The Deceptive Marketing of OxyContin by Purdue Pharmaceuticals
The start of the American Opioid Epidemic can be traced back to the early 1990s and Purdue Pharmaceutical’s influence over the prescription of Opioid medications. During that time, pain specialists in the United States began to argue that the nation faced an epidemic of untreated chronic pain. In response to such claims, Purdue Pharma declared to have a solution: OxyContin, a supposedly non-addictive Opioid drug that was extremely effective in treating non-cancer related pain. As part of the campaign to get doctors to readily prescribe the drug, Purdue provided financial support to the American Pain Society and other organizations to promote the idea that pain should be viewed as a “fifth vital sign” and that chronic pain was a serious condition that required treatment. This strategy led to an increasing number of professional and consumer groups prescribing OxyContin and other Opioids for pain management.
The widespread adoption of Opioids for pain relief was further facilitated by marketing strategies that downplayed OxyContin’s addictive potential. In much of the promotional campaign, Purdue claimed that the risk of addiction from OxyContin was extremely low. In fact, Purdue sales representatives were trained to say that the risk of addiction was “less than one percent.” Another core part of Purdue’s marketing plan included the use of complex marketing data to identify physicians that frequently treated chronic pain. Drug companies regularly assemble prescriber profiles on individual physicians and regions, and Purdue utilized these profiles to identify the highest and lowest prescribers of Opioid drugs in countless zip codes, counties, states, and even the entire country. Purdue Pharma drug reps would then frequent the offices of these identified high-prescribers and convince them that Oxycontin was the least addictive and best Opioid on the market to ease their patients’ moderate to severe pain.
The Influence of Gifts on Prescribing Practices
In addition to targeting specific physicians and downplaying the addictive nature of drug, giving gifts was an essential part of the marketing of OxyContin. OxyContin sales representatives visited thousands of doctors across the United States, leaving gifts, free patient samples, and invitations to all-expenses-paid conferences in destinations such as Miami and Las Vegas. All of these actions are known to influence prescribing, and other Opioid companies quickly followed suit, pushing vacations and free merchandise in exchange for drug prescribing rates.
The potential conflicts of interest created by gifts have been recognized for as long as it has been a practice. Countless studies have demonstrated that doctors tend to prescribe drugs from companies that give them incentives. As early as 1991, the American Medical Association issued a few recommendations: ideally, gifts should only be given if they benefit patients, like free samples for those who otherwise couldn’t afford them, but gifts to doctors are generally permissible as long as they are of “minimal value.” In the years since OxyContin came to market, the industry has implemented rules that banned both large gifts (vacations and tickets to sporting events) and small gifts (coffee mugs and pens). However, that policy is full of loopholes. Although pens are prohibited, pharmaceutical companies are still allowed to regularly purchase meals and drinks for physicians.
A 2017 study published by Social Science & Medicine demonstrated that even small gifts such as free lunches can influence doctors to prescribe specific drugs. Over the course of six years, it analyzed the prescription rates of new costly medications sold by reps at 19 academic medical centers from 2006 to 2012. Each institution banned small gifts and regulated pharmaceutical reps’ visits more strictly at some point during the study. This timeline allowed the researchers to examine how the rate of prescriptions for the drugs changed when the restricting policies went into effect. They found that these drugs lost 1.67 percent in market share to cheap generic drugs without the influence of drug reps and their gifts. Another study has found that while the number of Opioid prescriptions have dropped in recent years nation-wide, Opioid medications have continued to be steadily prescribed among physicians that still receive gifts from pharmaceutical companies.
Fighting the Current Crisis
Since the year 2007, Purdue Pharma has faced countless lawsuits due to their false marketing and “misbranding” of OxyContin. Multiple individual states have filed allegations against the company, claiming that the misrepresentation of the addictiveness of the drug has contributed to the national epidemic of Opioid-related addiction and deaths, as well as state-wide medical costs. In 2010, a new formulation of Oxycontin was developed, and manufacturing of the original effectively stopped. Unlike the original, the new arrangement uses an abuse-deterrent formula that is harder to crush and abuse. Although this form did reduce the abuse of OxyContin, a 2014 study demonstrated that the abuse-deterrent formulation simply pushed people to abuse other Opioid drugs, including Heroin and Fentanyl.
Both federal and state governments continue to make efforts to help reduce the number of patients who are prescribed and misusing Opioid medications. Strides are being made to broaden education and addiction treatment resources in hopes to prevent future addiction. Many states are also creating programs to distribute Naloxone, the Opioid overdose reversal drug, and make it more readily available.