How Purdue Pharma Created the Opioid Epidemic

Last Updated on January 24, 2022 by Shaun Snapp

Executive Summary

  • Purdue Pharma was behind the opioid epidemic.
  • Purdue had a long history of running a rigged drug system.

Introduction

Purdue Pharma had a system for rigging the development and rollout of their drugs for decades. This is the same company that is responsible for the opioid crisis. How Purdue Pharma did this is critical to understanding the opioid crisis.

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A Description of Opioids

The following is a good description of opioids.

Common semi-Synthetic Opioids include Percocet, Vicodin, and OxyContin.

These medications are generally used to treat moderate to severe pain, although some can be prescribed for coughing and diarrhea. These drugs are highly addictive and present a high risk of misuse. Semi-Synthetic Opioid misuse can cause slowed breathing, which often results in hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can induce coma, permanent brain damage, and even death. – Addiction Center

It is jaw-dropping that the opioid manufacturers extended opioid approval for coughing and diarrhea. This is referred to as “Evergreening,” where the pharmaceutical company makes successive applications to extend the drug for different conditions.

To understand opioids, it is important to understand heroin.

According to the CDC, the number of Heroin users has more than doubled; approximately 80% of new users are coming to Heroin after having abused prescription Opioids. According to the CDC, almost 33% of all Opioid fatalities are linked to Heroin. – Addiction Center

So the opioid epidemic, which is the fault of the pharmaceutical industry, drug distributors, MDs, the FDA, (the US congress which restricted the DEA from prosecuting opioid manufacturers), and the overall medical establishment, eventually led to a great rise in the use of heroin. The pharmaceutical industry and medical establishment have taken no responsibility for any of this.

Understanding the Company Behind the Opioid Epidemic

The opioid epidemic fails the health system to control corruption and was extensively promoted by the Sacklers and Purdue Pharma, which actively pushed opioids targeting doctors with financial needs to addict enormous numbers of US citizens to opioids.

This is explained in the following quotation.

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.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.

But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.

Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, has worked with hundreds of patients addicted to opioids. He told me that, though many fatal overdoses have resulted from opioids other than OxyContin, the crisis was initially precipitated by a shift in the culture of prescribing—a shift carefully engineered by Purdue. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.” – The New Yorker

There is much more to this topic. But Purdue Pharmaceutical marketed oxycontin as safe, even though it had been known for decades that it was not safe. Their primary innovation with the drug was to make it time-released.

However, even before Purdue Pharma came up with Oxycotin, it had a system for developing and getting drugs approved that was entirely corrupt.

This is explained in the following quotation.

In the early sixties, Estes Kefauver, a Tennessee senator, chaired a subcommittee that looked into the pharmaceutical industry, which was growing rapidly. Kefauver, who had previously investigated the Mafia, was especially intrigued by the Sackler brothers. A memo prepared by Kefauver’s staff noted, “The Sackler empire is a completely integrated operation in that it can devise a new drug in its drug development enterprise, have the drug clinically tested and secure favorable reports on the drug from the various hospitals with which they have connections, conceive the advertising approach and prepare the actual advertising copy with which to promote the drug, have the clinical articles as well as advertising copy published in their own medical journals, [and] prepare and plant articles in newspapers and magazines.” – The New Yorker

The best way of thinking of this is “vertical integration.” There was no independent party involved from the drug’s development all the way to the study.

It should be apparent that it is not possible to hide such a system for very long. However, the Sackler family and Purdue Pharma were able to continue operations without any department from the US government taking any interest.

How Purdue Pharma Targeted Doctors With Limited Pain Treatment Experience

Purdue Pharma looked for doctors they could take advantage of, as is explained in the following quotation.

A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. As May put it, “What Purdue did really well was target physicians, like general practitioners, who were not pain specialists.” In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.” Because OxyContin was so powerful and potentially addictive, David Kessler told me, from a public-health standpoint “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.

David Kessler, the former F.D.A. commissioner, believes that the destigmatization of opioids in the U.S. represents one of the “great mistakes” of modern medicine.  – The New Yorker

Purdue was looking for doctors that would act as pill mills. These are doctors with a strong money addiction that did not care much about their patients. All doctors receive training in drug addiction and on how to spot drug seekers. But these doctors ignored that training.

The Strategy to Compete Against Established Pain Medications

Purdue’s business was fundamentally changed after the F.D.A. approved OxyContin in 1995. The company marketed the drug as a long-acting painkiller that was less addictive than shorter-acting rivals like Percocet and Vicodin, a strategy aimed at reducing the stigma attached to opioids among doctors.

The court filings detailed a multipronged approach used by the pharmaceutical industry at that time to reshape public perceptions about pain and chip away at physicians’ reluctance to prescribe opioids, long known to be addictive, by describing an “epidemic” of untreated pain affecting 100 million Americans. – New York Times

How Purdue Lied and Continues to Lie About the Addictive Nature of OxyContin

Without this behavior by Purdue Pharma, they would not have been able to convince so many doctors to prescribe what was and is opium, as is explained in the following quotation.

Sales reps, May told me, received training in “overcoming objections” from clinicians. If a doctor inquired about addiction, May had a talking point ready. “ ‘The delivery system is believed to reduce the abuse liability of the drug,’ ” he recited to me, with a rueful laugh. “Those were the specific words. I can still remember, all these years later.” He went on, “I found out pretty fast that it wasn’t true.” In 2002, a sales manager from the company, William Gergely, told a state investigator in Florida that Purdue executives “told us to say things like it is ‘virtually’ non-addicting.”

According to training materials, Purdue instructed sales representatives to assure doctors—repeatedly and without evidence—that “fewer than one per cent” of patients who took OxyContin became addicted.

In discovery, Hanly obtained thousands of documents. “They demonstrated that this company had set out to perpetrate a fraud on the entire medical community,” he told me. “These pronouncements about how safe the drug was emanated from the marketing department, not the scientific department. It was pretty shocking. They just made this stuff up.” – The New Yorker

This illustrates yet again how pharmaceutical companies lie to doctors.

And they are now doing this to try to go after international markets and they again are lying about the addictive nature of OxyContin.

But the Sackler family has only increased its efforts abroad, and is now pushing the drug, through a Purdue-related company called Mundipharma, into Asia, Latin America, and the Middle East. Part of Purdue’s strategy from the beginning has been to create a market for OxyContin—to instill a perceived need by making bold claims about the existence of large numbers of people suffering from untreated chronic pain. As Purdue moves into countries like China and Brazil, where opioids may still retain the kind of stigma that the company so assiduously broke down in the United States, its marketing approach has not changed. According to a Los Angeles Times report from 2016—well after the Sacklers’ playbook for OxyContin had been repudiated by the medical establishment as possibly the main driver of the opioid epidemic—Mundipharma commissioned studies showing that millions of people in these countries suffered from chronic pain. – The New Yorker

How Purdue Pharma Controlled The Information on Oxycontin Totally

Purdue’s fake studies were a major factor in convincing doctors to write prescriptions for OxyContin.

May didn’t ask doctors simply to take his word on OxyContin; he presented them with studies and literature provided by other physicians. Purdue had a speakers’ bureau, and it paid several thousand clinicians to attend medical conferences and deliver presentations about the merits of the drug. Doctors were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Such spending was worth the investment: internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t. The company advertised in medical journals, sponsored Web sites about chronic pain, and distributed a dizzying variety of OxyContin swag: fishing hats, plush toys, luggage tags. – The New Yorker

This is not just a trick of Purdue but is common throughout the pharmaceutical industry. What the pharmaceutical companies list under medical education is normally just exposure to marketing, but placed within a medical framing.

How Purdue Pharma Provided Legal Opium to Millions

What seems to have been missed by so many doctors is that OxyContin is just opium. And it was obvious from how patients were reacting to OxyContin that it was highly addictive.

lmost immediately after OxyContin’s release, there were signs that people were abusing it in rural areas like Maine and Appalachia. If you ground the pills up and snorted them, or dissolved them in liquid and injected them, you could override the time-release mechanism and deliver a huge narcotic payload all at once. Perversely, users could learn about such methods by reading a warning label that came with each prescription, which said, “Taking broken, chewed or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose.” As more and more doctors prescribed OxyContin for an ever-greater range of symptoms, some patients began selling their pills on the black market, where the street price was a dollar a milligram. Doctors who were easily manipulated by their patients—or corrupted by the money in play—set up so-called pill mills, pain clinics that thrived on a wholesale business of issuing OxyContin prescriptions.

The company did not pull the drug from shelves, however, or acknowledge that it was addictive. Instead, Purdue insisted that the only problem was that recreational drug users were not taking OxyContin as directed. “Their rap has always been that a bunch of junkies ruined their product,” Keith Humphreys, the Stanford professor, said. – The New Yorker

From the perspective of a drug company, the more addictive a drug is the better it is for the company and the higher the will be sales. There is a reason that opium is illegal in all countries, however, using the respectability of medicine calling it a pharmaceutical, and making a few adjustments so that the drug is delivered in a time-phased way, Purdue was able to sell an illegal drug as a legal drug.

How the Drug Feels to Take

YOU NATURALLY PRODUCE ENDORPHINS, the body’s own version of opioids, which act in the reward circuits of the brain to make you feel good after you work out, hug a friend or eat your favorite foods.

A drug like heroin creates a tidal wave in the reward circuits of the brain. To an outsider, it looks as though you have passed out. But on the inside you feel like a master of the universe, like you’re being “hugged by Jesus,” as one user said; there’s peace in your skin and not a single feeling of pain.

Like other drugs, opioids produce a surge of dopamine, a chemical messenger that tells the brain that “taking this drug is good, repeat it.” The brain’s response to opioids and the surges in dopamine they cause can rewire circuits in the brain. New York Times

Purdue Pharma Comes Up With a New Name for Addition — Pseudo Addiction

It is difficult to know whether to laugh or sneer in disgust with the following quote.

Doctors who prescribed OxyContin were beginning to report that patients were coming to them with symptoms of withdrawal (itching, nausea, the shakes) and asking for more medication. Haddox had an answer. In a 1989 paper, he had coined the term “pseudo-addiction.” As a pain-management pamphlet distributed by Purdue explained, pseudo-addiction “seems similar to addiction, but is due to unrelieved pain.” The pamphlet continued, “Misunderstanding of this phenomenon may lead the clinician to inappropriately stigmatize the patient with the label ‘addict.’ ” Pseudo-addiction generally stopped once the pain was relieved—“often through an increase in opioid dose.” – The New Yorker

Interesting. OxyContin is opium. The prescribing doctors would have noticed patients coming back for refills and inventing excuses for why their pain had not yet subsided. Doctors are well trained in this, and the patients that do this are called “drug seekers.” Then the OxyContin patients also demonstrated signs of withdrawal — but Purdue Pharma tells them that this is fake withdrawal and nothing to be concerned about.

This fits a long-term pattern of Purdue gaslighting the medical community and Congress that their drugs were being misused, and it was not related to the drug itself.

The “Surprising” Outcome of Offering Perscription Opium

U.S. sales of OxyContin soon exceeded those of Viagra. Everywhere the drug spread, addiction followed. To Steven May, the sales representative in Virginia, it seemed as if the problems associated with OxyContin were metastasizing, “like a cancer.” – The New Yorker

Yes, that is what happens when you offer prescription opium. One should expect the same thing if prescription heroin were offered by doctors’ offices.

The disgusting thing about this is that Purdue Pharma created opium addicts out of people who were looking for pain medication, and did not realize they were taking opium.

Furthermore, the government paid for these people to become addicted to opium. The government has repeatedly called marijuana a “gateway drug.” Well, OxyContin is perhaps the ultimate gateway drug as it prescribes opium to people who were looking for main relief. Although, as soon as the patient began taking OxyContin, they were already taking one of the hardest drugs available, right off the bat.

The Impact of OxyContin on Communities

Seven out of ten respondents described OxyContin’s effect on their community as “devastating.” – The New Yorker

Why Purdue Settles Rather Than Going to Court

Purdue has sometimes claimed to have never “lost a case” related to OxyContin, but it’s more accurate to say that the company has never allowed a case to go to trial, often settling rather than litigating the culpability of the company—and the Sacklers—in open court. “That’s the main reason these folks don’t go to trial,” Denham said. “Because all these documents could end up in the public record.” The Kentucky prosecutors were required to destroy millions of documents, or return them to Purdue. – The New Yorker

This quote was written in 2017. Purdue eventually declared bankruptcy in 2021 to shield itself from thousands of lawsuits. This is explained in the following quotation.

In exchange for the protections, the Sacklers agreed to turn over $4.5 billion, including federal settlement fees, paid in installments over roughly nine years. Those payments, and the profits of a new drug company rising from Purdue’s ashes with no ties to the Sackler family, will mainly go to addiction treatment and prevention programs across the country.

Judge Drain delivered his ruling orally from the bench in a marathon session that ran to six hours, meticulously working through his reasoning in a case he called the most complex he had ever faced. “This is a bitter result,” he said. “B-I-T-T-E-R,” he spelled out, explaining that he was frustrated that so much Sackler money was parked in offshore accounts. He said he had expected and wished for a higher settlement.

Purdue pleaded guilty to federal criminal charges for drastically downplaying OxyContin’s addictive properties and, years later, for soliciting high-volume prescribers.

But in a concession that made the bankruptcy plan more palatable to many plaintiffs, the company and the Sacklers agreed to make public more than 30 million documents, including confidential emails, that may reveal comprehensive marketing strategies.

Another fund will compensate 130,485 individuals and families of those who suffered from addiction or died from an overdose, in amounts ranging from $3,500 to $48,000. Guardians of about 6,550 children with a history of neonatal abstinence syndrome may each receive about $7,000. – New York Times

The Change Made to OxyContin in 2010

In August, 2010, Purdue quietly replaced OxyContin with a drug that was subtly different. The company had been granted patents for a reformulated version of OxyContin. If you crushed these new pills, they became not a fine, dissolvable powder but an unwieldy gummy substance. Purdue had received F.D.A. approval for the reformulation, in part, by touting the ostensible safety of the new product. The F.D.A. had approved a label, the first of its kind, that included a claim about the drug’s “abuse deterrent” properties.

To a casual observer, it might have seemed that the makers of OxyContin, after years of obstructing efforts to curb the disastrous impacts of their painkiller, had finally seen the error of their ways. But Purdue was almost certainly motivated by another consideration: it needed to block competition from generic drugs. Arthur Sackler had often used the pages of the Medical Tribune to criticize generics. In 1985, the paper had published a story, “Schizophrenics ‘Wild’ on Weak Generic,” describing how “all hell broke loose” at a veterans’ hospital after the psychiatric unit switched from a brand-name antipsychotic to a generic. (According to the Times, the F.D.A. investigated and found that the story was bogus, because “the generic had been introduced six months before the purported problems began.”)

I spoke with a leading patent lawyer who frequently represents manufacturers of generic drugs, and she said that companies often make a minor tweak to a branded product shortly before the patent expires, in order to obtain a new patent and reset the clock on their exclusive right to produce the drug. The patent for the original OxyContin was set to expire in 2013. – The New Yorker

Patients Graduate to Heroin

A survey of two hundred and forty-four people who entered treatment for OxyContin abuse after the reformulation found that a third had switched to other drugs. Seventy per cent of that group had turned to heroin. – The New Yorker

How Purdue Targeted Areas to Create OxyContin Addicts

Mitchel Denham, the Kentucky lawyer, told me that Purdue pinpointed “communities where there is a lot of poverty and a lack of education and opportunity,” adding, “They were looking at numbers that showed these people have work-related injuries, they go to the doctor more often, they get treatment for pain.” The Xalisco boys offered potential customers free samples of their product. So did Purdue. When it first introduced OxyContin, the company created a program that encouraged doctors to issue coupons for a free initial prescription. – The New Yorker

How Opioids Are an Ineffective Pain Medication

The amazing thing was that opioids were not even an effective long-term pain medication. They relieved pain in the short term but then got the patient addicted to opium.

David Juurlink, the Toronto doctor, told me that opioids are problematic even for users who don’t succumb to addiction. “Opioids really do afford pain relief—initially,” he said. “But that relief tends to diminish over time. That’s, in part, why people increase the dose. They are chasing pain relief from a drug that has failed. – The New Yorker

The CDC’s Statement on Opioids

Last year, the C.D.C., which formally declared an opioid epidemic in 2011, introduced the first set of guidelines to help reduce the prescribing of strong painkillers like OxyContin. “Opioids should not be considered first-line or routine therapy for chronic pain,” the guidelines said, recommending that doctors first consider “non-pharmacologic” approaches, such as physical therapy, and “non-opioid pharmacologic” treatments. – The New Yorker

In 2020, nearly 70,000 people died of opioid overdose. However, according to the logic presented by the American Cancer Society, opioid medications are based upon solid research — as they are a prescription drug that was approved repeatedly by the FDA. 

More on this issue. 

Conclusion

It is incredible that Purdue Pharma could get away with this for so long and it shows how corrupt the US medical system is that this was allowed to occur. In 2021 Purdue Pharma declared bankruptcy and was hit with an $8.3 billion file for its behavior by the DOJ, an amount which only a small fraction will be paid. How the FDA behaved as a pharmaceutically controlled puppet agency is covered in the article How FDA Did Nothing to Stop And Turned a Blind Eye to The Opioid Epidemic.