Full disclosure: this is gonna be a long one. If seeing a bunch of sentences in a row gives you anxiety or you still have PTSD from that one class in college where you actually had to read, you might want to hop off now. But if you decide to stay along for the ride, I promise I’ll do my best to make this readable and hopefully throw in a few jokes along the way. I honestly believe what I’m about to lead you through is really goddamn interesting, but it’ll be up to my somewhat (very) lacking communication skills to make it compelling for you. Okay, here we go.
In 1996, the company Purdue Pharma launched a drug that would make them over $35 billion in revenue and change the face of medicine forever, which is great. It would also be the leading cause of opioid addiction and overdoses along the way, which is not so great. This drug is called OxyContin, and a few years ago it could’ve been available from your local doctor if you did a halfway decent job of convincing him your back hurt.
So what does OxyContin do? Well, the mechanism is relatively complicated and any attempt for me to try to explain it would essentially be the blind leading the super blind. But for the purposes of this blog all you need to know is that it does a really good job of relieving pain. At the time, it was the longest lasting pain medication by a fairly wide margin.
For the launch of their new drug, the company spent over $200 million and doubled its sales force. Using the pitch of OxyContin’s 12-hour long lasting pain relief, the drug was marketed to family doctors and general practitioners to treat common ailments such as backaches and knee pain. Which is like marketing a fire hose as a super soaker.
But there was a major problem; OxyContin rarely lasted 12 hours. In Purdue’s own clinical studies, about half of the patients required medication before the 12-hour mark, and for a substantial number of people, the drug barely lasted 8 hours. They were the pharmaceutical equivalent of a teenage boy telling his friend about the sex he had last night: “dude, it was crazy. We banged for like an hour.” When the only thing that lasted an hour was the shame-filled apology after he finished in under 2 minutes.
Company officials were worried that if OxyContin wasn’t seen as a 12-hour drug, insurance companies and hospitals would refuse to pay its hefty cost, making the drug significantly less profitable. So instead, Purdue declined to test the drug at shorter intervals, allowing it to argue that OxyContin had only been tested for 12-hour doses.
Dishonest? Yes. Deceitful? Certainly. But in the end, smart; because the drug received FDA approval in 1995 and went on to make the company $1-3 billion per year for the next two decades. Dr. Curtis Wright, who led the FDA’s medical review of the drug, would end up leaving the FDA two years later to join Purdue and assist the company with new product development. What a coincidence. I’m sure his review of the drug’s sketchy clinical trial history was wholly impartial.
Soon enough, patients were telling their doctors that the drug was wearing off way before the 12-hour mark, leaving them in pain and needing to take three or more pills a day instead of the prescribed two. When this information got back to Purdue Pharma, they held emergency meetings with their sales reps and told them to encourage doctors to stick to the 12-hour mantra and prescribe higher dosages instead of more pills. Furthermore, the company downplayed the risks of addiction, which would now only increase at higher dosages, and encouraged doctors to prescribe the drug widely for common aches and pains. In hindsight, this would be similar to a doctor saying, “Your elbow hurts? Well here’s some heroin. Oh the heroin wears off too quickly? Then here’s some super heroin.” Which would be cool for a while, until you realize that, like heroin, OxyContin is highly addictive and leads to thousands of deaths every year.
Purdue also failed to intervene when it became obvious that a large number of doctors and pharmacists were funneling OxyContin pills into the black market. The company had access to prescription data from pharmacies, which allowed them to identify physicians who were writing unusually large numbers of prescriptions. These physicians were placed in an internal database called “Region Zero.”
Federal law requires drug companies to report suspicious activity to the DFA. By 2013, there were 1,800 physicians listed in Region Zero, but Purdue only reported 8% of them to authorities. Instead, they used this data to encourage doctors who were writing smaller numbers of prescriptions to write more. This encouragement usually came in the form of high-end dinners and resort getaways for Purdue-sponsored “conferences,” where I can only imagine they spent the majority of their time in places with a lot more sand, sun, and strawberry daiquiris than a conference room.
So what has happened as a result of Purdue fudging the numbers in their clinical trials, downplaying the addictive effects of their drug, and failing to report 92% of doctors who were over-prescribing? Well, first Purdue has been on the receiving end of a lot of lawsuits. Mainly from patients who claimed that the company falsely and knowingly marketed their drug for 12-hour pain relief. Most cases were dismissed, but Purdue did pay undisclosed amounts of money to some plaintiffs. Then the West Virginia Attorney General took them to court, making similar claims and eventually settling for Purdue paying $10 million into the state’s drug abuse programs.
But then in 2007 the hammer came down. The company’s top three executives pled guilty to fraud for downplaying OxyContin’s risk of addiction, and Purdue was ordered to pay $635 million. Yay! We did it! Except for the fact that according to the CDC, 61% of drug overdose deaths in 2013 were from opioids and between 2013 and 2014, opioid drug overdoses increased by 14%. In other words, opioid drug addiction is still a major problem in this country.
This is a messy situation, but I’ll try to sum it up as neatly as possible. Also, congrats on getting this far, here’s a gif of a puppy in a bowtie as my way of saying thanks.
What’s the main takeaway from all this? I’d say it’s that corporate greed and lack of oversight led to our nation being in the midst of a major prescription drug addiction crisis. That pharmaceutical executives downplayed obvious flaws in their drug because they saw dollar signs instead of the lives that it would ruin through addiction and overdose. So take away from that what you will, just don’t take away my OxyContin.