The ill-informed might be tempted to take a strong opioid like Oxycontin to deal with back pain but it’s the wrong thing to do, says Peter Kelly…

In 1898, heroin was launched by the German company, F. Bayer & Co. It was mainly sold as a cough suppressant but was also advertised as a non-addictive substitute for morphine addiction. It took a while for the reality of heroin addiction to come to light, at which point it was banned. How could such a dangerous drug come to be sold so freely?

Of course, there was an element of drug company greed, arrogance and naivety. That is one side of the story, but there was also a desperate need for an effective drug to suppress coughs. At the time, tuberculosis and pneumonia were leading causes of death and historians say it was impossible to walk anywhere in public without hearing someone coughing.

This desperation to soothe coughs played a part in the drug being rushed to market, with physicians and patients being blinded to the obvious downsides.

The interesting thing about history is that the more you know, the more you realise it is always repeating itself. In 1996 Purdue Pharma took an old drug, oxycodone, and created a new slow-release formulation called Oxycontin. The company aggressively marketed this opioid drug as being affective for pain relief while having low potential for abuse and addiction.

They were wrong, very wrong. Oxycontin soon became known as ‘hillbilly heroin’ and was being crushed, snorted, injected and smoked. This would kickstart a wave of opioid addiction that is still ravaging America.

Purdue persuaded regulators to allow them to say in the patient information leaflet that the drug was unlikely to cause addiction. They pushed doctors to prescribe it outside its licensed indications for palliative care use. Its commercial success was phenomenal … and criminal.

It painted the pharmaceutical industry in a terrible light. Manufacturers, doctors, distributors and pharmacists all ignored patient care in the pursuit of profit. Politicians were paid off to keep this gravy train rolling. Alex Gibney, the Oscar-winning documentary maker, refers to it as the crime of the century in his outstanding documentary on the subject.

Purdue, the Sacklers, oxycodone, fentanyl and opioids

There had been much written about Purdue, the Sackler family, oxycodone, fentanyl and opioids. In many ways it mirrors what happened when heroin was first brought to market, but what was the cough in this version of the story? I believe the ‘cough’ that allowed this to happen with such ease was back pain.

Back pain is so widespread but it is never really talked about much. I constantly have people coming into the pharmacy asking me about back pain and find it a very difficult condition to advise on. Most of what I know about back pain comes from personal experience. I have injured my back a few times and even once had to a take a week off work as I could not walk.

The advice on the NHS Choices website for back pain is take ibuprofen and it will clear up in a few weeks, which is correct. I don’t know if there is much research being done on back pain, but I feel there are a lot of questions we could do with answers to.

Why do so many people get back pain? Are the rates increasing or decreasing? What are the main causes? The NHS website says there are many causes but that they are not always obvious. Is back pain more prevalent in some countries compared to others?

I believe the epidemic of back pain created a ripe environment for Purdue to exploit and profit from.

When my back pain has been at its worst, the pain is excruciating and oppressive in a way that is unimaginable. I’ve had nights where I’ve not been able to sleep, as I have to keep turning over to get into a position where I am not in pain. I have spent days either lying on a hard floor or sitting in a specialised office chair.

There is a famous story of how David Cameron used to lie on the floor when he got back pain. He was in a room during an EU conference lying on the floor when Angela Merkel stormed in to confront him about something. She stood over him complaining as he lay there … it made for quite a scene!

When in pain, I have taken ibuprofen and co-codamol. I have found little to no relief from paracetamol or ibuprofen. The codeine does help but it is a double-edge sword. Codeine can make you constipated and the last thing you want with back pain is constipation.

I can completely understand how the ill-informed might be tempted to take a strong opioid like Oxycontin when in this type of pain. When my girlfriend saw how I could not sleep, she wanted me to go to A&E to get stronger painkillers. My thinking was that I just needed to take it easy for a few weeks and lie on the floor as much as I could – this is referred to as the Alexander technique.

I personally think the economic model of American capitalism means that plenty of people who get back pain cannot afford the luxury of taking two weeks off work to get better.

I also think some work shifts are too long - 12 hours standing on your feet cannot be good for the health of your back.

Peter Kelly is a community pharmacist based in London and an occasional stand-up comedian.