Opioid Crisis: Did the Introduction of OxyContin Lead Us Down this Path?

 

For a week or two, I’ve been volunteering content to a start-up site called Politi Prattle.  It’s a good site and I highly recommend checking them out and volunteering to be a blogger.  Unfortunately, our schedules don’t mesh so I’m returning to jaiceharmon.com for the rest of the series.

With that said, in my post Our Nation’s Long History of Prescription by Addiction – Part 2, I asked a serious question – what changed between 1979 and 1992?  The reason why this question is important is the number of people reporting illegal drug use was cut in half during that time frame.  As a nation, we had to have been doing something right because something was working.

But, in 2001, the number of people reporting illegal drug use started to increaseSomething stopped working. 

I had a really hard time getting my head wrapped around this.  I knew that something had changed in the mid-1990’s because there was an uptick in heroin use that came through in fashion industry with the new look dubbed “heroin chic”.  It also came through in music as grunge became increasingly popular. Because I was looking in all the ‘usual’ places I couldn’t find a legislative connection so I left it off the timeline.

Last Friday, I tuned into to Tucker Carlson’s show on Fox News to listen in on his final segment discussing the opioid crisis.  It looks like he was also asking what changed and was able to identify that something regulatory, not legislative, changed in the mid-1990’s, but didn’t pinpoint exactly what changed under Clinton administration.  So, I dug deeper and found that, in 1995, sale of OxyContin was approved and by 1996, it had officially launched.

Instead of restricting opioids to end-of life, limited use after surgery, or extreme chronic pain suffering, Bill Clinton’s FDA allowed a more liberal, and general use, for the time released OxyContin, which included short term pain management for things like a broken arm, wisdom tooth extraction, etc.  It didn’t take long for that change to ripple through the nation and, obviously, into the music and fashion scenes.

I want to thank Tucker for filling in this massive timeline gap, and tremendous insight.

The uptick in addiction and arrests related to addiction caused multiple states to open investigations and it also caused the Department of Justice to look into what was happening.  By 2005, under the Bush Administration, Perdue Pharma, the maker of OxyContin, had their first visits from federal investigators in Roanoke, VA, and 26 other states.  What they found was staggering.

Before I continue, it’s important to level-set that OxyContin is a pure, high-strength version of a long-used narcotic, oxycodone which can be very addictive.  Perdue claimed that OxyContin provided 12 hours sustained relief and the patient only needed to take it twice per day.  Therefore, it didn’t pose the risk like other narcotic based pain killers.

What the investigations uncovered was the grim reality that most patients found their pain returning before the full 12 hours had completed and they needed more OxyContin to kill the pain.  In fact, one clinical trial study clearly demonstrated that 95% of the patients had to resort to ‘rescue’ medication because the drug wore off before the 12-hour time frame.

In other words, Perdue was completely aware that OxyContin didn’t relieve the pain for the full 12 hours for many patients thereby increasing the risk that patients would take something else to bridge the gap between the two dosages.  That meant the cheaper generic drugs that were taken more often, but less addictive, were a better solution for the patient.  Unfortunately, Perdue kept quiet and continued marketing OxyContin, knowing a large number of patients stated they needed addiction pain relief before the drug wore off.

Seeing a tremendous growth opportunity, Purdue convinced skeptical doctors that, due to the time-release agent in the drug, it wasn’t as addictive and encouraged doctors to prescribe OxyContin for common aches and pains when lesser, and non-addictive, drugs would have worked just as well and been far less damaging.

To ensure doctors bought into the fewer dosage message, Perdue spent $200 million on marketing materials with the tag lines like, “Remember, Effective Relief Just Takes Two,” along with other incentives for doctors to prescribe OxyContin over any other pain killer.

The challenge the marketing efforts posed were people (experienced addicts and recreational drug users) discovered that by chewing OxyContin, crushing it up into a power and inhaling it (snorting) or injecting it (shooting up/mainlining), they received a high as powerful, and addictive, as heroin.

Because the pain-relief didn’t last the full 12 hours, many non-addicts started abusing the drug to get the relief needed.  When their prescription was cut off or not increased, the patient started seeking OxyContin on the street and many turned to heroin.

But, Perdue left out the fact that the 12-hour relief wasn’t a guarantee and there was no mention of the high risk for addiction.   Instead, they maintained that the time release component mitigated the risk of addiction.

When doctors started to prescribe a more frequent interval for OxyContin due to the drug wearing off, Perdue saw the high risk for revenue losses as insurance carriers denied claims and insisted doctors go to the more frequent, but cheaper, generics.  To counter this, Perdue Pharma stepped in and trained sales reps that they should encourage doctors to prescribe higher dosages for their patients.  This increased the risk of addiction and overdose.  It also increased profits. Soon the $97 10mg bottle became a 80 mg bottle for $630 a pop.

It took only five years for OxyContin to become a major addiction issue in many parts of the United States, especially with teenagers in rural areas.  Virginia was hit especially hard.  This is why, in 2001, the Department of Justice under the Bush Administration took on Perdue Pharma.

In 2004, then West Virginia US Attorney, and the future Attorney General under Obama, Eric Holder, settled with Perdue for a paltry $10 million dollars.  Holder agreed to a no-fault settlement if Perdue agreed to pay $10 million to support drug abuse prevention programs, but not treatment for the people who became addicts, just prevention programs.

Alas, West Virginia wasn’t the only state that had taken Perdue to court.  The US Attorney General’s was getting aggressive, and G.W. bush appointee, John Brownlee, and other District Attorneys across the nation kept digging and asking more questions.

They were charging addicts and doctors alike.  While they were questioning doctors, they learned that the doctors were prescribing based on Perdue’s recommendation.  So they started digging into Perdue Pharma’s practices as well.

Brownlee, and his colleges, were able to successfully tie the fraudulent marketing practices of Perdue Pharma to the rise in addiction in all demographics (teens were hard hit), an increase in crime rates, over doses, death by overdose, and a host of other things that come with an addiction outbreak.

In 2007, Perdue Pharma, pled guilty to deceptive marketing practices and was ordered to pay $600 million in fines.  Because OxyContin is time released, Perdue had previously maintained that it posed a lower threat of abuse and addition than other class IV painkillers like Darvocet, even though OxyContin was a class II drug.   US District Attorneys in multiple states proved otherwise.

Perdue’s marketing practices garnered the company more than $1 billion in annual revenues for OxyContin alone.

During a press conference discussing the guilty pleas, Brownlee stated, “The results of Purdue’s crimes were staggering.”  He also stated, “I think we had a responsibility to bring cases against everyone who was making money.”

In 2011, the British Medical Journal issued a paper regarding OxyContin after reviewing documents from the US courts US congressional investigations.  In this paper they state that Perdue Pharma’s strategy was “particularly remarkable”.  The Journal continued, “The manufacturer targeted physicians who prescribed OxyContin frequently, paid is sales representatives large bonuses as an incentive to increase OxyContin sales, and issued coupons entitling new patients to free samples at participating pharmacies.”

Not only were sales reps highly incentivized, they were encouraged to fly the doctors out for weekend retreats at four star resorts, wined and dined, and gave the doctors, and staff, expensive company swag.  They then asked the doctors to spread the word of OxyContin to their colleagues.

Between 1995 and 2001, there was a period of time where the sales of OxyContin alone made up 90% of Perdue’s net sales.

Remarkable indeed.

 

#More2Come

To lean about our nation’s history with prescription addiction, click here and here

To learn about the GOP primary candidates whom have been impacted by addiction, click here.

To learn about Gov. Chris Christie’s efforts to fight addiction in New Jersey, click here.

April is Alcohol Awareness Month.  If you’re concerned you may have a problem, take one of these quizzes. 

Getting a grip on the addiction pandemic that swept our nation isn’t a competition or something to be politicized, folks.  Our reality is we have to collaborate, stand firm (not ‘lean in’) and work together if we have any hope of ending it. 

 

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