Two Cancer Society lobbyists worked against the bill, even though prescribing painkillers for cancer patients is a widely accepted medical practice that would have remained legal.
“We injected ourselves into the debate because we did not want cancer patients to not be able to have access to their medication,” said Theodore Morrison, a lobbyist working for the network that year.
The society’s annual ranks of about 200 lobbyists around the country have taken similar positions elsewhere, defending rules that some argue encourage extensive prescriptions and opposing opioid measures even if the proposed legislation specifically exempted cancer patients.
The Cancer Action Network listed four major opioid makers that provided funding of at least $100,000 in 2015, in addition to five that contributed at least $25,000. Companies that donate such sums get one-on-one meetings with the group’s leaders and other chances to discuss policy.
The network said only 6 percent of its funding last year came from drugmakers and that its ties to drug companies do not influence the positions it takes. “ACS CAN’s only constituents are cancer patients, survivors, and their loved ones nationwide,” spokesman Dave Woodmansee said.
The network said it advocates for certain measures despite exemptions for cancer because some patients continue to experience pain even after their cancer is gone.
ACS CAN teamed up with another group to defend the Tennessee painkiller law — the Academy of Integrative Pain Management, an association of doctors, chiropractors, acupuncturists and others who treat pain, until recently known as the American Academy of Pain Management. The group promotes access to pain drugs as well as non-pharmaceutical treatments such as acupuncture.
Seven of the academy’s nine corporate council members listed online are opioid makers. The other two are AstraZeneca, which has invested heavily in a drug to treat opioid-induced constipation, and Medtronic, which makes implantable devices that deliver pain medicine.
The academy’s executive director, Bob Twillman, said his organization receives 15 percent of its funding from pharmaceutical companies, not including revenue from advertisements in its publications. Its state advocacy project is 100 percent funded by drugmakers and their allies, but he said that does not mean it is beholden to pharmaceutical interests.
“We don’t always do the things they want us to do,” he said. “Most of the time we’re saying, ‘Gosh, yes, there should be some limits on opioid prescribing, reasonable limits,’ but I don’t think they would be in favor of that.”
Both the academy and the cancer group have been active across the country, making the case that lawmakers should balance efforts to address the opioid crisis with the needs of chronic pain patients. Between them, they have contacted legislators and other officials about opioid-related measures in at least 18 states.
In Massachusetts this year, they helped persuade lawmakers to soften strict proposals that would have limited first-time opioid prescriptions to three days’ worth. They also have weighed in on how often doctors should be required to check prescription-monitoring databases, which can help crack down on prescription-shopping with multiple doctors.
The academy reported on its website that, since 2013, its state advocacy network had provided “extensive comments” on clinician guidelines in New Mexico, Pennsylvania, Indiana and elsewhere; issued action alerts resulting in more than 300 emails and phone calls to more than 80 legislators in 2014 alone; and held teleconferences with more than 100 advocates.
Purdue, which gives to both the academy and the cancer network, said it contributes to a range of advocacy groups, including some with differing views on opioid policy. “It is imperative that we have legitimate policy debates without trying to silence those with whom we disagree. That’s the American political system at work,” the company said in a statement.
As for Williams, he tried again last year to repeal Tennessee’s intractable pain law — and won unanimous approval in both houses. The extra year had given Williams and his co-sponsor time to help educate their fellow lawmakers, he said, even though the Cancer Society still opposed the repeal.
Lobbyists ‘were killing it’
The tried-and-true tactics of lobbying and campaign contributions remain a major plank of the pharmaceutical playbook. In 2014 alone, for instance, participants in the Pain Care Forum spent at least $14 million nationwide on state-level lobbying.
Two years earlier — facing the threat of limits on opioid-prescribing — forum members had upped their number of lobbyists in New Mexico, which is second only to West Virginia in per-capita deaths primarily due to prescription and illegal opioid drugs, according to the most recent federal data available.