Purdue Pharmaceutical has been subject to a number of state lawsuits for the company’s role in the opioid epidemic we are seeing today. Previously undisclosed court documents from Massachusetts were released in January. These documents, along with other state lawsuits like the one in Oklahoma allege that the company, and the family that runs it, misled doctors and patients about the dangers of powerful opioid painkillers, despite a federal lawsuit from 2007 in which the company plead guilty and had to pay more than $600 million for deceptive marketing tactics.
Court documents from Massachusetts and Oklahoma allege that Purdue Pharma and the Sackler family, who owns the company, targeted specific groups of people and engaged in unethical practices to market their drugs to patients and maximize profits.
Oklahoma court documents say that “over a period of several years, defendants executed massive and unprecedented marketing campaigns through which they misrepresented the risks of addiction from their opioids and touted unsubstantiated benefits.”
The new Massachusetts court documents allege that Purdue was pushing its opioids by targeting specific populations. Elderly patients, veterans, and opioid-naive patients were three of the company’s main targets. The company trained sales representatives to target these vulnerable subgroups and encourage doctors to put them on opioids, without disclosing the risks of these drugs.
Elderly patients are at a greater risks of dangerous adverse health problems from opioids, including health problems such as respiratory depression and overdose. The documents say that Purdue knew that prescribing opioids to older individuals increased risk of death, but that the pharmaceutical giant was too focused on the potential revenue.
“Purdue saw the opportunity to earn millions of dollars by getting elderly patients on opioids because the public would pay through Medicare,” the document said.
Similarly, Purdue used a deceptive claim that opioids should be used to treat osteoarthritis, the most common form of arthritis. However, opioids are not approved to treat osteoarthritis, and may not be effective in treating it.
Regardless, Purdue trained sales representatives to mislead doctors by promoting opioids for osteoarthritis. Osteoarthritis was specifically mentioned during 35% of sales visits the document said.
“Purdue decided osteoarthritis would be a money-maker because it was widespread,” The court document said. “Purdue’s documents emphasize that more than 20 million Americans have osteoarthritis, including most people over 75.”
The documents also say that Purdue would target veterans with deceptive claims. Like elderly patients, they understood that prescriptions would be paid for by the public, providing another source of revenue.
To help target veterans, Purdue funded a book called Exit Wounds, advertised as a story of a wounded veteran but, in reality, was all part of Purdue’s marketing campaign.
“[Opioids] are today considered the ‘gold standard’ of pain medications,” Derek McGinnis writes in Exit Wounds. “Yet, despite their great benefit, opioids are underused...Long experience with opioids shows that people who are not predisposed to addiction are unlikely to become addicted to opioid pain medication.”
Further, Purdue targeted patients who were not already taking opioids, described as “opioid-naive”, all without disclosing the fact that they face even higher risks of overdose and death.
“Your opportunity here is with the naive community, let’s use the naive trail to make our case,” Purdue managers allegedly said during training calls.
They also promoted the drugs using the deceptive term “first line opioid” referring to promoting OxyContin as the first thing that would be taken to treat pain.
Deceive Doctors and Patients to Use Higher Doses
Court documents indicate that a bottle of 100 10 milligram (mg) tablets of OxyContin costs $269.17 while a bottle of 80 mg tablets costs over $1500. A patient that takes the lowest dose pill twice a day per week earns Purdue $38. However, Purdue collects $210 for the highest dose, an increase of 450 percent. This difference incentivized Purdue to promote higher dosages for patients.
“For patients, taking higher doses of opioids increases the risk of addiction and death,” court documents said. “But for Purdue, higher doses mean higher profits.”
Purdue even analyzed how much of its profit depended on the patients taking higher doses of opioids. In a internal strategy presentation, Purdue reminded staff that lower doses would be bad for Purdue’s revenue.
It is also economically beneficial for Purdue to keep patients on its products for a longer time. If a patient could be kept on the 80mg pill for a year, Purdue would collect almost $11,000.
However, it is much more likely for patients to die when they are on prescribed opioids for a long period of time. According to the documents, patients who receive three months of prescribed opioids are 30 times more likely to overdose and die, with patients who stay on opioids for 6 to 11 months being 46 times more likely to die, and a patient who stays on for more than a year at 51 times the likelihood of dying.
Purdue gave its salespeople explicit instructions to “extend average treatment duration” to drive sales and profitability according to the documents. Purdue made an effort to teach employees that there is a direct relationship between getting patients on higher doses and keeping them on Purdue products longer in order to maximize profits.
One of the most alarming details of the court documents is that that even when patients showed signs of addiction to Purdue’s opioids, doctors were allegedly urged to respond by increasing opioid doses. To convince doctors to increase the dose for addicted patients, Purdue allegedly claimed that patients were suffering from something called “pseudoaddiction”.
Purdue assured doctors that the traditional concern about addiction was wrong and that patients suffered from pseudoaddiction because “opioids are frequently prescribed in doses that are inadequate.”
“Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when the pain is effectively treated,” a Purdue pamphlet said.
One of the most powerful tactics that Purdue took advantage of was to give patients discounts on their first prescriptions. Discounts would have cut Purdue’s revenue only if the patients took opioids for a short time. By doing this, they were banking on the fact that patients would keep using their opioids. And they were right.
According to internal analysis from Purdue, the savings cards had the highest return on investment in the entire “OxyContin Marketing Mix”. They were receiving a return of 4.28, meaning that every $1,000,000 they gave away in savings came back to the company in $4,280,000 in revenue because patients would stay on these opioids longer.
Keeping Patients Away From Safer Alternatives
Internal documents from Purdue admitted that it cannot suggest that its drugs were safer or more effective, because it had no drugs with evidence that could back up such a claim. Despite this, Purdue went ahead and made deceptive claims about competitors to steer patients away from alternatives.
“Purdue not only lit the fire that killed so many patients; it also tried to block the exits that patients could have used to escape,” the court documents said.
Court documents also indicate that Purdue selected doctors for target lists based on its estimates of which doctors could be influenced to increase opioid prescriptions the most. This was done by gathering data on which doctors prescribed the most across certain locations.
Case Study: Oklahoma
In 2017, Oklahoma State Attorney General Mike Hunter filed a lawsuit against a number of pharmaceutical companies, with Purdue Pharmaceutical and a number of its sister companies being the first three defendants named.
Oklahoma is one of at least 13 states that have filed lawsuits against drug makers alleging fraudulent marketing of drugs that went on to fuel the opioid epidemic that has taken hold of the country. A state-led task force found that this opioid problem costs the state billions of dollar annually.
Like the other documents allege, the state of Oklahoma said that “defendants elected to falsely downplay the risk of opioid addiction and overstate the efficacy of opioids for more wide-ranging conditions, including chronic non-cancer pain.”
Oklahoma is one state that was hit particularly hard by the opioid epidemic..
“The damage Defendant’ false and deceptive marketing campaigns caused to the state of Oklahoma is catastrophic,” Hunter’s lawsuit said. “Oklahoma is one of the leading states in prescription painkiller sales per capita, with 128 painkiller prescriptions dispensed per 100 people in 2012. Drug overdose deaths in Oklahoma increased eightfold from 1999 to 2012, surpassing car crash deaths in 2009. According to 2016 statistics, Oklahoma ranks number one in the nation in milligrams of opioid distributed per adult resident, with approximately 877 milligrams of opioid distributed per adult resident.”
Court documents say that the defendants repeatedly misrepresented critical aspects of their drugs to physicians and doctors in Oklahoma. It should be noted that there was a recent study in the Journal of the American Medical Association, finding that opioid prescribing rates increased when marketing of the drugs increased and that it mediated the association between marketing and mortality.
According to the Oklahoma State Department of Health, from 2007 to 2016, oxycodone, the main component in OxyContin, was the most deadly drug in the state of Oklahoma. Out of the 6813 overdose deaths between this nine-year period, 1370 of them, or 20 percent, were due to oxycodone.
In 2014, Oklahoma’s unintentional poisoning rate was more than 100 percent higher than the national rate. According to a National Survey on Drug Use and Health, Oklahoma leads the nation in non-medical use of painkillers. Nearly 5 percent of the population aged 12 and older is abusing or misusing painkillers.
This is an issue that is affecting everyone of all ages, even newborns. Another adverse effect of the increase in opioids in the states is the parallel increase in Oklahoma hospitals reporting newborns testing positive for drugs or alcohol at birth. According to a report done by a healthcare provider in the state, the rate of neonatal abstinence syndrome (NAS) in 1000 live births increased by 450 percent from 2008 to 2014.
On a similar note, the state has passed stricter legislation to combat opioid over prescription. However, this has caused some Oklahomans who are addicted to prescription opioids to turn to other illicit opioids like heroin as a cheaper and more accessible alternative, in fact, from 2007 to 2012, the number of heroin deaths in the state increased tenfold.
The opioid crisis has also had an overwhelming effect on the state’s criminal justice system. According to the court documents, the opioid epidemic costs Oklahoma millions of dollars a year on criminal justice related costs. Oklahoma spends 50 percent of its annual budget on substance abuse related costs.
Oklahoma is just the tip of the iceberg, there are dozens of other states that have found themselves in similar, and sometimes worse, predicaments because of the rise of opioids. Like Oklahoma, many states are choosing to sue the pharmaceutical companies that they believe are the reason behind the tens of thousands of drug overdose deaths that the country is seeing each year.
If the trend continues, opioid lawsuits could become the largest civil litigation agreement in United States history.
Court documents from Massachusetts, Oklahoma, and many other states allege that pharmaceutical companies, like Purdue Pharma, and their marketing tactics were instrumental in bringing opioids to the mainstream. They say that these companies are responsible for the opioid epidemic that we are experiencing today. By targeting specific populations and misleading both doctors and patients about the details and risks of addiction, Purdue Pharma was able to create a drug, OxyContin, that has earned more than $35 billion in sales since its inception in the 1990's.
Recently, states and the federal government are working toward a solution to solving the drug problem that is affecting the country. Landmark Recovery is dedicated to being a part of the solution. Landmark’s drug and alcohol treatment facilities are staffed with knowledgeable therapists and physicians that can help you or your loved one begin their journey to recovery and help educate them on how to stay sober. If you would like more information about our drug and alcohol recovery facilities, please reach out to our admissions team today.