Did the Media Manufacture the Oxycontin Crisis
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Holmes Report

Did the Media Manufacture the Oxycontin Crisis

Purdue Pharma is celebrating its 50th anniversary this year, but the company’s new advertising campaign isn’t touting a half-century of pioneering pharmaceutical research, or its leadership role in the field of pain management.

Paul Holmes

Purdue Pharma is celebrating its 50th anniversary this year, but the company’s new advertising campaign isn’t touting a half-century of pioneering pharmaceutical research, or its leadership role in the field of pain management. Instead, the new ads will focus on an issue that has come to dominate Purdue’s thinking over the past two years: the abuse of prescription pharmaceuticals.

Two years ago, Purdue—a closely held, privately owned company—found itself as the center of the controversy over prescription drug abuse. Its biggest selling product, the highly potent painkiller OxyContin, was being sold on the black market, its active ingredient ingested by drug addicts for a high they likened to heroin.

Purdue was ill prepared for the spotlight of publicity that soon began to shine of the company, its product, and its marketing practices. For 48 of its 50 years, the existence of Purdue Pharma went almost unremarked in the national media. A search of media databases (including press releases) for 1999 reveals just 180 stories that mention the company—and 1999 was a busy year, because Purdue acquired biotech company Cytogen.

So for 48 years, “there was no one in public relations, no one in community relations, no one in government relations,” says Robin Hogen, who was hired as executive director of public affairs about two years ago. At the time, “there was no infrastructure to deal with the outside world.

“This was a very private company. It was run by physicians who were focused 100 percent on their mission, which was to develop new drugs.” The only notable media coverage in the company’s history occurred in 1969, when its Betadine surgical scrub was used to decontaminate Neil Armstrong’s lunar module on its return to earth. Even then, coverage focused on the product; Purdue’s name was never mentioned. Says Hogen, “It was an invisible company.”

But then, on April 6, 2000, Purdue Pharma found itself making headlines. A story in the Bangor Daily News turned the spotlight on Purdue’s biggest-selling drug, the painkiller OxyContin.

“It wasn’t the promise of expensive stereos, TVs or even cash that motivated two masked men to burst into a Millinocket home last month,” the Daily News reported. “It was a small bottle of white tablets tucked inside an elderly woman’s purse. The woman was elbowed in the throat and knocked to the floor before the intruders fled empty-handed. Police believe the two young men, still at large, were searching for OxyContin.”

The story went on to allege, “Along with other pharmaceutical opiates and heroin, OxyContin’s addictive quality is producing a growing number of opiate addicts throughout the state, leading to increased crime and, sometimes, violence.”

The article did not identify Purdue Pharma by name, or seek any comment from the company on the way its product was being abused. Still, it came as a shock to management at Stamford-based Purdue, “especially since this was a company that had always prided itself on doing the right thing, even if it never sought any credit,” says Hogen.

“This was a company with a long, proud history of providing good value to physicians, of taking good care of its employees, of quiet philanthropy. This was a product that had been on the market since 1995, and for the first four years there had been no hint of any problem. So the company was absolutely blind-sided.”

OxyContin is a powerful painkiller—a synthetic narcotic many times more potent than similar products such as Percocet—that is considered highly effective in treating severe, chronic pain because its time-released form enables the drug to work over many hours. But abusers soon discovered they could defeat the time-released mechanism by crushing or dissolving the tablet, giving them immediate access to the drug’s active ingredient, which could then be snorted or injected.

DEA officials say the appeal of OxyContin to abusers is the relatively large amount of active ingredient—oxycodone—present in the product in comparison with other similar products. Percodan and Percocet contain only 5 milligrams to 10 milligrams of oxycodone plus other ingredients such as aspirin and acetaminophen.

By 2000, OxyContin had become the most important product in Purdue’s history. It was the 18th best-selling brand-name drug in the United States by retail sales, with 5.6 million prescriptions written, and accounted for about 80 percent of the company’s revenues, estimated by Forbes at around $1.2 billion.

Under the circumstances, any threat to OxyContin was a threat to Purdue. Hogen, a veteran of corporate communications positions at United Technologies, Merck, and Fisher Scientific, was brought in to build the company’s public relations team from scratch, and was joined by senior director of public affairs Timothy Bannen and associate director James Heins.

“We developed a new Internet site,” says Hogen. “We developed a new press kit. The company really didn’t have these things.”

In October, an article in the Roanoke Times & World News described OxyContin as “the poor man’s heroin,” and by February 2001 politicians were calling for the company to address the issue, with Virginia attorney general Mark Earley citing “an epidemic of addiction and a surge in criminal behavior.” That was the first time newspaper reports suggested the company might bear some responsibility for the way its drug was being abused—or at least for ending the abuse.

To this point, the story had been confined to a handful of states where abuse was rampant: Maine, West Virginia, Virginia, Alabama and Kentucky. OxyContin had become the drug of choice in the rural areas of these states “because the people who abuse drugs there can’t get heroin or crack cocaine the way people in big cities can,” according to Hogen. “The abuse is mainly in poor rural communities where there is high unemployment and high substance abuse already.”

But the February sweeps week changed all that. Television news reports jumped on the story “as if they had discovered gold,” he says. “If there’s one thing I’ve learned from all this it’s that no PR guy should go on vacation in February.”

The company’s senior medical director, Dr. J. David Haddox, quickly became a regular guest on television news shows. Haddox, who is board certified in addiction medicine and a former president of the Academy of Pain Management, joined the company a few months before the crisis broke.

“We are joined at the hip,” says Hogen. “He is a nationally respected figure in the field, and we felt he was the right person to be out front representing the company on this.”

Haddox has had some success reaching out to key stakeholder groups—he is the only physician to have addressed the annual conference of the National Association of Drug Diversion Investigators—but the vultures were already circling the company: trial attorneys were feeding exaggerated statistics and hostile quotes to the media, and politicians were sensing an opportunity to score some east points with the voters.

“I don’t think any of us expected this to get as big as it got as fast as it did,” says Hogen. “We had no one in state government relations, and it quickly became a huge issue in the states. We were used to dealing with science, where facts matter. We found ourselves in the political sphere, where everything was impressions and nuance. Frankly, we were quite naïve politically.”

Tom Shales, writing in Electronic Media, was critical of the way television news had covered the OxyContin crisis. “TV news doesn’t really cover the field of medicine. Instead it goes about the business of fomenting hysteria. Sometimes it’s a kind of benign hysteria, the careless spreading of false hope by reporting on a small advance in scientific research that may or may not result in a medical breakthrough three, six, 10 or 20 years down the pike….

“But what the TV news boys and girls really love is a hot juicy story that spreads fear and loathing about drugs and their dangers, real or imagined… Every network news department has now done a story or two on a drug called OxyContin… It turns out that in some areas where the usual hard-core recreational drugs like crack cocaine are in short supply, substance abusers have found a way to get high on OxyContin. They grind it up into powder and snort it or make it soluble and inject it into their veins.

“A national epidemic? No. Not even close. But TV newscasts have tried to portray it that way in stories filled with hype and half-truths. The hysteria gets whipped up by each succeeding piece until we reach the point, noted in an NBC Nightly News report last week, that doctors are reluctant to prescribe the drug because it’s suddenly got this ‘bad’ reputation.”

Hogen warned that sensationalized news reports ran the risk of turning a localized problem into a national epidemic, providing detailed instructions on how to use the drug, and scaring physicians. “None of these clowns on television are reporting the beneficial aspects of the drug. Only the abuse. They are scaring pharmacists, scaring doctors and scaring patients.”

By the first week of March that OxyContin had become a national crisis for Purdue. On March 5, The New York Times magazine produced a special report, “Medicine Merchants,” which reported on “OxyContin, a powerful painkiller that has helped thousands in pain and racked up $1 billion in sales in little over four years, but at considerable cost. The drug, manufactured by Purdue Pharma, has been factor in deaths of at least 120 people, and Drug Enforcement Administration says no other prescription medication in last 20 years has been abused by so many people so soon after it release.

According to the Times, “Officials attribute part of problem to overselling of drug’s benefits without adequate warning of potential for abuse… [the] company used often criticized but increasingly common marketing strategy of currying favor of doctors in private practice with free trips and paid speaking engagements to promote use of painkillers and contributed to foundations supporting research on pain, to pharmacy schools and Internet sites aimed at educating consumers.

“As the marketing message spread, the drug caught on with many doctors who medical experts say had little experience in prescribing powerful narcotics and often could not spot those with potential for abuse,” the paper said.

Hogen rejected charges that Purdue was guilty of over-aggressive marketing. “We would contest that up, down and sideways,” Hogen told reporters. “This company is a conservative marketer by any measure and responsible by all measures.”

But reporters did not have any difficulty finding physicians who saw things differently. Dr. Art Van Zee led a national petition drive to have OxyContin recalled. He said Purdue sent printed promotional material containing studies about OxyContin with an offer of a compact disc with 1950s dance tunes and a smiling, elderly couple under the words “swing in the right direction with OxyContin.” The offer also included a pedometer with the drug’s name and the words “a step in the right direction” and a beige beach hat with a large OxyContin logo.

“Is Purdue an outlier because we hand out a $2 pen with a conversion chart on it,” asks Hagen, rhetorically, referring to a promotional pen that helps doctors switching to OxyContin from other medications figure out the correct dosages. “We had Drug Enforcement Administration administrator Asa Hutchison standing in front of Congress brandishing this pen as if it was outrageous, as if offering a doctor a $2 pen was going to persuade him to prescribe your medication.”

The FDA has not found any fault with Purdue’s marketing of Oxycontin, except for a case in May 2000 when the regulatory body told Purdue it should “immediately discontinue” an ad that appeared in the New England Journal of Medicine that said OxyContin was “proven effective in arthritis pain.” The FDA said it found the ad unsubstantiated and misleading because OxyContin had been tested on some but not all types of arthritis.

And in December 2001, the company won its first court victory when a U.S. district court judge in Kentucky denied a preliminary injunction to restrict the marketing of OxyContin “The plaintiffs have failed to produce any evidence showing that the defendants’ marketing, promotional, or distribution practices have ever caused even one tablet of OxyContin to be inappropriately prescribed or diverted,” said the judge in her ruling.

More troubling were suggestions of high-pressure sales tactics. A CVS pharmacist told the Roanoke Times & World News that after a local store stopped carrying OxyContin, a Purdue Pharma sales representative warned that it could be sued for failing to fill a doctor’s prescription.

“Salesmen are aggressive,” says Hogen. “It’s part of their genetic makeup. But they are not coercive. We have some of the best-paid, best-trained salesmen in the industry. We only hire people who have at least two years experience, and we only hire people who are among the most productive at their previous company.

“They are also passionate about what they do. You can’t work in this field if you don’t feel you are on the side of the angels. We believe pain is under-treated. That’s the real health crisis here.”

In July of 2001, the Food and Drug Administration placed a black-box warning— the strongest warning it can issue—on OxyContin’s labeling in an attempt to prevent the drug being prescribed inappropriately for less severe pain or for other disorders. By this time the company had already suspended shipments of 160 mg Oxycontin pills, the highest dosage produced, and was working to develop abuse-proof forms of OxyContin: a patch and an oral tablet that contains naloxone, an opioid antagonist. The antagonist would pass through the body with little effect if the tablet is swallowed whole, but would be released if it is crushed, negating the effect of the active ingredient. (The oral tablet began clinical trials in December).

The company had also introduced a 10-point plan to address the issue of abuse. The plan includes the distribution of special prescription pads for OxyContin to physicians. The pads cannot be photocopied, and if a forger does attempt to photocopy them to create illegal prescriptions, every copy is marked “void.” Purdue has also mailed educational brochures about drug diversion to more than 400,000 physicians and 60,000 pharmacists and is sponscring more than 300 continuing-medical-education programs for healthcare professionals on the subject of responsible pain management and ways to prevent people from illegally obtaining controlled substances.

The company’s PR team explained the plan in meetings with reporters and editorial boards at key media outlets including the Wall Street Journal and at local newspapers that had covered the issue, such as The Hartford Courant.

Also in July, Purdue announced plans to fund an entrepreneurial program for students in the areas hardest hit. Based on the theory that poverty contributes to drug abuse—a theory supported by the localized nature of the OxyContin problem—the company announced a $100,000 gift to train teachers in rural communities to teach business skills to poor children.

Predictably, the move was denounced by plaintiffs’ attorneys. Emmitt Yeary, a lawyer who filed a Virginia class-action lawsuit against the company, described the donation as ridiculous and suggested the money would be better spent “teaching their own corporate executives about morality and ethics and true compassion for fellow human beings.”

The company also ran into problems with some of its efforts to cooperate with public officials.. In May of last year, Alabama Governor Don Siegelman took Purdue associate medical director Sheryl Siegel to task at a press conference to announce a task force to fight prescription drug abuse.

According to newspaper reports, Siegelman interrupted Siegel in the middle of her remarks, and told her, “I find this very offensive... When people are agonizing over the loss of their children, we don’t need to turn this into a press conference for your company or this drug. We’ve had enough public relations and enough sugarcoating of this issue and, quite frankly, as governor, I am fed up.”

In June, West Virginia attorney general Darrell McGraw became the first to file suit against Purdue, alleging that Purdue had engaged in a “coercive and deceptive” marketing campaign to doctors in order to make more money and form an illegal monopoly on the pain medication market. The suit named both Purdue and marketing partner Abbott Laboratories.

“This has taken the market by storm over the past five years,” McGraw said. “It is a major threat to public health in our area.” A negligence count in the suit states that the manufacturers had an obligation to exercise reasonable care in the marketing and making of the drug.

McGraw also alleged that the drug was marketed directly to consumers, citing an Internet site called “Partners Against Pain.”

“If you can find any direct to consumer advertising this company has ever done, I will buy you a very expensive car,” says Hogen. “We have never spent as much as one dollar on direct to consumer marketing. The idea that this website, which is an educational resource for professionals and caregivers and sufferers, would prompt patients to coerce their doctors into prescribing a particular product is just absurd.”

In August of 2001, the company attracted more criticism when it announced plans to hire law-enforcement officials to work with police grappling with the widespread abuse of the drug. In Virginia, for example, the company hired Landon Gibbs, former head of the Virginia State Police drug diversion unit in Roanoke. Haddox told reporters the company planned to hire seven law enforcement officers with expertise in drug interdiction, to help Purdue better understand how the drug was getting into the hands of abusers.

“We want to be able to collect information and experiences from police officers from around the nation,” said Haddox. The law enforcement experts would also help the company explain the drug’s benefits to police, and help them distinguish between legitimate prescriptions and likely criminal activity, Haddox explained.

Said Heins, “That’s part of our whole initiative: to work with law- enforcement to make sure they see pain management from our point of view, and we see drug diversion from their point of view.”

Again, critics of the company were quick to dismiss the move as a ploy.

“I think it’s more of a public relations thing than anything else,” said Dennis Lee, prosecutor in Tazewell County, one of the cities at the epicenter of the abuse problem. Plaintiffs’ attorney Yeary agreed: “It’s a public relations ploy, and I think it’s another hypocritical gesture of denial on their part that aggravates the situation. They’re continuing to say the problem is the abusers, when they created this demon drug and they’ve created the victims.”

Hogen makes no secret of his frustration. “If we hired Mother Theresa someone would say she was for sale and that her hiring was just a public relations ploy,” he says. “We went out and hired a Virginia state policeman who had been running the prescription drug control unit and whose reputation was above reproach. His role was to work with the law enforcement community to make sure that any law enforcement effort focused on preventing abuse and did not impair the medical care of people who rely on our product.”

Not surprisingly, patient groups have rallied to the company’s defense, concerned that their access to a drug that is safe and effective when used as directed could be severely curtailed.

The American Pain Foundation, for example, has been critical of media coverage of the issue. “While these often-sensationalized stories have focused primarily on the illegal and dangerous use of these medications by drug abusers, they have often failed to balance the problem of abuse with the real news about these drugs-that they provide valuable relief for people suffering with serious pain. The danger of these stories is that they perpetuate long-standing myths and misconceptions about pain management and have the potential to discourage people with pain from receiving treatment that works.

Similarly, the American Academy of Pain Medication says, “We are very concerned and strongly opposed to the diversion and abuse of controlled substances and support law enforcement efforts to stop these criminal activities. However, there is an issue of greater importance to public health resulting from the inadequate treatment of patients with serious pain disorders.”

“Patient groups have lined up to help,” says Hogen. But for the most part they have been ignored by the media. A Factiva search found 1,798 articles in 2001 including the words “OxyContin” and “abuse.” Only 25 mentioned the American Pain Foundation or the American Academy of Pain Medication. No wonder, then, that Hogen sounds frustrated with the media’s coverage of the story.

In one case, Hogen says, a New York Times stringer wrote an article on pain management, looking at what it was like to live with chronic pain. The story was heavily edited because it contradicted an earlier Times piece that was critical of OxyContin.

“It’s been a circus,” says Hogen. “The sloppiness has been extraordinary. I’m amazed at how little fact checking there seems to be. People can get away with the most outrageous statements. I saw a report that OxyContin killed more people than died from heroin overdoses in the first six months of 2001. It was a complete misreading on the data.

“Then I was at a conference at the Enterprise Institute and I saw a reporter from the Charleston Gazette who was being interviewed an expert on the subject of OxyContin abuse.”

So in November, the company announced an ad campaign featuring radio advertisements in Palm Beach County, Fla.; Cincinnati; Philadelphia; and Charleston, W.Va. The campaign, tagged Painfully Obvious, was the first educational program for prescription-drug abuse.

“Prescription-drug-abuse education has not been addressed in the past,” public affairs manager Kevin McIntosh told Med Ad News. “Everyone knows what crack cocaine is, but no one thinks of going into the medicine cabinet and crushing or doing something to legitimate prescription products.”

“We realized we had to get into the paid space,” says Hogen. “We were not getting our message across, so we had to made a commitment of several million dollars to get into the advertising hole, to try to put some context around the issue. The context is that this is a problem, that effects four million people a month and we have about two million patients a year. Prescription drug abuse is not about a single drug or a single company.”

For that reason, the ads did not mention OxyContin by name. Instead, they addressed the broader issue of prescription drug abuse. According to the National Institute on Drug Abuse, about 9 million people 12 years old or older reported using sedatives, stimulants, tranquilizers, or opioids for nonmedical reasons in 1999, and those numbers are increasing, particularly among older adults, adolescents, and young women.

Now the company is planning an expanded campaign that will include print and television ads. The campaign, conducted in partnership with the National Institute on Drug Abuse and the Coalition of Anti-Drug Communities of America, includes educational materials such as discussion guides, posters, and stickers, advertisements on the leading teen radio stations, a website. It also includes a guerrilla-marketing component featuring Brain Bugs—Volkswagen Beetles designed to look like the campaign’s naked human brain icon. The cars will cruise the streets of the four target regions, where they will catch the attention of teenagers and dire ct them to the Website.

North Castle Partners, a consumer agency that specializes in marketing to teens and is probably best known for its work for Slim Jim, developed the ads.

According to North Castle president Clif McFeely, “We learned through our teen panels that it is not so much the physical effects—after all, teens are “immortal”—but the social consequences of prescription drug abuse that capture attention.” The company’s research also indicated that teens do not see the same stigma attached to the recreational use of legal prescription drugs that they see with abusing street drugs such as cocaine and heroin.

The ad campaign will hopefully help change perceptions about prescription drug abuse, playing a valuable educational role. But critics will likely see it as yet another “public relations ploy” from a company that two years ago would have had to find a dictionary to know what public relations was. It’s learning, though.

“It’s not easy to turn the tide,” says Hiogen. “What we have tried to do is monitor what is being said and to be assertive in responding. We have tried to get into every story. If a new station runs a bulletin previewing a story that will run on the six o’clock news, we call the producer and offer Dr. Haddox as a source. We want to insert ourselves into the story, even if it’s only for 20 seconds.”

Clearly, Purdue could have been better prepared for the events that plucked it from obscurity and turned its best-selling product into a household word in some regions of the country. Equally clearly, the company was hurt by its naïveté in dealing with the media and the world of politics. But its experiences provide a lesson for every company in America, from the most sophisticated to the least: when a company is under attack, and when people have a vested interest in thinking the worst, even the best intentioned decisions are likely to be interpreted cynically, and even real efforts to address the underlying issues are likely to be dismissed as mere public relations.

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