Purdue Pharma and the Roots of the Modern Opioid Epidemic
Purdue Pharma was founded in 1892 by John Purdue Gray and George Frederick Bingham. In 1952, the Sackler brothers, Arthur, Mortimer, and Raymond, bought what was at the time the small pharmaceutical company. In 1966, Purdue Pharma created new technology allowing for drugs containing higher doses of opium. It produced a drug called MS Contin, short for morphine sulfate controlled release; Morphine sulfate, the active ingredient, was covered in a sugar tablet-like seal, which allowed the pill’s effects to last for a continuous period of time. The drug was therefore coined “contin.” Like many other opioids at the time, MS Contin was essentially only used for intense pain, but it was still immensely profitable.
Purdue realized the same technology employed in MS Contin could be used with other opioids. Almost twenty years later, in 1985, Purdue’s patent on MS Contin was about to expire, allowing companies to make generic versions of the drug. Aware that its profits were about to nosedive, Purdue’s scientists began conceiving a new drug. They were intrigued by oxycodone, an opioid significantly more powerful than morphine, and used it to design OxyContin. Historically, oxycodone was rarely used in established medicine because of the danger of its immediate potency, but the “contin” technology allowed OxyContin to slowly trickle into the bloodstream over the course of 12 hours.
OxyContin was clearly perilously addictive from the outset, even more so than MS Contin. Its creation process entails purifying the natural molecules found in the opium poppy, creating a vigorous new substance that enters the brain faster with a more rewarding effect. This process is essentially identical to the process for creating heroin. Dr. Andew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, asserts that OxyContin is comparable to “heroin pills” that “give effects indistinguishable from heroin.”
Purdue, like every doctor at the time, was fully aware of these addictive and dangerous qualities from the beginning of the drug’s creation and knew OxyContin wouldn’t sell if the real risks of it were understood. In its initial rejected application to the FDA, Purdue employed misleading and arguably false information regarding the potential for addiction, stating, for example, that “‘addiction to opioids legitimately used in the management of pain is very rare.” In its greed, Purdue continued to expand on its false claims and added that “most chronic pain patients” should be targeted as potential OxyContin users, significantly widening the demographic for opium.
To make OxyContin as commercially viable as possible, Purdue needed to shift the narrative of opium use from unbearable pain to an everyday headache, but one barrier kept it from beginning its mammoth advertising campaign: the FDA. Without its approval, the claims Purdue wanted to make about OxyContin would be classified as false advertising, and the company would risk flurries of fines, imprisonments, and a sharp decline in profits. And so, Purdue committed one of the most destructive crimes of the recent era by bribing the FDA. In December of 1995, three of the company’s executives began working closely with Curtis Wright, a Team Medical Review officer for the FDA. They rented a room close to Wright’s home and worked with him there for upwards of three days, drafting the official FDA review of OxyContin in a manner Wright was sure would be approved; subsequently, it was. While this behavior alone was blatantly illegal, evidence suggests there were also heavy bribes made by Purdue executives to Wright. About 13 months after OxyContin’s approval, Wright was hired to an executive position at Purdue at a starting yearly salary of over $370,000.
Once granted FDA approval, Purdue had free rein to market OxyContin as a safe and non-addictive medication to a wide audience. Packaging labels on prescription bottles stated, “Delayed absorption as provided by OxyContin tablets is believed to reduce the abuse liability of [OxyContin].”
Purdue spared no time in marketing OxyContin to its largest possible audience, and subsequently, its profits skyrocketed. Between 1996 and 2001, Purdue held over 40 complimentary pain-management and speaker training conferences at various locations across the country; more than 5000 physicians, pharmacists, and nurses attended. By 2000, Purdue had more than doubled its internal sales force from 318 sales representatives to 671. Purdue trained its new representatives to aggressively market to the “non-malignant pain market,” widening potential profits by 86%, increasing its physician call list from around 40,000 to about 85,000, and escalating Purdue’s income from about $670,000 in 1997 to about $2 million in 2002. Sales representatives were motivated by an incredibly lucrative bonus system. In 2001, the average base salary of a Purdue Pharma sales representative was $55,000, but annual bonuses averaged $71,500 and totaled $40 million. This bonus system was paired with sophisticated marketing data that informed sales representatives which physicians nationwide prescribed the most opioids, causing the sales representatives to compete with each other to land contracts at key sites and creating a cut-throat atmosphere that incentivized both medically unsafe and overly hasty deals.
Purdue fabricated medical terms so that representatives could continually prescribe more opioids. If patients reported withdrawal symptoms, such as nausea or fatigue, Purdue sales representatives were told to say that it was a form of “pseudo-addiction,” which was not “addiction” and therefore totally safe. If physicians wanted to further research “pseudo-addiction,” they could find a single case study conducted by Purdue’s scientific advisor, J. David Haddox, describing how symptoms that identically resembled drug-seeking behavior were instead caused by unrelieved chronic pain and indicated that physicians should increase their patients’ prescriptions. None of these studies were supported by any clinical research or official testing.
Purdue praised opioids as society’s saviors. Sales representatives were told they were serving a role filled with dignity, helping people with chronic pain return to happy and healthy lives. Purdue advertised opioids similarly to the general public. “Pain is suffering” became its mantra. During sales pitches in physician’s offices and on living room TVs, an advertisement titled “I got my life back” in which “patients in pain tell their stories” played frequently. Patients in the video often took outlandishly inflated doses to demonstrate OxyContin’s safety, such as a swimmer who was on a daily dosage of 1200 milligrams and exclaiming, “this drug does not make you a zombie!”
Purdue began mass-distributing misinformation in the forms of videos, manuals, flyers, and posters to hospitals around the country, causing hospital administrators to call meetings to reeducate their medical force on pain management. Dr. Anna Lembke, psychologist and current Medical Director of Addiction Medicine at Stanford University, recounted material taught in these meetings, such as “pain should be treated like the fifth vital sign. When you take blood pressure, when you take respiratory rate, when you take heart rate, temperature, you should show [the patient] this scale from 1-10, one is like a tiny little bit amount of pain, and ten is the worst pain you can imagine… we were constantly being told there was a growing epidemic of pain, that more and more people were in pain, that it was the responsibility of the doctors to alleviate pain.” Purdue was fundamentally changing the way pain management was medically perceived, cementing its product as the solution and ignoring the inevitable health risks to come.
With the use of these deceptive marketing strategies, Purdue Pharma was making an incredible amount of money. By 2001, OxyContin sales had exceeded $1 billion annually, making it the most profitable drug of all time. Unfortunately for Purdue, however, the triumphs of its drug directly manufactured its downfall: the opioid epidemic.
Opioid-related deaths increased alongside rising numbers of prescriptions. 9% of all prescription opioid users overdose. In 2000 alone, an estimated 11,615 people died of opioid overdoses. By 2010, this statistic more than doubled to an estimated 25,565. Compared to the population growth, that statistic is twelvefold what it should be. From 1999 to 2015, nearly 183,000 people fell victim to opioid overdose. OxyContin launched the United States into the thick of an opioid epidemic.