One trillion dollars. That’s 1 billion round-trip flights from America to Europe. 4 billion nights at a New York City hotel. 250 billion Big Macs from McDonald’s. Or 1 nationwide opioid crisis.
The opioid epidemic is estimated to be a trillion-dollar problem. And with over 200,000 lives lost to opioid overdoses and over 2 million addicted to the drug, the numbers continue to grow.
This epidemic began the way everything does – with an idea.
In the late 1980s, Mortimer and Raymond Sackler of Purdue Pharma were nearing the completion of a painkiller that would revolutionize the pharmaceutical world. The drug used oxycodone, a chemical cousin to heroin, which was created by a German scientist in 1916. Purdue Pharma’s drug, named OxyContin, would provide extended relief for pain from surgeries and cancer. The drug was marketed as revolutionary for two main reasons:
- It provided relief for 12 hours, allowing users to sleep through the night. Other painkillers such as Morphine required more frequent doses. OxyContin only required two doses a day.
- It wasn’t addictive. Once swallowed, doses of the drug were released from the pill gradually due to a unique drug absorption mechanism.
The Power of Marketing
After receiving approval from the Food and Drug Administration (FDA), OxyContin was released in 1995. It was unique from the beginning. Not only was it structurally and chemically different from its predecessors, it was marketed. Marketing didn’t play a large role in the pharmaceutical world before. Arthur Sackler, brother to Mortimer and Raymond, was later posthumously inducted into the Medical Advertising Hall of Fame for his campaigns. And his younger brothers were following in his footsteps.
OxyContin was lauded as providing 12-hour relief and not being addictive. It was advertised with an image of two pill cups – one labeled 8am and the other labeled 8pm. The drug was also one of the first to be marketed to clinicians, rather than to the state or other large bodies. The philosophy was that the drug would be seen as more trustworthy if it was approved directly by a clinician.
Purdue Pharma’s sales team set out to share this revolutionary drug with medical professionals. They distributed brochures describing its effectiveness with testimonials from doctors who had prescribed it and sat on Purdue Pharma’s speaker bureau.
Not just for cancer treatment
OxyContin, a strong and powerful painkiller, wasn’t just to treat severe pain from surgery or cancer. Purdue Pharma’s sales team also encouraged that OxyContin be used to treat back pain, arthritis, sports injuries, fibromyalgia, and more. In other words, OxyContin wasn’t just being used for short term prescriptions for severe and sometimes terminal pain. It was also being used for less acute long-term pain.
And the cracks start to show
This drug was exciting. People who suffered from life-long pain were now pain-free and had their lives back. And were sleeping through the night because they didn’t have to wake up for more medicine. OxyContin brought in over $40 million in its first year alone.
But the cracks quickly began to show. Almost immediately after its release in 1995, the drug was being abused in rural areas like Maine and Appalachia.
But wasn’t it non-addictive?
When the pill is ground up and snorted or injected after dissolving in liquid, it overrides the time release resulting in a huge release of narcotics into the person’s system. Ironically, this was included in the warning label on the product – broken, crushed, or chewed pills could result in a toxic release of OxyContin. Purdue Pharma stated that it wasn’t their fault the drug was being used incorrectly.
Doctors were clear with their patients.
This drug was only supposed to be taken twice a day. That’s it. Twice a day and you’ll be pain free.
But that wasn’t the case. Many prescription users of the drug found that it wore off around the 8-hour mark. Which meant they had four, long, excruciating hours before their next dose. Can you blame them that they couldn’t wait the four hours and often took their second pill early?
And some did wait. And they experienced harrowing withdrawal-like symptoms. Purdue Pharma described this as pseudo-addiction in a pain-management pamphlet. It seems like addiction because people experience such intense, withdrawal-like symptoms. The symptoms are due to unrelieved pain and typically go away when the pain is relieved.
Many doctors still believed this miracle drug was the answer to their patients’ long-term pain and kept prescribing it. The more they prescribed, the more addiction began to spread across the country. And not just through communities who were abusing the drug. Many people who followed their doctor’s instructions became addicted just through swallowing the pills.
Purdue Pharma receives inquiries
In 2003, the Drug Enforcement Administration (DEA) stated that Purdue Pharma‘s aggressive marketing methods had not only exacerbated the widespread abuse of OxyContin, but also minimized its risks. Purdue Pharma continued to blame those abusing the drug and taking it incorrectly.
That same year, the FDA also sent Purdue Pharma a warning letter about their ads not acknowledging the fatal risks of OxyContin and overstating its safety.
Purdue Pharma wasn’t just receiving inquiries from the DEA and FDA. Many who used or prescribed OxyContin reported that it didn’t provide 12-hour relief and were looking for answers. Some within the company may have always been aware that the drug didn’t provide 12-hour relief for those who took it. In OxyContin’s beginning, it was tested on a group of women in Puerto Rico. Almost half reported their pain returning before the 12-hour mark.
Pill mills began popping up.
While the company collected data to see how much product each customer ordered, they only used this data to know who their sales team should target. When they noticed a doctor ordering an unusually large amount of OxyContin, they sold him more. When a local pharmacist noticed that a doctor was ordering a large amount of OxyContin, he alerted the authorities. The doctor was convicted for running a pill mill.
An unfortunate paradox
OxyContin underwent a makeover in 2010. It was replaced with a drug that, when crushed, became a gummy substance rather than a snortable powder. It was marketed as an “abuse-deterrent” in response to the current crisis. And it also limited Purdue Pharma’s competition.
OxyContin was no longer easy to crush and snort. Sales fell 40% after the change, showing a potential relationship between sales and illegal usage of the drug.
And then it backfired. The original form of the pill caused a widespread addiction. The new form of the pill made it impossible to crush and snort or inject. So, many switched to heroin for a similar experience. And the crisis grew.
What’s happening today
A lot has changed since OxyContin was introduced into the market in 1995. Perhaps the most noticeable change is the way we view addiction. When the drug first began causing problems, many just assumed the person could stop taking the pill and move on. Today, we know that addiction is far more complex than that and requires specialized treatment. It’s a disease that affects the individual’s mind and behavior.
President Trump declared the opioid crisis a public health emergency in 2017. In 2018, he sent a 2019 spending proposal to Congress asking for $17 billion to fight this $1 trillion problem.
Cities like Philadelphia are allowing safe-injection sites, hoping to at least limit the number of overdoses and the spread of diseases. Some police officers carry Narcan to be able to stop those they find overdosing. Many addiction treatment plans include a methadone component where the individual can receive a dose of methadone to combat their opioid cravings.
Purdue Pharma and the opioid crisis are still intertwined, but they’re taking action. On February 12, 2018, they announced that they were dramatically changing their marketing. In the midst of hundreds of law suits, they’ve cut their sales team in half and will no longer be aggressively marketing their product to doctors.
Hopefully, this is the first step of many to eradicating this crisis. But we’ll just have to wait and see.