In 1996, Purdue Pharma introduced a new painkiller called OxyContin. Within just four years, sales of the drug went from $48 million to $1.16 billion. By 2004 OxyContin was a leading drug of abuse in the United States. How did this happen so fast?
It was a perfect storm — a combination of astute marketing by Purdue Pharma and changes to healthcare protocol — that produced this phenomenon. Most experts in substance abuse believe the storm is not over yet.
In 2000, the Joint Commission on the Accreditation of Health Care Organizations (JCAHCO) changed their rules for medical professionals. Instead of checking four vital signs of patients on a regular basis, they now would monitor five: blood pressure, temperature, respiration, pulse rate and pain.
Caretakers would ask patients if they were in pain, and then would be required to discover the location, intensity and cause of this pain. Unlike the other four vital signs which are monitored with instruments, monitoring pain is based on the patient’s subjective descriptions of it. Monitoring pain required caretakers to spend more time with each patient and to keep extensive records. It also opened the door for drug companies to sell more painkillers.
OxyContin, an opiate painkiller, came on the market just as the Commission’s rules were being debated and changed. It was not a new drug, but rather a new version of oxycodone, a drug most often used to control the pain of terminally ill patients, who are not in danger of addiction because of the shortness of their life spans.
OxyContin, however, was not just marketed to doctors who treat cancer, but to primary care physicians. The idea was to make it available to people in chronic pain, such as those suffering from arthritis, and even those in acute pain, such as those with sports injuries. By 2003 half of the physicians prescribing OxyContin were primary care doctors.
Purdue Pharma used sophisticated strategies to market their new product. The company set up pain management conferences in Florida, Arizona, and California, and then paid for the travel expenses of 5,000 doctors, nurses and druggists to attend them. Purdue Pharma increased their sales force from 318 to 671 representatives between 1996 and 2000, and paid out over $40 million in bonuses to top salespeople.
Salespeople told doctors that the new drug was not addictive, and they often cited several studies of over 11,000 people who had taken OxyContin. The studies found that less than 1% became addicted. All of this was highly effective: the number of prescriptions for the new drug went from 670,000 in 1997 to 6.2 million in 2002.
Since the mid-1990s, new studies have found that oxycodone-based drugs are indeed highly addictive. The research used to market OxyContin had focused on people in acute pain, and not those in chronic pain who are more likely to use the drug for months and more likely to become addicted. Another problem is that some people have genetic susceptibilities to drug abuse, and if they have mental problems such as depression, anxiety or eating disorders, their risk for abuse is even higher. This group of people can become addicted to opiate painkillers within a week.
In 1997, Purdue Pharma and three company’s current executives pleaded guilty to misleading the public about the safety of OxyContin and agreed to pay $634.5 million in fines. The U.S. Department of Health and Human Services barred these men from doing business with Medicare or other taxpayer-financed healthcare programs for 20 years, and in December 2010, a federal judge upheld the disbarment.
By then the National Institute of Drug Abuse was estimating that over five million people were addicted to opiate painkillers. This agency, the United States Substance Abuse and Mental Health Services, and Partnership for a Drug-Free America are finding that prescription drug abuse is now more prevalent that abuse of cocaine, heroin, and other street drugs. They are reporting a 400% increase in the number of people being treated for prescription drug overdoses in emergency rooms and admissions for prescription drug abuse into treatment centers.
These once highly-regulated drugs are now readily available in many people’s medicine cabinets. “Pain clinics” have sprung up all over the country, making it easier for people to obtain them by prescription if they cannot get them in emergency rooms or from their own doctors.
Opiate painkiller abuse has become such a crisis that local police departments are holding seminars to educate the public about its dangers. A recent one in Portland, Vermont, was sponsored by Purdue Pharma.