Purdue Pharmaceuticals announced Saturday that it would stop marketing its painkiller OxyContin directly to doctors, according to NBC News, following lawsuits over its role in the wave of opiate drug addiction sweeping the US.
“We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers,” according to a statement from the company.
The pharmaceutical giant has been widely criticized in recent years, over its aggressive promotion and misleading sales tactics in marketing OxyContin. The drug was first marketed in 1995, as a non-addictive version of oxycodone, intended to treat chronic pain. The company brought in $1.94 billion in revenue from the drug in 2017, down about a billion dollars from its peak in 2013.
Purdue’s move is a prime example of “too little too late,” when it comes to private sector action to combat, and take responsibility for, the opioid crisis.
For one, the opiate epidemic has taken on a life of its own, with many addicts having moved on from pills such as oxycodone to ever more widely available heroin. Studies have shown that the average modern heroin addict first started using opiates with painkillers prescribed by a doctor. Heroin is roughly one tenth the price of opioid painkillers, and increasingly easy to acquire in the US. According to the DEA, availability has increased vastly in recent years, with seizures of heroin increasing 80 percent between 2011 and 2015.
Perhaps a move like this would have made a difference ten or fifteen years ago. But it’s unclear how it will impact the situation now.
2016 saw over 42,000 opiate related fatal overdoses in the US, according to data from the Centers for Disease Control. This staggering figure followed years of increases, including a 248 percent increase from 2010 to 2014.
There’s no question that the opiate epidemic in the US has reached epic proportions – now riding a wave of cheap and plentiful heroin. But why blame companies who produce medical painkillers? Didn’t they simply put their product on the market, where doctors and patients knowingly chose to overprescribe and abuse it?
Well, not exactly.
Purdue’s early efforts to market OxyContin were both aggressive and misleading – especially for the doctors tasked with making choices about painkillers for their patients.
As soon as OxyContin was introduced in 1996, Purdue marketed OxyContin by talking up its low risk of addiction. A series of pain-management conferences advertised the apparent harmfulness of the company’s new miracle drug, directly to doctors, pharmacists, and nurses, who were recruited as advocates within the industry. Massive bonuses, larger than their annual salaries, encouraged pharmaceutical representatives to focus on boosting OxyContin sales. These sales representatives described the risk of addiction from the drug as “less than one percent,” citing studies that had only examined short-term use for acute pain. Ultimately, this helped to blind the medical world to the dangers of long-term use.
This coincided with a movement of doctors pushing to take a more aggressive approach to treating pain. Traditionally, strong opioid painkillers were reserved for the treatment of cancer-related pain. Now, drugs like OxyContin were being market for chronic pain such as injuries.
In 2000, the Joint Commission, responsible for accrediting hospitals, began requiring healthcare facilities to demonstrate that they were properly treating their patient’s pain.
This worked out well for Purdue. In 2001, they were spending $200 million on marketing OxyContin, which was bringing in $1.5 billion annually the following year. In the period between 1991 and 2013, opioid prescriptions in the US skyrocketed, from 76 million to 207 million. Overdoses and addiction rose with it. By 2002, 5,000 people were dying each year from opioids in the US. That number would triple over the following ten years.
In the last decade, Purdue has faced both lawsuits and investigations over its aggressive approach to marketing OxyContin. At least 14 states have sued the company, and the Connecticut US attorney’s office is conducting a federal investigation. In 2007, the company and three executives plead guilty to federal charges over their misrepresentation of the risks associated with Oxycontin.
According to Massachusets Senator Ed Markey, speaking to the LA Times:
“OxyContin is the original sin of the current opioid epidemic. For years, Purdue Pharma lied to federal regulators and the public about the addictiveness of OxyContin and countless patients got hooked on this deadly painkiller.”
In 2010, in response to the unwanted attention they had earned from the Department of Justice, Purdue reformulated OxyContin to include an abuse-deterrent mechanism that made it much more difficult for users to crush or dissolve the pills.
A study, published last year by the National Bureau of Economic Research, confirmed what many had long suspected. These efforts, which came 10 to 15 years after the addictions really took root, only pushed addicts towards the more accessible and affordable heroin. The reformulation alone was responsible for “as much as 80% of the three-fold increase in heroin mortality since 2010,” according to the research. The researchers found that the rises in post-2010 heroin fatalities in each state were closely linked to the levels of pre-2010 OxyContin abuse there.
“Results show that this differential increase in heroin deaths began precisely in the year following reformulation,” according to the researchers. And furthermore, the research showed there was no link between these numbers before the reformulation. While the move reduced abuse of OxyContin “each percentage point reduction in the rate of OxyContin misuse due to reformulation leads to 3.1 more heroin-related deaths per 100,000.”
After 2010, state and federal laws were enacted to more closely monitor the prescription of pain medication. Prescription Drug Monitoring Programs (PDMPs) were created to keep track of opiate prescriptions. But it was largely too late for these measures.
The authors of the paper suggest an approach that works to reduce demand in addition to supply – as in treatment and prevention.
The recent move by Purdue is good news. It is a sign of cultural shift towards an awareness of the dangers surrounding drugs like OxyContin. Hopefully, other pharmaceutical companies will follow suit. What it is not, in 2018, is a reason to praise the company for its sensitivity. And, it is not a solution to the still-growing opiate crisis. That will require public-health based, demand-focused efforts that center around treatment and education. In the long-run, a much-needed overhaul to the broken, profit-driven healthcare system in the US is the only thing that will stop similar crises in the future.