How One Painkiller Ignited The Addiction Epidemic
9:25 PM 08/28/2017
President Donald Trump declared the opioid epidemic a national emergency Aug. 10 on the advice of a White House commission that pointed out, “with approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks.” Purdue Pharma, the maker of the popular painkiller OxyContin, often faces the brunt of the blame for the crisis due to the role the company’s marketing played in hooking the nation on opioids.
Purdue Pharma is owned by the Sackler family, listed at 19th on the annual Forbes list of wealthiest families in the country at a worth of $13 billion. The family’s fortune largely comes from OxyContin sales, which their company branded and introduced as an extended release painkiller in 1995.
Purdue Pharma pleaded guilty in 2007 to felony charges for false marketing of OxyContin and paid $635 million as a result. The company overstated how long the effects of the medication lasted and severely downplayed the addiction risks of the drug. Three executives also pleaded guilty to criminal charges but dodged prison time.
Purdue Pharma reformulated OxyContin in 2010 to be “abuse-deterrent” in an effort to cut down on people crushing the pills to snort or inject. There is evidence this reformulation indirectly fueled greater heroin use in the U.S. Addicts could no longer get their high from the pills, so many substituted heroin to get their fix.
Critics are still suspicious of Sackler’s involvement in company marketing of OxyContin from the mid-1990s to 2007, and the response of company leadership to reports of widespread abuse of their drug.
Democratic Sen. Richard Blumenthal, the former attorney general of Connecticut, sent a letter directly to Sackler in 2001 asking Purdue Pharma to take action “beyond cosmetic and symbolic steps” to address reports of abuse and addiction, though it is unclear if Sackler acted on the request.
Sackler gave a sealed deposition in a lawsuit against Purdue Pharma by the state of Kentucky in 2015, which may shed light on his involvement with the marketing of OxyContin. The company is currently fighting a judge’s order to make the deposition public at the request of the health care news organization STAT.
Medical professionals say a shift in the 1990s to “institutionalize” pain management opened the doors for pharmaceutical companies to encourage the mass prescribing of painkillers by doctors, and Purdue Pharma led that effort.
The Joint Commission on Accreditation of Healthcare Organizations, or simply the Joint Commission (JC), provides accreditation for hospitals nationally who meet their standards for care. In 2001, the JC network made up roughly 80 percent of all hospitals in the U.S., which accounted for roughly 90 percent of hospital beds in the country, according to research published by the National Institutes of Health in 2014.
As the medical profession shifted towards a focus on pain management and reduction, the JC adopted new standards for treating pain in patients. The standards, implemented in January 2001, downplayed the risks of opioids and served to encourage doctors who wanted to remain in good standing to prescribe the drugs for pain treatment, whether acute or chronic.
If hospitals wanted accreditation and doctors wanted positive journal reviews and recommendations, they had to bend to the new standards.
Purdue Pharma was one of two companies that worked with the JC to fund educational materials and programs to teach the medical community how to treat pain. Purdue Pharma was the only company the JC allowed to distribute educational materials and videos on pain management.
“There is no evidence that addiction is a significant issue when persons are given opioids for pain control,” a video the company released in 2000 claimed. In the year following this initial education push, doctors wrote 11 million more prescriptions for opioids, reports KevinMD.
Purdue’s profits from OxyContin sales topped $1.5 billion in 2001, up from $48 million in 1996.
Critics say the coordinated elevation of pain management treatment within the medical profession by the JC and Purdue Pharma primed the system that would eventually devolve into the current epidemic of addiction. The JC has previously responded to criticism by “encouraging our critics to look at our exact standards, along with the historical context of our standards.”
Representatives of Purdue Pharma did not respond to questions from TheDCNF regarding their relationship with the JC.
“Purdue Pharma markets its opioid pain medications in strict conformance with their FDA-approved statements and evolving science regarding the benefits and risks of these medications,” a company spokesman said in a statement to TheDCNF. “In response to the opioid crisis, the company reformulated the original OxyContin, invested in other products with abuse-deterrent properties, and, most recently, distributed the CDC opioid prescribing guideline to prescribers — reflecting our commitment to addressing the opioid crisis while responsibly serving the real healthcare needs of pain patients.”
A recent STAT analysis predicts the annual death toll from opioids will rise by roughly 35 percent between 2015 and 2027. Their research predicts up to 500,000 people could die from opioids over the next decade. The experts agree, even in a best-case scenario, the crisis will not visibly start to subside until after 2020.
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