During the Covid Crisis, don’t forget the Opioid Crisis

This week in a remotely conducted hearing in federal court in New Jersey, Purdue Pharma’s chairman, Steve Miller, acknowledged  that in order to meet sales goals, the company told the Drug Enforcement Administration that it had created a program to prevent OxyContin from being sold on the black market, even though it was marketing the drug to more than 100 doctors suspected of illegally prescribing OxyContin.

In essence, Purdue pleaded guilty to criminal charges that it misled the federal government about sales of its blockbuster painkiller OxyContin, the prescription opioid that helped fuel a national addiction crisis. The admission brought a formal end to an extensive federal investigation that led to a multibillion-dollar settlement between the company and the Justice Department.  A recent story in the New York Times also reveals that the global consulting firm, McKinsey, was also involved in helping to promote opioid sales.  Specifically, McKinsey’s advice to the Sackler family, Purdue’s billionaire owners, provided guidance on how to “turbocharge” OxyContin sales at a time when opioid abuse had already killed hundreds of thousands of Americans.

Although the COVID crisis has led to the death of more than 225,000 Americans, doctors overprescribing OxyContin, along with illicit distribution of the drug, have contributed to the deaths of more than 450,000 Americans since 1999.

What was the underlying reason for the growth of drugs such as Oxycontin?  

In 2000, at a conference sponsored by the Joint Commission on Accreditation of Healthcare Organizations and the American Pain Society, pain was defined as a “patient’s rights” issue, to be attended to, when necessary, as a “fifth vital sign,” joined in prominence with the four other vital signs of life: blood pressure, pulse, temperature, and respiratory rate.  Congress further declared the decade beginning January 1, 2001, as the Decade of Pain Control and Research, deeming chronic pain not only a matter of public health, but also a necessity to ensure and maintain a healthy economy. This promotion of opioids as a solution to pain opened the floodgates to the rise of over-prescribing of opioids which led ultimately to decades of opioid addiction.

Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” GAO Reports noted that “The Drug Enforcement Administration (DEA) expressed concern that Purdue’s aggressive marketing of OxyContin focused on promoting the drug to treat a wide range of conditions to physicians who may not have been adequately trained in pain management.”

Today, unmitigated chronic pain is estimated to cost the U.S. economy between $560 billion and $635 billion per year.  There is no question that the management of pain was an important reason for the development of opioid drugs like Oxycontin.  There are indeed legitimate instances when pain medication needs to be administered to ease patients’ suffering.  Millions of patients found the drug to be a vital health aid for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal. Purdue’s marketing team launched a sophisticated marketing plan, that included a number of strategies to promote the drug to patients who were not prime candidates for pain medication.  As a result, many patients who started to take pain medication, trusting their physicians, found themselves addicted to a drug that they couldn’t stop using.  Let’s not forget that addiction is a disease, and the incoming administration needs to continue to introduce legislation that will help curb this disease, and to address the over-prescription of opioids that has led to this national crisis.