{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:48:45Z","timestamp":1792072125740,"version":"4.4.0"},"reference-count":73,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"unspecified","delay-in-days":105,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The role of pharmaceutical companies in promoting overuse of opioids by influencing medical discourse is underexamined. Marketing messages have been seeded in journal articles, continuing medical education (CME), prescribing guidelines, educational activities, and professional society recommendations. Terms generated or redefined by industry created a framework for promoting opioids. This paper focuses on the terms \u201copiophobia,\u201d \u201cpseudoaddiction,\u201d \u201cbreakthrough pain\u201d and \u201cpain is the 5th vital sign.\u201d The reframing of incipient opioid use disorder as \u201ctolerance\u201d and \u201cdependence\u201d is also discussed. The proliferation of these industry-supported terms within medical discourse created a false evidence base that opioids were safe and effective for chronic pain and that withholding opioids deprived patients of the best care.<\/jats:p>","DOI":"10.1017\/jme.2026.10258","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:07:44Z","timestamp":1776334064000},"page":"305-311","source":"Crossref","is-referenced-by-count":0,"title":["Redefining Pain and Addiction: How Opioid Manufacturers Changed Medical Language to Foster Opioid Use"],"prefix":"10.1017","volume":"54","author":[{"given":"Aidan","family":"Kaspari","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00hjz7x27","id-type":"ROR","asserted-by":"publisher"}],"name":"Georgetown University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2999-5864","authenticated-orcid":false,"given":"Judy","family":"Butler","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00hjz7x27","id-type":"ROR","asserted-by":"publisher"}],"name":"Georgetown University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriane","family":"Fugh-Berman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00hjz7x27","id-type":"ROR","asserted-by":"publisher"}],"name":"Georgetown University Medical Center"},{"id":[{"id":"https:\/\/ror.org\/00hjz7x27","id-type":"ROR","asserted-by":"publisher"}],"name":"Georgetown University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"S1073110526102587_r71","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1136430"},{"key":"S1073110526102587_r16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.18472"},{"key":"S1073110526102587_r22","volume-title":"Pain as the 5th Vital Sign Toolkit","year":"2000"},{"key":"S1073110526102587_r9","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200093050-00006"},{"key":"S1073110526102587_r7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-720X.1994.tb01303.x"},{"key":"S1073110526102587_r69","unstructured":"69. 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Model Guidelines for the Use of Controlled Substances for the Treatment of Pain (Federation of State Medical Boards of the United States, May 1998), archived December 3, 1998, https:\/\/web.archive.org\/web\/19990202032433\/http:\/www.fsmb.org\/pain.htm."},{"key":"S1073110526102587_r56","unstructured":"56. Compl, ., State of Mississippi v. Purdue et al., No. G.2015-1814 (Chancery Court of the First Judicial District of Hinds County, Mississippi 11\/12\/2019), https:\/\/attorneygenerallynnfitch.com\/wp-content\/uploads\/2021\/11\/292-Amended-Complaint-MS-MN.pdf (last visited September 8, 2025)."},{"key":"S1073110526102587_r28","unstructured":"28. 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Special Report: An Integrated Risk Evaluation and Mitigation Strategy for Fentanyl Buccal Tablet (FENTORA) and Oral Transmucosal Fentanyl Citrate (ACTIQ) (McMahon Publishing,and Cephalon, Inc., 2011), UCSF Industry Documents Library, San Francisco Walgreens Litigation Documents, https:\/\/www.industrydocuments.ucsf.edu\/docs\/fmbx0257\/ (last visited September 8, 2025)."},{"key":"S1073110526102587_r12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m105"},{"key":"S1073110526102587_r29","first-page":"78","article-title":"Controlled Substances and Pain Management: A New Focus for State Medical Boards","volume":"85","author":"Joranson","year":"1998","journal-title":"Federation Bulletin Journal of Medical Licensure and Discipline"},{"key":"S1073110526102587_r47","volume-title":"The Hard Sell: Crime and Punishment at an Opioid Startup","author":"Hughes","year":"2022"},{"key":"S1073110526102587_r21","doi-asserted-by":"publisher","DOI":"10.1016\/S1082-3174(96)80076-6"},{"key":"S1073110526102587_r58","unstructured":"58. 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Tin, Alexander , \u201cDrugmakers to Stop Making Controversial Fentanyl Lollipops, FDA Says,\u201d CBS News, September 19, 2024, https:\/\/www.cbsnews.com\/news\/drugmakers-to-stop-making-controversial-fentanyl-lollipops-fda-says\/ (last visited September 8, 2025)."},{"key":"S1073110526102587_r4","unstructured":"4. Morgan, , \u201cAmerican Opiophobia.\u201d"},{"key":"S1073110526102587_r41","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(90)90004-W"},{"key":"S1073110526102587_r20","article-title":"Rethinking the \u2018KOL Culture,\u2019","volume":"4","author":"Watermeadow","year":"2006","journal-title":"Next Generation Pharmaceutical"},{"key":"S1073110526102587_r53","unstructured":"53. Compl, , Commonwealth of Massachusetts. v. Purdue Pharma et al., No. 1884-cv-01808, (Suffolk County Superior Court, 1\/31\/2019), https:\/\/s3.documentcloud.org\/documents\/5715954\/Massachusetts-AGO-Amended-Complaint-2019-01-31.pdf (last visited September 8, 2025)."},{"key":"S1073110526102587_r37","unstructured":"37. Manchikanti, et al., \u201cOpioid Epidemic in the United States.\u201d"},{"key":"S1073110526102587_r55","unstructured":"55. Clinical Issues in Opioid Prescribing (Partners Against Pain), UCSF Industry Documents Library, National Prescription Opiate Litigation Documents, https:\/\/www.industrydocuments.ucsf.edu\/docs\/thpw0232\/ (last visited September 8, 2025)."},{"key":"S1073110526102587_r13","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnw352"},{"key":"S1073110526102587_r1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.131714"},{"key":"S1073110526102587_r68","unstructured":"68. Heit, , \u201cThe Truth About Pain Management.\u201d"},{"key":"S1073110526102587_r48","unstructured":"48. US Attorney\u2019s Office, District of Massachusetts, \u201cFounder and Former Chairman of the Board of Insys Therapeutics Sentenced to 66 Months in Prison,\u201d press release, January 23, 2020, https:\/\/www.justice.gov\/usao-ma\/pr\/founder-and-former-chairman-board-insys-therapeutics-sentenced-66-months-prison (last visited September 8, 2025)."},{"key":"S1073110526102587_r11","unstructured":"11. Clark, Katherine and Rogers, Hal , Corrupting Influence: Purdue and the WHO. Report: Exposing Dangerous Opioid Manufacturer Influence at the WHO (2019), 43, https:\/\/katherineclark.house.gov\/_cache\/files\/a\/a\/aaa7536a-6db3-4192-b943-364e7c599d10\/818172D42793504DD9DFE64B77A77C0E.5.22.19-who-purdue-report-final.pdf."},{"key":"S1073110526102587_r15","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S342409"},{"key":"S1073110526102587_r43","unstructured":"43. Manchikanti, et al., \u201cOpioid Epidemic in the United States.\u201d"},{"key":"S1073110526102587_r67","first-page":"862","article-title":"Treatment of Osteoarthritis Pain with Controlled Release Oxycodone Plus Acetaminophen Added to Nonsteroidal Antiinflamatory Drugs: A Double Blind, Randomized, Multicenter, Placebo Controlled Trial","volume":"26","author":"Caldwell","year":"1999","journal-title":"Journal of Rheumatology"},{"key":"S1073110526102587_r5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1990.tb01693.x"},{"key":"S1073110526102587_r49","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-016-1490-4"},{"key":"S1073110526102587_r73","first-page":"E529","article-title":"Increase Your Confidence in Opioid Prescribing: Marketing Messages in Continuing Medical Education Activities on ER\/LA Opioids","volume":"24","author":"Goodwin","year":"2021","journal-title":"Pain Physician"},{"key":"S1073110526102587_r52","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(89)90097-3"},{"key":"S1073110526102587_r72","unstructured":"72. Achenbach, Joel and Bernstein, Lenny , \u201cOpioid Crackdown Forces Pain Patients to Taper off Drugs They Say They Need,\u201d Washington Post, September 10, 2019, https:\/\/www.washingtonpost.com\/health\/opioid-crackdown-forces-pain-patients-to-taper-off-drugs-they-say-they-need\/2019\/09\/10\/3920f220-c8da-11e9-a4f3-c081a126de70_story.html (last visited September 8, 2025)."},{"key":"S1073110526102587_r10","first-page":"105","article-title":"Opiophobia as a Barrier to the Treatment of Pain","volume":"16","author":"Bennett","year":"2002","journal-title":"Journal of Pain and Palliative Care Pharmacotherapy"},{"key":"S1073110526102587_r36","unstructured":"36. Fauber, John , \u201cFollow the Money: Pain, Policy, and Profit,\u201d Milwaukee Journal Sentinel\/MedPage Today, February 19, 2012, https:\/\/www.medpagetoday.com\/neurology\/painmanagement\/31256 (last visited September 8, 2025)."},{"key":"S1073110526102587_r26","doi-asserted-by":"publisher","DOI":"10.1053\/jpmn.2000.5833"},{"key":"S1073110526102587_r42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2006.02.003"},{"key":"S1073110526102587_r66","unstructured":"66. 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Fauber, John , \u201cNetworking Fuels Painkiller Boom,\u201d Milwaukee Journal Sentinel, 2012, https:\/\/medicalxpress.com\/news\/2012-02-networking-fuels-painkiller-boom.html (last visited September 8, 2025)."},{"key":"S1073110526102587_r19","unstructured":"19. Report to Congressional Requesters: Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem (United States General Accounting Office, December 2003), https:\/\/www.gao.gov\/assets\/gao-04-110.pdf."},{"key":"S1073110526102587_r34","unstructured":"34. Letter from Humayun J. Chaudhry to Senators Max Baucus and Charles Grassley (June 8, 2012), https:\/\/files.cand.uscourts.gov\/files\/18-CV-07591_CCSF_v_Purdue\/P-18027_00001.pdf (last visited September 8, 2025)."},{"key":"S1073110526102587_r2","volume-title":"Society and Medication: Conflicting Signals for Prescribers and Patients","author":"Morgan","year":"1983"},{"key":"S1073110526102587_r8","doi-asserted-by":"publisher","DOI":"10.1023\/A:1025697920944"},{"key":"S1073110526102587_r45","unstructured":"45. Department of Justice, \u201cBiopharmaceutical Company, Cephalon, to Pay $425 Million & Enter Plea to Resolve Allegations of Off-Label Marketing,\u201d press release, September 9, 2008, https:\/\/www.justice.gov\/archive\/opa\/pr\/2008\/September\/08-civ-860.html (last visited September 8, 2025)."},{"key":"S1073110526102587_r62","doi-asserted-by":"publisher","DOI":"10.1177\/204946370900300204"},{"key":"S1073110526102587_r32","unstructured":"32. 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