The strategy proved wildly successful. Sales revenues climbed because the pill was widely prescribed not just by those treating terminally ill patients, but also by family doctors who were already responsible for nearly half of all Oxycontin prescriptions by 2003.
The Devastation Becomes Undeniable
Doctors increasingly prescribed Oxy to treat pain (often from work-related injuries) and their patients quickly became addicted. Gripped by the drug, some feigned continuing pain in a frantic effort to get fresh supplies. "Doctor shopping" became common as well. Others stole pills from relatives or friends or bought them from illegal dealers, including those selling through the Internet at, among other places, social media sites like Facebook. Addicts also snorted pulverized pills or liquefied them and injected them intravenously, risking Hepatitis B or C or HIV/AIDS from shared needles. Still others turned to heroin.
Obviously, not everyone who took Oxycontin for pain got hooked, let alone died from an overdose. But when addiction did strike, it could ruin lives, as some addicts even fed their habit through petty crime or prostitution. The children of addicts often suffered from neglect or mistreatment as well -- an estimated 676,000 of them in 2016 -- or became the responsibility of grandparents or ended up in foster care.
As the evidence of a disaster mounted, some intrepid doctors, along with the relatives of people who had died from overdoses, started sounding the alarm. But Purdue had a formidable PR machine, the big bucks needed to hire top-flight attorneys, and the determination to fight back. As for clout in Washington, the company's wealth and access to power far exceeded anything its adversaries could muster.
Yet as the addiction wave began to sweep the country and the death toll rose, medical researchers began highlighting the risks posed by Oxy and questioning its efficacy compared to less potent opioids. The FDA, the Justice Department, and the attorneys general of various states also began to pay attention. In 2007, following charges that it had failed to provide adequate warnings about the risk of addiction, Purdue paid $634.5 million as part of a plea deal with the feds. Three of its senior employees were fined a total of $34.5 million, which Purdue covered (though they avoided jail time). The company itself did not cop to any wrongdoing.
Numerous states also initiated lawsuits against the company, insisting that it was aware of the dangers of Oxycontin addiction but made misleading or false claims to deny or downplay the risks. In 2007, Purdue negotiated a $19.5 million settlement with 25 states and the District of Columbia, again without admitting to any wrongdoing. In 2015, it settled with Kentucky for $24 million. In 2018, six more states initiated lawsuits against the company.
In 2010, the FDA approved an addiction-resistant -- that is, harder to snort or inject -- version of Oxy and the original version was pulled from the market. As part of its legal settlements, Purdue also agreed to stop pitching opioid medications to physicians and slashed its sales staff.
Lest you feel any sympathy for the embattled pharmaceutical giant, know this: by 2001, addiction to oxycodone (the active agent in Oxycontin) had already increased five-fold. Yet Purdue and its experts-for-hire downplayed the danger and kept promoting the drug vigorously. According to a Justice Department report, the company also knew early on that the drug was being snorted or liquefied and injected, but did not think it useful to divulge news of the abuse. It also sat on evidence its own investigators amassed on the criminal trafficking of Oxy and on cases of doctors or drugstores dispensing it recklessly.
As for those fines, they amounted to chump change for the company, which by 2017 had amassed $35 billion in revenue, largely from Oxycontin sales in the United States and elsewhere. And the Sackler family? None of its members were ever charged, let alone convicted of anything; and, with a net worth of $14 billion, in 2015 they first made the Forbes list of the 20 wealthiest families in America.
Someone nabbed for a non-violent drug offense or even shoplifting could face years of jail time, but the titans of a company responsible for a public health disaster have gotten a remarkable pass.
What Next?
The current opioid crisis transcends Purdue. For one thing, there are numerous, widely prescribed opioid medications out there besides Oxy, even though the number of annual prescriptions for opioid painkillers has actually declined since 2012. According to a report issued by the Surgeon General, they totaled 289 million in that year compared to 76 million in 1991. The CDC reports that they had fallen to 191 million in 2017. But as the agency notes, that still makes for a stunning 58.7 prescriptions for every 100 people in the United States, which remains peerless in the global consumption of opioid pain medications.
Since perhaps 2013, another problem has amplified the opioid crisis: the abuse, illicit manufacture, and smuggling of Fentanyl, a synthetic opioid analgesic whose potency exceeds morphine's by 50 to 100 times and oxycodone's by a factor of 1.5. A two-milligram dose can prove fatal.
Deaths linked to synthetic opioids, mainly Fentanyl, reached 29,406 in 2017, a nearly six-fold increase since 2014. The CDC found that Fentanyl was implicated in at least three-fifths of opioid overdose fatalities in 10 states during the last half of 2016 alone. The drug's wallop and widespread availability from illicit Internet sites only heightens the risk of addiction and fatalities. Meanwhile, heroin overdose deaths, which started to increase sharply at about the same time as opioid-related fatalities, reached 15,958 in 2017 -- a three-fold increase from 2014.
To make matters worse, there are numerous Fentanyl analogs, including 3-Methylfentanyl, four times more powerful than Fentanyl itself. Though its illegal manufacture dates to the 1970s, it has recently made a comeback on the street and via the Internet. Then there's Carfentanil. Used to tranquilize elephants and other large animals, it's 100 times stronger than Fentanyl and it, too, has begun to make its deadly mark. In the first half of 2017, Carfentanil-related deaths nearly doubled, reaching 815. Just how deadly is it? For sedating an adult elephant, the safe dose is 13 milligrams. Just .05 milligrams will kill a human being, scientists warn.
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