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Case Study 10.1: Marketing the Opioid Epidemic

One hundred forty-five Americans die from opioid overdoses every day. In addition to causing deaths, opioid addiction damages local economies, raises health care costs, increases the demand for drug treatment, boosts the crime rate, and breaks up families. President Donald Trump declared the opioid epidemic a national emergency in 2017.

Most observers blame Purdue Pharma, owned by the Sackler family, for triggering the opioid epidemic. In 1995, the company launched an aggressive marketing campaign to promote OxyContin®. The oxycodone in OxyContin is closely related to heroin, which is twice as powerful as morphine. Up until that time, doctors were reluctant to prescribe strong opioids for fear of addicting patients. Their use was restricted to treating cancer pain and end-of-life palliative care.

Purdue changed prescribing habits by funding favorable research studies and by paying doctors to argue that fears of opioid addiction were overstated. They did so at a time when attitudes about pain care were changing. Prominent physicians believed that many patients were needlessly suffering because they couldn’t get strong enough painkillers. The company convinced the Food and Drug Administration that the drug was safer than rival products because it had a delayed absorption formula that “is believed to reduce the abuse liability.”1

Company executives set up a speakers’ bureau, paying clinicians to attend medical gatherings to deliver presentations touting the medication. (Those attending these seminars prescribed OxyContin more than twice as much as those who did not attend.) Purdue also sponsored research studies demonstrating the drug’s effectiveness; advertised in medical journals; distributed luggage tags, plush toys, and other promotional items with the OxyContin label; and sent tens of thousands of videos to physicians containing testimonials from pain specialists and satisfied patients.

Purdue more than doubled its sales force in order to push the drug. They targeted general practitioners, who are not pain specialists, encouraging them to prescribe OxyContin for less severe forms of pain like arthritis, sports injuries, and back pain. Purdue told sales reps to assure doctors that the addiction rate for patients taking OxyContin was less than 1% when, in reality, it was much higher. Salespeople were handsomely rewarded for their efforts. In 2001, the company paid average bonuses of over $70,000. It encouraged physicians to offer coupons for a free initial prescription to patients and marketed heavily to doctors in poor communities. Within five years, OxyContin was generating $1 billion a year for Purdue Pharma, becoming the firm’s top money maker. By 2004, OxyContin was the most abused prescription opioid in the United States.

Users quickly discovered that they could get a powerful, often toxic, high by crushing OxyContin pills and then snorting them, dissolving them in liquid, or injecting them. Patients began selling their pills, and some doctors set up “pill mills” to profit from issuing OxyContin prescriptions. In Los Angeles, the Crips street gang transported groups of homeless people to pill mills where they would be handed prescriptions for the drug and took the transients to nearby pharmacies to get the prescriptions filled. Gang members would then sell OxyContin on the street for as much as $100 a pill.

Despite evidence of abuse, Purdue didn’t withdraw the drug but blamed recreational users for abusing it. “We have to hammer on abusers in every way possible,” then Purdue president Richard Sackler said in 2001. “They are the culprits and the problem. They are reckless criminals.”2 The firm had data indicating which doctors and pharmacists were overprescribing but refused to act. Company executives claimed that because they shipped the medication to wholesale distributors, it was the responsibility of the wholesalers to cut off supplies to pharmacies and to notify the Drug Enforcement Administration of suspicious activity. They also ignored evidence that their claims of 12-hour relief were false. Patients had to dose every 8 hours. Even those following their doctor’s orders to take a pill twice a day began experiencing withdrawal symptoms and were likely to become addicted.

Purdue Pharma replaced the original OxyContin pill with a new version that can’t be ground up, and prescription rates have dropped. Addicts who can’t get OxyContin on the street have turned to heroin, fentanyl, and other synthetic opioids. As the market for OxyContin shrinks in the United States, Purdue appears to be ramping up its efforts to market the drug overseas using the same tactics—commissioned studies, junkets, paid medical presenters, and videos.

In 2007, the company pled guilty to criminal charges that it had marketed OxyContin “with the intent to defraud or mislead.” Three company officers were convicted, and they and the company paid $635 million in fines. There are currently thousands of lawsuits against Purdue Pharma, including those brought by nearly every state. Sackler family members are included in many of these legal actions.

The Sacklers, one of the richest families in the world, are also among the most philanthropic, funding museums, colleges, and institutes. These include the Sackler Museum at Harvard, the Sackler Wing at the Louvre, and the Sackler Institute for Biological, Physical and Engineering Sciences at Yale University. Some of these institutions are now refusing gifts from members of the Sackler family who run the company. The Metropolitan Museum of Art in New York dropped ties with the Sacklers after protests by activists. The Guggenheim Museum in New York, the National Portrait Gallery in Britain, some academic institutions, and other organizations followed suit. The Louvre removed the Sackler name. However, many museums and universities will keep previous donations from the family, and the Sackler name will stay on their buildings.

Discussion Probes

What ethical principles and standards did Purdue Pharma violate in its marketing strategy?

What similarities do you see between how Purdue Pharma marketed OxyContin and how other industries market questionable products like tobacco, e-cigarettes, and energy drinks?

What restrictions should be placed on the sale of OxyContin and other prescription painkillers?

What punishment should Purdue Pharma face for its role in triggering the opioid epidemic? What punishment should the Sackler family face?

Should schools and museums reject the donations of the Sackler family? Should they return previous donations and take the Sackler name off of buildings and institutes?

Sources: Mariani, M. (2015, March 4). How the American opiate epidemic was started by one pharmaceutical company. The Week.

Marshall, A. (2019, July 17). Louvre removes Sackler family name from its walls. The New York Times.

Ryan, H., Girion, L, & Glover, S. (2016, July 10). More than 1 million OxyContin pills ended up the hand of criminals and addicts. What the drug maker knew. Los Angeles Times.

Smith, J., & Gould, M. (2019, January 29). Secrets of one of America’s richest families will be exposed in court. Daily Mail.

Van Zee, A. (2009). The promotion and marketing of OxyContin: Commercial triumph, public health tragedy. American Journal of Public Health, 99, 221–227.

Walters, J. (2019, May 15). The Met museum to reject donations from Sackler family over opioid crisis. The Guardian.