[Originally published March 18th, 2017 on Wordpress]
Introduction:
The ramifications of the opioid epidemic are jarringly evident at this point in time. The genesis of this malignancy can be traced back over 20 years ago, to the advent of the over-prescribing of opioid painkillers. While brand name opioids such as Percocet and Vicodin have certainly contributed to this epidemic, the real accelerant to the fire was OxyContin.
The medication is a 12-hour extended release pill version of Oxycodone, which drug users quickly learned could be crushed to be snorted or injected. After years of lawsuits and millions of lives ruined, the manufacturer, Purdue Pharma, developed a new pill to prevent such abuse. In 2010, Purdue, developed a Pill coated with a long molecule chain plastic polymer. In an effort to curtail abuse and prevent users from getting a powerful high. [3]
However, the expression "A day late and a dollar short" seems to come to mind. To implement such a safeguard a decade-plus after the introduction of the drug seems like an empty gesture. Especially, when you analyze the wanton manner in which it was marketed in the late 1990s. Essentially, benefit from a decade of sales to addicts and then after YEARS of criticism do something about it. However, in the wake of the DEA placing CBD oil on the schedule I list and their campaign against Kratom, looks like the Big Pharma cartel will have the upper hand against opioid alternatives. [4] [5]
BACKGROUND:
Prior to the 1990s, it was a rare occurrence in the 20th century for physicians to prescribe opioid painkillers for non-terminal conditions. However, the apprehensions over prescribing became stifled by a study published in 1986, by researchers Portenoy and Foley. In their study, it was found that only 2 out of the 38 patients monitored were found to exhibit patterns of opioid addiction. All patients were receiving opioid therapy for non-cancer related conditions .
Which succeeded 1980, that did a case study based on 11,000 patients found only 4 that exhibited symptoms of addiction. By the late 1980s, the medical establishment put pressure on doctors to prescribe opioids for pain management. This was engendered by holding physicians accountable for the pain their patients were experiencing. Pain management advocate John Campbell introduced the concept of pain as the fifth vital sign in 1995. By 2000, The Joint Commission began utilizing pain management as the variable of assessment for accreditation. All of these changes to the perceptions about opioid therapy let too much looser prescribing practices. Which provided the scaffolding for the development, marketing of OxyContin, as well as the addiction, abuse, and increase in opioid-related deaths.
All of this is quite alarming, especially when you consider between 2002 and 2011, using opioids for non-medical use. While the epidemic of abuse peaked in 2010, ironically, the same year Purdue Pharma made alterations to OxyContin, it was the eleventh consecutive year to see a rise in opioid-related deaths. The total fatalities of 2010 in the United States were 16,651, related to prescribed opioids. Which was more than double those deaths associated with cocaine or heroin from that same year. This perfect storm of addiction and death was engendered and exacerbated by increased access to opioids, marketing of such drugs, and a slow reaction by the medical community to remedy this foreboding plight.
OXYCONTIN MARKETING AND THE TRUTH:
Since OxyContin inception in 1996, through its salad days, it was heavily marketed. Purdue Pharma, the company that synthesized the drug, saw a drastic increase in sales from 48 million to 1.1 Billion dollars from the first year to the fourth year on the market. At the apogee of Purdue's aggressive marketing of the drug (2001), the company spent $200 million dollars alone on marketing that year. The most aggressive duration of marketing in the history of the drug was 1996-2001. Within this time Purdue held 40 all expenses paid symposiums for physicians at luxury resorts, for training and education on the drug. Researchers have found contrary to the perceptions of physicians who did attend such events, there has been found a strong correlation between the prescribing practices of OxyContin and attendance. In addition to lavish conferences, Purdue also keeps prescribing profiles for physicians within a specific territory, would target the physicians with the highest rate of prescribing. That coupled with the extreme financial bonuses for Purdue sales representatives (average income 2001, $240,000), gave the company a clear line of product distribution for the drug and incentives to increase sales.
Beyond the marketing towards physicians, Purdue also aggressively targeted patients as well. A program the company terminated in 2001 was 7-30 day free prescriptions for the drug. By the end of this specific promotion, 34,000 vouchers had been redeemed. They also utilized television advertisements as well to increase sales. One of the more disturbing marketing ploys was the company's use of merchandise. Everything ranging from compilation CDs to PLUSH TOYS. Which the DEA stated as being " unprecedented for a schedule II opioid".
However, despite all of this lofty marketing, was OxyContin really the wonder drug that it was purported to be? Well, maybe not. As early as 2001, the actual effectiveness of the drug came into question. The publication, Medical Letter on Drugs and Therapeutics, in 2001 found the drug to be no more effective than other strong opioid medications if taken as prescribed. The double-blind study found no significant difference between morphine and OxyContin to treat chronic back pain and cancer. Even in FDA's review of the drug's efficacy in 1995, found it to be no more effective than the oxycodone, the non-time release variant of OxyContin. However, did Purdue properly represent the risks? Purdue went to great lengths to in their marketing to portray the drug as being safe. While addiction is only impacting 3-16 percent of the general population, no scientifically rigorous studies have been done in regards to long-term opioid therapy. Yet, Purdue sales representatives were trained to form physicians and patients that number was less than 1 percent. All of the drugs educational literature and media stated the risk of addiction was very minute. In May 2007, Purdue was ordered to pay $634 million in fines for miss representing the drug as being less apt for addiction, abuse, and diversion. [7]
PURDUE AND LOBBING:
Naturally, Purdue did spend some money in regards to government lobbying, however, not nearly as much as they did for marketing. Right after the apogee of Purdue's marketing campaign in 2003, the height of their lobbying spending was at approximately $1 million dollars. The height of Purdue's spending for PAC contributions was reached in 2002, at the amount of $ 240,000 from individual donors and $19,000 to each party with 63 percent going to the Democratic Party. Please note that in 2016 Purdue gave the majority of their PAC contributions to the Republicans. So they are an equal opportunity donor. While there may be some influence from their lobbying, it is evident that Purdue spent significantly more on marketing than on lobbying. [8]
CONCLUSION:
By this point in time is well known that there is quite a bit of corruption in the pharmaceutical industry. However, learning the details of Purdue's marketing of OxyContin is sobering. The irresponsible manner in which this drug was marketed is astounding. However, this should be seen as a historical case of why we should be critical and skeptical consumers. If we fail to learn from OxyContin, we will be doomed to repeat it. I would say while understand people wanting stricter regulations on the Pharma industry, I would not advocate such. All the warning signs were there, however, no one in the ranks did anything about. They preferred to accept faulty research and investigate the matter. Which means that it is up to us the customers to do our research. Remember, bureaucracy failed us in regards to the opioid epidemic. So now we need to vote with our wallets.
FOOT NOTES:
1. https://youtu.be/pkeQifzvSNE
2.https://invertedlogicblog.wordpress.com/2017/03/18/political-opinions-16-inquiries-into-the-opiod-epidemic
3. http://www.popsci.com/science/article/2013-05/science-un-crushable-oxycontin
4. https://www.painnewsnetwork.org/stories/2016/12/1/over-22000-comments-on-deas-kratom-ban
5. http://www.nbc-2.com/story/34125279/dea-rules-cbd-oil-an-illegal-schedule-i-drug 6. http://opioidremsresource.com/articles/opioid-epidemic-united-states/fulltext#bib16
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/#!po=23.7705
8. https://www.opensecrets.org/pacs/lookup2.php?cycle=2002&strID=C00370643