they may be taking for pain management, then this argument should be made on the basis of relevant evidence – and OxyContin being a trendy street drug is not relevant evidence here. And even if it did carry additional risks, those risks should be weighed against its effectiveness as a painkiller, and viewed in light of the need these children have for pain relief. This isn’t as simple as “everyone is focusing on people abusing this one drug, therefore it can have no legitimate medical use.” If OxyContin itself is really so ethically objectionable, why not just pull it from the market entirely?