were plied with plush toys, fishing hats, and CDs with
songs like “Get in the Swing with OxyContin.”
were flown to Sun Belt resorts for national pain
management and speaker conferences, the tab picked up by
Purdue Pharma, the Connecticut company that had just
introduced a powerful new opioid pill on the market
the five years after the drug’s launch in 1995, Purdue
held 40 conferences and paid for 5,000 physicians,
pharmacists and nurses to go, according to a journal
article by physician Art Van Zee. The message: Forget
fears about prescribing opioids to a more general pain
population. This isn’t heroin. This pill has a unique
time release mechanism that means it’s not very
addictive at all.
OxyContin sales grew from $48 million to $1.1 billion in
Pharmaceutical companies - not just Purdue - spend
billions each year on promotion (OxyContin is far from
the only opioid on the market - there’s also Vicodin,
methadone, and fentanyl, for starters.) But Purdue took
marketing to new levels.
problem is, it wasn’t all true.
was devious. It was ruthless. It was just a big lie,”
says Peter Jackson, whose daughter, Emily, 18, died
after ingesting OxyContin prescribed for an uncle who
had passed away of cancer. He now runs a national
advocacy group against prescription opioids.
“They were systematically lying to doctors for many
years, coming up with bogus graphs and all kinds of
things,” said Jackson. “The track record of sales for
OxyContin follows directly from that; it just shot up.”
understate addictive properties
By 2007, three of Purdue’s executives had pleaded guilty
to misbranding the drug by understating its addictive
properties. They were convicted of criminal misdemeanors
and paid a massive fine. But the drug remained on the
Purdue is a family-owned Connecticut company, founded by
psychiatrist brothers. Sent questions, including one
asking about addiction risk (studies are mixed, but many
experts consider the drug highly addictive for some
patients), the company responded in writing:
more than a decade, Purdue has been working with
policymakers and health experts to address the risks
associated with prescription opioids. We believe the
pharmaceutical industry has the responsibility and
unique ability to help evolve the analgesic market,
which is why we’ve taken a leadership role in developing
opioids with abuse-deterrent properties.”
People have used opium in a cruder sense throughout
history; morphine, invented to help wounded soldiers,
was named after Morpheus, Greek god of dreams, according
to History Today.
German scientists working for Bayer, known for aspirin,
created heroin (the word “heroisch” means “heroic” in
German) from morphine in 1874, trademarking and selling
it as a cough suppressant, according to the White House
Agency for National Drug Control Policy. Doctors
worldwide soon prescribed heroin.
According to History Today, heroin was Bayer’s first
“commercial medicine.” By 1928, though, a regulatory era
began as Congress banned heroin after murders in New
Illegal heroin spiked during the Vietnam War, as anyone
who has seen the movie “American Gangster” knows.
Purdue’s spokesman provided research showing OxyContin
is just 2.7 percent of opioid pill prescriptions. But
OxyContin’s launch sent statistics soaring, coming on
the heels of a decade-old national pain movement that
slowly liberalized doctors’ prescribing habits.
Official agencies and groups now embraced the pain
movement’s concept of “balance.” In 2001, the federal
Drug Enforcement Administration and 21 other
organizations issued an unprecedented statement urging
“balance” in opioid regulation - finding a way to
regulate abuse without stopping legitimate use for pain.
Numerous states passed Intractable Pain Acts to shield
doctors from punishment who used controlled substances
to treat patients in pain. Professional societies worked
against what was called “opiophobia.” Studies showed
regulatory bodies used outdated terms and were too
restrictive, and medical boards started rewriting
These actions gave Purdue’s marketing the legitimacy it
needed to many doctors (although some researchers and
associations were taking drug company grants).
Then, data started to come in, showing more abuse than
expected. Last year, the Centers for Disease Control and
Prevention found that over 60 percent of drug overdose
deaths now involve pharmaceutical drugs, mostly opioids.
Heroin deaths doubled in nine years, according to the
Recently seized heroin. It is
often packaged in small amounts for easier distribution at
cheap prices. People addicted to opioid painkillers
frequently turn to heroin because the drugs are chemically
Photos from Waukesha
County Metro Drug Unit
Medical examiner’s statistics for the last 11 years of
Waukesha County overdose deaths show most of the 385 who
died had ingested opioid pills. According to the medical
Drug overdose deaths rose from 15 in 2003 to a high of
59 in 2012. Last year, there were 37. About 17 percent
were suicides. Almost all of the rest were accidents,
with a few undetermined.
almost 80 percent of drug overdose deaths since 2003,
people had opioids in their bodies (heroin or
prescription pills), often in combination with other
prescription drugs or alcohol. In 21 percent, oxycodone
was the opioid found (that’s the drug in OxyContin;
however, Purdue Pharma points out that oxycodone, also
developed by scientists long ago, is found in many
Heroin was found in 55 cases; the peak year was 2012,
with 20 deaths. Morphine was found in 74 more cases.
Sometimes, because heroin metabolizes so fast, medical
examiners only detect morphine. However, sometimes
people die from taking morphine. People also died after
ingesting opioids like methadone and fentanyl.
More victims were male. The average age was 37, dropping
from a high of 51 in 2004.
reason those poppies put Dorothy to sleep as she headed
to Oz. According to the CDC, overdoses occur because the
drugs depress people’s breathing.
Purdue’s marketing efforts were critical, says Dr.
Michael Miller, who runs the addiction recovery center
at Rogers Memorial Hospital in Oconomowoc; now opioids
were prescribed to a general pain population, a huge
market - some 76 million Americans. Previously, opioids
were restricted to surgical use and terminal cancer
Opioids that aren’t heroin still are not controversial
for “end-of-life” patients. But Andrew Kolodny, a
leading opioid addiction expert, says that wasn’t a big
enough market for a “blockbuster” drug - terminal
patients won’t be on the drug long. Backs, knees - now
those were fair game too. However, some doctors say the
term “non-chronic cancer pain” is not easily defined; as
anyone whose loved one has suffered from pain knows, it
can be truly debilitating; and some cancer patients are
in remission and aren’t “end-of-life” either.
The question becomes where and how to find balance - how
much risk can and should society tolerate to stop the
pain of millions? Should risk be stopped with regulation
and limiting access, merely with education (put pills in
a lockbox) or a mixture?
answer depends on which part of the elephant a person
sees: If you’re a grieving parent whose child used
heroin, you might fall one way; if you’re a doctor with
suffering patients, another.
Jackson is frustrated that years after convictions and
with public health costs of OxyContin well known
(including its heroin link), more hasn’t changed
(although in 2010, Purdue reconfigured the pills so they
can’t easily be crushed and snorted. The company also
stopped selling a higher dosage).
There is evidence the reformulation pushed some pill
addicts to use heroin instead. James Bohn, who runs the
local DEA office, says people also turned to other forms
was at their sentencing hearing in Virginia in 2007 and
we thought, ‘Oh here’s a victory, finally, they’re
convicted.’ We thought that would change things, but if
you look at the statistics, their sales kept going up,
they didn’t take a setback at all,” says Jackson.
Americans want opioids for pain. Patients don’t just
want their pain controlled, doctors say; they want it
eliminated. Their expectations have changed.
“It’s a great drug,” insists UW-Madison pharmacology
professor June Dahl of OxyContin. Dahl was one of a few
researchers whose pain management advocacy helped relax
doctors’ attitudes toward prescribing opioids. “It’s no
different than morphine in any real sense,” she says.
David Cleary, who now runs the UW’s Pain & Policy Group,
which advocates international and national medical use
of opioids for serious pain relief, provided a study
showing only 3.6 percent of opioid users try heroin.
However, research says 80 percent of heroin users start
with opioids; Kolodny thinks there is an even bigger
prescription pill crisis.
“OxyContin is continually overprescribed by doctors for
people with many types of moderate pain who should never
have been given this drug in the first place,” says
Jackson. “This widened use can be directly traced to the
marketing campaign of Purdue Pharma.”
Dahl could change one thing, it’s “Purdue’s marketing,”
she says. She was one of their speakers; respected
researchers she knew were hired by Purdue and were
“doing the asking.” Now she feels “possibly used.”
Purdue had marketing down to a science. Drug companies
identified physicians with many chronic pain patients
and gave a lucrative bonus system to OxyContin sales
representatives who reached them, Van Zee wrote,
training sales reps to say the addiction risk was 1
percent (Kolodny says it’s about 25, but others say it
ranges from below and above that and depends on the
Parent questions FDA
Jackson believes enough attention isn’t given to the
Food and Drug Administration, which had the power to
stop the drug. The FDA’s small staff size for overseeing
promotional materials compounded things, said Van Zee.
FDA’s response has been to weigh the risks and benefits.
Last year, in response to a petition from Kolodny’s
group, the FDA ordered changes to extended-release
prescription opioids’ labeling to “more effectively
communicate the serious risks of misuse, abuse, neonatal
opioid withdrawal syndrome (NOWS), addiction, overdose,
and death.” But the FDA stopped short of other requests,
saying chronic pain is also a public health crisis in
America with societal costs.
law already requires that such prescriptions can’t be
refilled; a new one is required. There are also “strict
record-keeping and reporting” rules reflecting the “high
potential for abuse,” says the FDA. In Wisconsin, there
is a new database that allows doctors to track whether
patients are “doctor shopping.”
public hearing last year, the FDA heard from two groups:
Those with lost loved ones who wanted the drugs
restricted, and those concerned restrictions would block
legitimate pain relief, including some prominent medical
marketing mattered. Ashley Wazana, a doctor writing in
the Journal of the American Medical Association,
reviewed 29 scholarly studies, which showed interactions
between doctors and pharmaceutical companies started as
early as medical school. Most physicians met with reps
four times a month.
Interactions with pharmaceutical reps made doctors
quicker to prescribe drugs. Although professional
societies developed guidelines, many doctors were not
aware of them.
need to figure out how to put the genie back in the
bottle,” Miller says.
question is how, and to what degree.
Coming Friday: The cartel connection.