Court battle over opioid marketing indicates broader healthcare dysfunction

Court battle over opioid marketing indicates broader healthcare dysfunction

Written by Eric Geyer
Published 21 January 2019

(Banner image source: Toby Talbot/AP, via NPR)

On January 15th, 2019, the Superior Court of the Commonwealth of Massachusetts released a 274-page pre-hearing memorandum detailing the Commonwealth’s lawsuit against Purdue Pharma. The basis of this lawsuit was Purdue’s efforts to influence prescribers to write prescriptions for its famed drug Oxycontin, over the course of a decade.

The reason for this is that Purdue (and its top three executives) previously accepted a plea deal, which had them pay $634.5 million in fines, penalties, and forfeitures to the United States and various other state or federally run programs.

In this memo, the Commonwealth of Massachusetts shows how, following aggressive sales campaigns by Purdue to prescribers (particularly in 2012), a large rise in opioid related deaths occurred within the state. These deaths roughly tripled from 2012 to 2016, from 742 in 2012 to 2155 in 2016. Additionally, an investigation by the Attorney General of Massachusetts revealed that since 2009, 671 people who filled prescriptions for opioids made by Purdue died due to the opioids they were taking. This investigation also cited the cost the state of Massachusetts alone over $6 billion. All of this information followed several studies, which questioned the marketing and education tactics of Purdue, as well as the effectiveness of Oxycontin.

Purdue’s actions have come under fire, as they paid their sales representatives bonuses in direct relation to how many opiates were prescribed by the providers they visited. Per the memorandum, after one sales representative emailed her sales pitch to a provider, Purdue’s Vice President of sales immediately ordered for her to be fired – presumably because he knew what they were doing was illegal. Given that Purdue was rewarding the providers who prescribed the most of their Oxycontin with lunches, gifts and even cash, this only appears to be more evident.

This memo also cites 59 ways that Purdue participated in deceptive practices to increase their sales to targeted populations and disease states, in which opioid pain medications are not appropriate. For example, in 2007, Oxycontin represented over 90% of Purdue’s total sales (which was already double what they had planned for). Also included was how aggressively Purdue increased their number of sales representatives, quotas for physician visits and sales, the cost per visit, and more, without even being able to see the large chunk of redacted material.

From information on the CDC’s website, it appears that Massachusetts was one of the targets of Purdue due to lower prescribing rates that other areas of the country.  Where I currently practice, Ohio, has much higher rates of providers prescribing for opiates, based on this data. This would then make sense if Purdue specifically targeted Massachusetts, since most businesses work on improving their weaknesses.

Upon further digging, there are also lawsuits currently against or recently settled against Purdue in Kentucky, Ohio, Virginia and New York. Purdue has also fought patent challenges with their products, albeit not always successfully, and even reformulated its sales star Oxycontin to extend patent life. While there was little benefit to the effectiveness of the drug with the new formulation, but it was supposed to be harder to abuse it.

As a pharmacist, I clearly see that what Purdue did with Oxycontin is wrong on several levels. While I have no problem with promoting the education of disease states and mismanaged disease states, spreading misinformation and falsehoods disguised as “research” and “safe medicine” is morally and legally wrong.  I’ve actually been visited by some of these sales representatives myself, both as an intern and a pharmacist, and I’ve seen how they try to promote Oxycontin as “safe.” It is disturbing to see that a company, which claims it is committed to providing quality medications and drive innovations in patient care, appears to be solely committed to increasing its profits.

To this day, Purdue still tries to downplay its role, to the point of marketing that Oxycontin only represent 1.8% of the total opiate medications prescribed in the United States.  This is accurate for the volume of tablets for 2017, but was not true at the peak of their efforts in 2012, nor is it true for the total dollar figure.  

While Purdue is now in several ongoing court battles for its actions, its tactics are neither unprecedented nor unlike what other drug companies continue to do.  In 2017, Pfizer spent $14.784 billion on selling, informational and administrative expenses, but only $7.657 billion on research and development. That same year, GlaxoSmithKline spent £9.672 billion and £4.476 billion on the same categories, respectively.  While it is important for drug manufacturers to get the message out on their products, shouldn’t they be spending 30% of their revenues on research and less than 15% on their selling related costs, instead of the reverse?

These companies aren’t alone in this practice either, and the United States is where they spend the largest amount of their sales dollars, and where direct-to-consumer ads are very high, as are other methods. Purdue may be under more scrutiny because of the type of medication they make, as well as their tactics – but the industry as a whole is not much different.

It is critical for federal and state regulators to crack down on excessive prescription of opioids, which has been shown by robust research to directly contribute to increased rates of addiction and deaths by overdose. To seriously protect the health and well-being of the American public, our government must stifle nefarious business tactics by the pharmaceutical industry.