By Dr. Mercola
Every day, 91 Americans die from an opioid overdose, including those obtained via a prescription. Intended to be reserved for only the most serious cases of pain, opioids are being vastly overprescribed, including for noncancer chronic pain, such as back pain or that from osteoarthritis. With overdose deaths on the rise, public health agencies are urging doctors to cut back on inappropriate prescribing of these powerful drugs — which could be spurring more people to look for them elsewhere.
PetMed Express, an online store selling pet medications, may be exploiting this epidemic by selling pet opioids for use in people, although they've denied all accusations. An investigation suggests the company specifically targeted humans looking to buy opioids online using Google advertisements. According to research firm Aurelius Value, which conducted the investigation:1
"Using Google, which drives over 55% of the traffic to 1800petmeds.com, PetMed has deployed a vast predatory campaign that dangles ads featuring pictures of Tramadol to drug users searching for how to get high or quickly score a variety of different opiates, narcotics, and street drugs without a prescription. Egregiously, PetMed's ads even specifically bait opiate addicts searching for remedies for their withdrawal symptoms."
Opioid Epidemic May Be Driving People to Seek Opioids Online
Even as pain levels have remained largely stable in the U.S., prescriptions for opioids nearly quadrupled from 1999 to 2010. Deaths from such drugs, including oxycodone, hydrocodone and methadone, have also quadrupled since 1999.2
It's easy to become addicted to opioids because your body can develop a tolerance, which means you need an increasingly stronger dose to get the pain-relieving effects. Physical dependence can also develop, which means you develop withdrawal symptoms if you stop taking the drugs. If you take too many prescription opioids, it can stop your breathing, leading to death.
It's estimated that 1 in 4 patients on long-term opioid therapy struggle with addiction.3 According to the U.S. Centers for Disease Control and Prevention (CDC), most people who abuse prescription opioids get them from a friend or relative or using their own prescription, but those most at risk of overdosing are more likely to buy them from a drug dealer or other stranger.4
In 2016, new federal guidelines were released urging doctors to try other options, including physical therapy, exercise and over-the-counter medications, before resorting to opioids for pain. The guidelines also recommended prescribing the lowest dose possible and limiting them to three days of treatment for short-term pain.5 The guidelines may have made it harder for some opioid abusers or addicts to get the drugs from their doctors, causing them to seek opioids elsewhere, including online.
Did Selling Opioids to Humans Make PetMed's Business Boom?
According to Aurelius, PetMed, a distributor of pet medications, has seen fairly stagnant business levels for the last seven years. Then, seemingly out of nowhere, their business began to grow, with the company enjoying the most profitable quarters in their career in 2017. Meanwhile, PetMed shares more than doubled. To explain the unprecedented growth, PetMed's CEO Menderes Akdag cited a shift to "new generation medications."
But, according to Aurelius, "Mr. Akdag must have thought no one would scrutinize his claims. It is our belief that the actual 'secret sauce' lies in PetMed's efforts to aggressively market dangerous painkillers to human opiate addicts and drug users."6 Among their products is tramadol, a synthetic opioid prescribed by both veterinarians and physicians. A CDC report ranked tramadol as among the drugs most highly associated with chronic use, with 64 percent of patients still taking the drugs after one year.7
It's worth noting that the U.S. Drug Enforcement Agency (DEA) named tramadol a class IV substance in 2014, at which time other major online pet pharmacies stopped selling it. PetMed, however, obtained the necessary approvals to sell class IV substances in 2015, Aurelius reported.
Aurelius: 'Aggressive Ad Campaign … Preyed on Opioid Addicts'
PetMed uses online advertising to drive customers to their site. This isn't surprising, and using an analytics platform that archives Google advertisements based on keywords, Aurelius found that prior to 2017, PetMed emphasized predictable keywords in its advertisements, such as the flea medication "comfortis" and its website "1800petmeds." This changed in 2017, when tramadol became their most effective advertising term, driving about 25 percent of the total paid search traffic to their site.
Aurelius enlisted the help of an online marketing expert to home in on PetMed's ad campaign, which revealed that the ads offer discounts for the drug and do not mention the medication is for pets. Aurelius further reported:8
"PetMed displays ads that target people looking to get high or purchase a wide variety of dangerous drugs. Petmed's Tramadol pills are flashed alongside searches for drugs including Oxycontin, Oxycodone, Vicodin, Hydrocodone, Conzepam, and even 'Pink Pills' (Synthetic Heroin).
Ads have also been displayed on searches for Ultram (Human Tramadol), 'Trammies' (the street name) and Tramadol formulations not recommended for pets. PetMed also targets non-recreational users by marketing its drugs to people merely searching for remedies for their back pain, tooth ache, joint paint, or arthritis."
Even people searching for "pills to fight my tramadol addiction" or "opiate withdrawal remedies" could be met with an ad for PetMed's tramadol, according to the report. Their ads also appeared for search terms like "opiate pills online no prescription easy" and "need cheap narcotics online no prescription." Aurelius also dug up some past information about PetMed's co-founders, who were reportedly imprisoned for conspiracy to distribute cocaine.
Further, in 2002 PetMed was charged (and later settled) with creating a program to sell prescriptions for animals who had not seen the veterinarians who wrote the prescriptions. A prosecutor in the case stated, "Petmed was engaged in an enterprise whereby a customer could log on to their website, fill out a questionnaire regarding their animal's health complaints, and that information would then be forwarded to a veterinarian who was either employed by, or under contract with, Petmed."9
Is Aurelius Interested in Exploiting the Stock Market?
Aurelius' allegations are serious, but there's still a lot we don't know. PetMed has denied Aurelius' allegations, calling them "false and defamatory," and even going so far as to say it was a major manipulation to drive their stock price lower in order to support short sellers (including Aurelius). They also claimed that tramadol and another drug, gabapentin, make up only 0.4 percent of their total sales.
Speaking to Forbes, Mark Henry of Midwood Capital Management said, "Taking this statement at face value, it would then not be fair to primarily attribute the recent surge in sales and earnings to Tramadol sales." When asked whether he agrees with the substance of the Aurelius report, he noted, "We find it suspicious that PETS' CEO has been so close-lipped about the shift to 'new generation medications.'"10
Another layer to the story is Google removed ads for PetMed's tramadol following the allegations. It's unclear, however, whether the ads were pulled by Google or asked to be pulled by PetMed. Google wouldn't comment on the case, but according to Benzinga:11
"[PetMed CFO Bruce] Rosenbloom told Benzinga he was 'sure some things were done' with the Tramadol ads beyond Petmed's control, as the company had never paid for term searches referenced in the condemning report and 'weren't targeting those [consumers] at all.' Google algorithms were to blame for inappropriate ad placement, he said.
An Aurelius Value spokesperson rejected the defense and said that, at a minimum, Petmed was 'turning a blind eye' to Google ad data. '[You] can't claim to be a good online marketer and not know what was going on' with Tramadol ads, the spokesperson said."
Opioid Addicts Increasingly Turning to Pet Meds
At this point, there are still a lot of question marks regarding Aurelius' accusations against PetMed, but what is clear is that pet owners are increasingly taking medications from their pets to support their own addictions. In Palm Beach Gardens, Florida, for instance, veterinarians report a list of "blacklisted" clients who go from vet to vet, seeking pain medications like tramadol. Other popular requests include anxiety medications like Xanax and Valium.
While some owners try to make up excuses for why they need another refill of pills, such as spilling them on the floor, others have gone so far as to physically harm their pets to get a new prescription. In some veterinary schools, classes even exist to teach new veterinarians how to deal with addicts trying to game the system.12
In one of the biggest dog-related cases to date, 100,000 tramadol pills were seized near Portland, Oregon, and 17 dogs living at the site were rescued from filthy living conditions. Four people were arrested who claimed to be breeding puppies but who police suspect were actually distributing opioids.13
Meanwhile, online vet-specific forums are lighting up with stories of pet owners trying to get tramadol from their dog's vet. Jim Arnold, chief of policy and liaison for the diversion control division at the DEA, told the New York Post, "They've gotten very sophisticated in how they obtain drugs and go about their activities … It's an area that allows drug seekers to fly under the radar. We know it's happening, but I wouldn't be surprised if there's a lot more activity than we're aware of." 14
Nondrug Solutions for Pain Relief
The health risks associated with prescription opioids are great and addiction and overdose happen far more often than you might think. So if you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and even over-the-counter painkillers — alternatives that do not carry these steep risks.
The pain remedies that follow are natural, providing excellent pain relief without any of the health hazards that pain medications often carry. Prescription pain medications like opioids do have their place in cases of severe pain for which there are no other options for relief, but for moderate or mild chronic pain, try these instead:
Astaxanthin: One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required and one may need 8 milligrams or more per day to achieve this benefit.
Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added only 200 milligrams of curcumin a day to their treatment plan had reduced pain and increased mobility.15 In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.
Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites, as I have seen it work well with many rheumatoid arthritis patients.
Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.
Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma-linolenic acid (GLA), which is useful for treating arthritic pain.
Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.
Dietary Changes and Additional Pain Relief Options
When treating chronic pain, you need to look at the underlying causes of the pain. Toward that end, there's a good chance you need to tweak your diet as follows (all tips that can be used alongside chiropractic and other forms of complementary care):
- Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
- Reduce your intake of most processed foods as not only do they contain sugar and additives, but also most are loaded with omega-6 fats that upset your delicate omega-3 to omega-6 ratio. This, in turn, will contribute to inflammation, a key factor in most pain.
- Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
- Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain. This satisfies your body's appetite for regular sun exposure.