The role of marketing in the pharmaceutical industry—the apparatus that profits more from maximizing use than optimizing outcomes—is at an inflection point. A reckoning could lead to serious reform. But a settlement deal currently on the table—in which Purdue Pharma, the Connecticut-based producer of Oxycontin, would pay about $11 billion—stands to repeat the mistakes of the past, and to achieve little meaningful progress.
While opioid use has always led to some level of abuse, today’s epidemic of addiction and misuse is new. Beginning in the late 1990s, drug makers inundated the pharmaceutical market with potent and long-acting opiates. Aggressively marketed messages of the pills’ efficacy and safety made their way into medical-school lectures and clinical-practice guidelines.
Medical schools, in turn, taught students that the drugs were important scientific advancements, often good and even necessary to prescribe. When I was in residency, I was told to think of pain as “the fifth vital sign.” My job was to use every tool in the pharmaceutical arsenal to keep pain “well controlled.” The pharmaceutical companies’ marketing push had put the stigma on not using pills, and even when it was technically accurate, it had the effect of focusing doctors’ concern on pain—and drawing that focus away from the future potential for abuse.
This escalation of salesmanship and market competition involved many global pharmaceutical corporations. But unfettered profit-seeking in the sale of potent opioids has been widely traced to the 1996 introduction of Oxycontin by Purdue. In 2007, Purdue pleaded guilty in federal court to a felony charge, having misled doctors and patients about the drug’s potential for abuse and addiction. The company and some executives were ultimately forced to do community service and pay a total of $634 million in fines.
In a subsequent congressional hearing, Senator Arlen Specter asked why these executives didn’t go to jail. The prosecutor John Brownlee had wanted to indict them individually on felony charges, The New York Times later reported. Brownlee possessed records that Purdue had known about Oxycontin’s growing abuse for three years, according to the Times. But after meeting with Purdue’s legal team, the Justice Department reportedly refused to get behind Brownlee’s recommendations. The individual executives were allowed to plead guilty to misdemeanor charges instead, and were not personally implicated in any felony wrongdoing.
Purdue continued aggressive promotion of Oxycontin, and opioid overdoses only increased. In the ensuing five years, enough pills were sent to overdose-mired West Virginia alone that there would be 433 per person.
Then, in June of last year, Massachusetts Attorney General Maura Healey filed a lawsuit against Purdue alleging yet again that the company knowingly misled doctors and consumers about the dangers of its product. (Purdue denied this.) Thousands of other state and federal lawsuits followed.