MARK KARLIN, EDITOR OF BUZZFLASH AT TRUTHOUT
In the October 30 edition of the New Yorker, reporter Patrick Radden Keefe writes a thorough examination of the role of one pharmaceutical company, Purdue Pharma, in abetting the high number of deaths due to opioid overdoses in the United States. The connection is through the firm's patent on one highly addictive pain killer, OxyContin. Although there are many factors that fuel the opioid crisis in the United States -- including social injustice and economic inequality issues -- Keefe's thoroughly researched article is a telling reminder that the biggest drug pushers in the United States are legal ones: our pharmaceutical companies.
Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids. Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. The most recent figures from the Centers for Disease Control and Prevention suggest that a hundred and forty-five Americans now die every day from opioid overdoses.
Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, has worked with hundreds of patients addicted to opioids. He told me that, though many fatal overdoses have resulted from opioids other than OxyContin [such as fentanyl and heroin], the crisis was initially precipitated by a shift in the culture of prescribing—a shift carefully engineered by Purdue. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.”
In fact, Keefe makes the comparison in his article between drug companies that emphasize sales by persuading doctors to prescribe certain medications and heroin dealers. In the case of OxyContin, the pills are legal, while heroin is considered a Class A illegal drug. However, heroin and OxyContin are both opiates, or derivatives of opium, which in its unprocessed form is -- of course -- illegal. Purdue Pharma, which is privately owned by the Sackler family, according to Keefe, has made billions of dollars off of OxyContin.
Until recently, Purdue Pharma enlisted its hundreds of sales representatives to convince doctors that OxyContin was not addictive. It also sent physicians who advocated for OxyContin on lavish trips to speak at medical conferences, where they would praise the drug, and employed other strategies to try and ensure the continued maximum prescribing of the drug. As Keefe notes: "Between 2006 and 2015, Purdue and other painkiller producers, along with their associated nonprofits [front groups for advocating for specific drugs], spent nearly nine hundred million dollars on lobbying and political contributions—eight times what the gun lobby spent during that period."
The importance of the sales force cajoling doctors cannot be overemphasized, as Keefe reports:
Within five years of its introduction, OxyContin was generating a billion dollars a year. “There is no sign of it slowing down,” Richard Sackler told a team of company representatives in 2000. The sales force was heavily incentivized to push the drug. In a memo, a sales manager in Tennessee wrote, “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!” May [a former sales rep for Purdue Pharma], who was assigned to the Virginia area, was astonished to learn that especially skillful colleagues were earning hundreds of thousands of dollars in commissions. One year, May’s own sales were so brisk that Purdue rewarded him with a trip to Hawaii. As prescriptions multiplied, Purdue executives—and the Sackler family members on the company’s board—appeared happy to fund such blandishments. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses.
In the preface to a photo essay on opioid overdose deaths that appears in the print edition of the New Yorker, writer Margaret Talbot states,
Opioids, in fact, now kill more than fifty thousand Americans a year, ten thousand more than AIDS did at the peak of that epidemic -- more, too, than gun homicides and motor-vehicle accidents. Opioid overdoses are now the leading cause of death for Americans under the age of fifty.
Again, it is important to remember that the surge in opioid overdoses is not solely due to pharmaceutical firms, including Purdue Pharma. The opioid crisis is much too complicated and nuanced to attribute to any single factor. As just one example, the industrial economic collapse of many towns and smaller cities in the Midwest and Appalachia have contributed to that area being particularly hard hit.
However, there is a lesson in the role Purdue Pharma has played in contributing to the crisis. The so-called "war on drugs" allows companies such as Purdue Pharma to make billions of dollars by pushing pills through misrepresentation of the product, while a ruinous "war" is waged on those who sell and use drugs that are classified as illegal. This is one reason that you can expect Donald Trump's solution to the opioid crisis to be as unenlightened, harmful and feckless as the "war on drugs" itself has been.
You might call OxyContin the ultimate gateway drug.