Purdue Pharma’s OxyContin Crisis
Photo by Toby Talbot, AP News
Between 1999 and 2019, approximately 247,000 people in the United States died from prescription opioid overdoses. Among these opioids was the narcotic oxycodone hydrochloride. To us, this opioid is known as OxyContin, developed and patented in 1996 by Purdue Pharma L.P. It is a painkiller available in the United States only by prescription, sold as a 10, 20, 40, or 80-milligram tablet. Some common street terms for Oxycontin are 40 (a 40-milligram tablet), 80 (an 80-milligram tablet), Blue, Hillbilly heroin, Kicker, and Oxycotton.
Doctors can prescribe OxyContin for relief of moderate to severe pain resulting from injuries, bursitis (inflammation in joints), neuralgia (irritation or damage to nerves), arthritis, and cancer. Individuals abuse OxyContin for the euphoric effect it can produce – an effect similar to that of heroin. OxyContin tablets have a controlled-release feature (specific amounts of the drug are released into the body at a time) and are designed to be swallowed whole. In order to bypass this controlled-release feature, abusers can chew or crush the tablets. Then, these crushed OxyContin tablets can be snorted or dissolved in water and injected. Bypassing the controlled-release feature means the drug is released all at once in the body, highly increasing the risk of overdose.
There are associated risks with abusing OxyContin. First, Oxycontin is like most drugs administered via shared needle use. Abusers who inject the drug in this way expose themselves to HIV (human immunodeficiency virus), hepatitis B and C, and other blood-borne viruses. Additionally, users of Oxycontin can develop a tolerance for the drug, needing increasingly higher doses to achieve the same effects or high. Individuals who take a large dose of OxyContin are at risk of severe respiratory depression and slowness of breath, possibly leading to death. Long-term abuse of the drug can lead to severe addiction, potentially causing withdrawal symptoms after they attempt to quit. Withdrawal symptoms associated with OxyContin dependency include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, and involuntary leg movements. There are a variety of risks associated with oxycontin, so it must be used responsibly.
The Problematic Marketing of Oxycontin
From 1999 and 2019, approximately 247,000 people in the United States died from prescription opioid overdoses. Owned by the Sackler family, Purdue Pharma began marketing OxyContin in the mid-1990s, earning them billions of dollars in sales from the drug. In 1999, 86% of the total opioid market was centered around non–cancer-related pain. Due to this, Purdue promoted OxyContin for the treatment of non–cancer-related pain, contributing to a nearly tenfold increase in OxyContin prescriptions, from 670,000 in 1997 to 6.2 million in 2002.
The Sacklers also employed aggressive marketing strategies for OxyContin. A lucrative bonus system centering around fiscal rewards encouraged Purdue’s hired sales representatives to increase sales of OxyContin in their territories. Purdue’s sales representatives received a base salary of $55,000 per year with additional annual bonuses ranging from $15,000 to nearly $240,000 depending on how much they sold. In much of Oxycontin’s promotional campaign—literature and audiotapes for physicians and brochures and videotapes for patients—Purdue claimed OxyContin carried an extremely small risk for addiction. Sales representatives were trained to say that the risk of addiction was “less than one percent.” These representatives would pay a large number of visits to physicians, pushing them to give patients more opioid prescriptions. Using these representatives, Purdue Pharma also provided patients with a free limited-time prescription for a 7- to 30-day supply of OxyContin through their patient starter coupon program.
OxyContin Advertising Materials
An OxyContin-branded windshield sun blocker. The front features the OxyContin logo, with the slogan, “The longest-lasting oxycodone ever.” It says below in smaller wording: “Warning — May be habit forming.” The reverse side of the sun blocker says in red lettering: “NEED HELP PLEASE CALL POLICE.”
On May 10, 2007, Purdue Frederick Company Inc., an affiliate of Purdue Pharma, along with three company executives, pled guilty to criminal charges of misbranding OxyContin. For falsely claiming that it was less addictive and less subject to abuse and diversion than other opioids, they paid $634 million in fines. Following the ordeal in 2007 were thousands of lawsuits. Fearful of negatively impacting legal action, the Sacklers initiated a “milking program” over the next decade. Ultimately, they withdrew from Purdue approximately $11 billion, roughly 75% of the firm’s total assets. In 2020, Purdue again pleaded guilty to three felony offenses: one count of dual-object conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, and two counts of conspiracy to violate the Federal Anti-Kickback Statute. Purdue confessed that from May 2007 through at least March 2017, it conspired to defraud the United States by impeding the lawful function of the Drug Enforcement Administration (DEA). The company had violated the Food, Drug, and Cosmetic Act (the F.D.A.’s oversight of the safety of drugs in the U.S.) by allowing unlawful prescriptions of its opioid products, including OxyContin, without legitimate medical purposes. Purdue also admitted to violating the federal Anti-Kickback Statute between June 2009 to March 2017, making payments to two doctors through Purdue’s doctor speaker program to influence them to write more prescriptions for Purdue’s opioid products.
Aftermath
In total, Purdue Pharma faced a criminal fine of $3.544 billion and an additional $2 billion in criminal forfeiture. The Sackler family paid $225 million in damages. Excluding Purdue’s criminal admissions, the claims resolved by the civil settlements are only allegations and there hasn’t been a decision of liability. Regarding the fear-rooted withdrawals made from Purdue, the firm was in a significantly weakened financial state. Naturally, in 2019, Purdue filed for Chapter 11 bankruptcy. The Sacklers proposed to return approximately $4.3 billion to Purdue’s bankruptcy estate. The centerpiece of this proposal was the bargain. In exchange for returning this money, the Sacklers sought a judicial order releasing the family from all opioid-related claims and enjoining victims from bringing such claims against them in the future. The bankruptcy court approved Purdue’s bankruptcy deal, including Sackler’s proposed legal protections. After a few more legal disputes, the Sacklers made it to the Supreme Court in Harrington v. Purdue Pharma L.P. The Supreme Court, in a 5-4 decision on June 27th, 2024, decided that nothing in the law authorizes bankruptcy courts to extinguish claims against third parties like the Sacklers, without the claimants’ consent. The Supreme Court denied the Sacklers of their proposed bankruptcy deal and immunity from civil opioid-related lawsuits. Legal concerns aside, the effects of Oxycontin are most evident from its misadvertisement. Doctors and patients alike were assured of Oxycontin’s safety, coaxed into this belief by Purdue’s deceitful advertising.
Sources
https://www.justice.gov/archive/ndic/pubs6/6025/index.htm#Top
https://rehabilitationguide.com/oxycontin-addictive/
https://pmc.ncbi.nlm.nih.gov/articles/PMC2622774/
https://www.supremecourt.gov/opinions/23pdf/23-124_8nk0.pdf
https://link.springer.com/article/10.1007/s40261-017-0561-9
https://www.statnews.com/2016/10/24/oxycontin-opioids-swag/
https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html
