In a shocking reversal of their earlier corporate policies, Purdue Pharma, one of the country’s largest drug manufacturers, announced that it will immediately discontinue promoting OxyContin and other prescription opioids. In addition, the drug giant laid off over half of its sales staff. The remaining salespeople will now focus on promoting the company’s other products. With this reversal, Purdue now joins other so-called “Big Pharma” drug manufacturers. Janssen Pharmaceuticals and Allegan stopped opioid marketing years ago. Purdue Pharma’s shift is especially significant, however. While opioid pain medications make up a fraction of the other manufacturers’ total revenue, the opposite is true with Purdue. They are the manufacturer of OxyContin – the world’s best-selling opioid painkiller, generating over $31 billion in sales since its introduction.
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A Major Shift in the Industry
This comes while Big Pharma companies are currently facing dozens of liability cases at every level – individual cities, counties, and states—aimed at holding the drug industry accountable for a public health emergency largely of its own making. While the drug companies deny wrongdoing and the outcome of most of these cases has yet to be decided, this move is important. It is a tacit admission by Purdue that Big Pharma shares the blame for a crisis that every year, kills more Americans than the entire Vietnam War. This is a dramatic turnaround from the business practices of not too long ago. Purdue salespeople once set a ridiculous standard for aggressive targeted marketing aimed at persuading doctors to prescribe OxyContin. The staff was specially-trained to identify the highest prescribers and zealously focus on those providers. An actual internal memo from that era reads, “As you continue to carry the OxyContin banner onto the field of battle, it is important to keep highlighting OxyContin benefits to your doctors.” The hyperbole was real – reps were given such grandiose titles as “Knight” or “Royal Crusader”, and they were rewarded for doing the bidding of the “Empress of Analgesia” But as salespeople sallied forth from the “Royal Court of OxyContin”, they oversold the benefits while misrepresenting the real hazards:
- Minimizing OxyContin’s addictive potential
- Pushing OxyContin as a remedy for chronic pain
- Overstating how long OxyContin remains effective
- Falsely representing OxyContin as granting steady pain relief
In 2007, Purdue pled guilty to purposely misleading both doctors and consumers. They were fined over $634 million. For perspective, Purdue Pharma sold $1.94 billion worth of OxyContin in 2017 alone. The White House Council of Economic Advisers reported that in 2015, the opioid epidemic cost this country over $500 billion in criminal justice spending, healthcare, and lost productivity.
Lawsuits Making a Difference
“We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers.” ~official statement from Purdue Pharma
Putting an end to aggressive marketing to prescribers was one of the key demands of many of the ongoing lawsuits. Among the restructuring moves:
- Sales reps will no longer visit prescribers’ offices to discuss any opioid products.
- If a prescriber has any questions about any of Purdue’s opioid medications, they will be directed to a special Medical Affairs department within the company.
- Purdue’s main focus will be on promoting Symproic – ironically, a drug used to treat opioid-induced constipation.
- Increased effort will be made to develop non-opioid medications.
In some ways, this newest step by Purdue is a continuation of earlier efforts. When reports about the abuse of OxyContin first began surfacing in 2000, the company worked with Food and Drug Administration to create a “risk management plan” to devise strategies to prevent divergent and abuse of the drug. In 2010, the company began selling a crush-resistant formulation of OxyContin. This change made it more difficult for addicts to misuse the medication by injecting or snorting it. And, for the last few years, Purdue has tried to educate prescribers by directing them to The Centers For Disease Control And Prevention’s Guideline for Prescribing Opioids for Chronic Pain. In a statement, the company said, “We are deeply troubled by the opioid crisis, and we are dedicated to being part of the solution.” Currently, Purdue manufacturers three opioid pain medications:
- Butrans – a transdermal Patch containing buprenorphine
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The Big Question Everybody’s Asking: Will I Still Be Able to Get My Pain Meds?
“Pain is a more terrible lord of mankind than even death itself.” ~ Dr. Albert Schweitzer
According to the National Institutes of Health, roughly 1 in 4 Americans have experienced pain lasting more than 24 hours. Millions more suffer from short-term, or acute, pain. In fact, long-lasting chronic pain is the most-common cause of disability in this country. With that in mind, it comes as no surprise that many people are worried about their ability to receive effective pain medications moving forward. To set the record straight, Purdue is not discontinuing the manufacturing of OxyContin or their other opioid products – only the direct marketing and promotion to doctors. Where appropriate, the medications will still Be available. But it does signal that things are changing. To curb opioid abuse, steps are being taken to ensure that providers are prescribing medications in a responsible manner:
- New CDC prescribing guidelines
- The Department of Justice’s Opioid Fraud and Abuse Detecting Unit
- The American Medical Association’s Task Force to Reduce Opioid Abuse
Working in cooperation, federal agencies and the medical community are looking to end an epidemic that kills approximately 115 Americans every single day.
Health Care Coverage Is Changing
“Our focus is on helping customers get the most value from their medications – this means obtaining effective pain relief while also guarding against opioid misuse.” ~ Jon Maesner, PharmD, Chief Pharmacy Officer for Cigna insurance
In October 2017, major insurer Cigna announced that it would not cover OxyContin for customers using its employer-based insurance plans. OxyContin is the only opioid painkiller that Cigna is removing from its list of covered medications. Customers were notified in time to discuss alternate treatment options with their physicians. Patients already prescribed OxyContin treatment for cancer or hospice care will continue to have coverage. Beyond that, individual prescriptions determined by a doctor to be “medically necessary” will be reviewed on a case-by-case basis. Cigna will continue providing coverage for Xtampza, another oxycodone-based painkiller, but if too much of the drug is prescribed, a financial penalty will be imposed on the manufacturer. This coverage exclusion follow’s Cigna’s 2016 announcement that it was committed to reducing customer opioid use by 25% by the year 2019. In the statement, Cigna’s President and CEO, David Cordani, said: “To respond to this crisis, all stakeholders – patients, physicians and other providers, pharmaceutical manufacturers and distributors, payers, pharmacists, and governments – must join together to prevent substance abuse disorders and assure access to all appropriate treatments.” By April 2017, the use of prescribed opioids among Cigna customers had already dropped by almost 12%. Cigna’s commitment has had far-reaching implications. 158 medical groups within their network – representing almost 62,000 doctors – have signed a pledge to reduce the prescribing of opioids and to treat opioid abuse as a chronic medical condition. “The decline in opioid use that we have seen in just one year is encouraging and reinforces how much more we can accomplish as we continue to work together,” said Cordani.
Why Is All of This Necessary?
In 2016 alone, there were more than 42,000 drug fatalities involving opioids – accounting for two-thirds of ALL overdose deaths in America. To put that number in greater perspective, that’s more lives than are lost to breast cancer. But it goes deeper than that, because while the opioid crisis began with deceptive marketing and problem prescribing, the problem has mushroomed from there.
- Prescription drug misuse leads directly to heroin abuse. 80% of heroin addicts in treatment say that they started out by using opioid painkillers.
- 94% of those say that they made the switch because heroin is cheaper and easier to obtain.
- 15,446 people Americans died in 2016 because of heroin.
- That is a 739% increase since 2002.
- Synthetic opioids like fentanyl and its analogues are also on the rise.
- Since 2013, the overdose death rate from synthetic opioids – excluding methadone – has jumped 88% annually, on average.
- 2009: Breakdown of opioid involvement among all overdose deaths:
- Prescription painkillers – 26%
- Heroin – 9%
- Synthetics – 8%
- 2016: Everything changed
- Synthetics – almost one-third
- Heroin – approximately one quarter
- Prescription painkillers – 23%
But there is a measure of good news – efforts to curtail prescription opioid abuse are having a positive effect. 1999-2009, the prescription painkiller overdose death rate rose an average of 13% a year. Since then, the average annual rate of increase has dropped to just 3% While there is much room for improvement, if prescription painkiller abuse can be controlled, then greater focus can be placed on curbing illicit opioid use. Dr. Andrew Kolodny, the Executive Director of Physicians for Responsible Opioid Prescribing, says, “Even though deaths are going up among people who are addicted heroin users, who use black-market opioids…it’s possible that we are preventing less people from becoming addicted through better prescribing.”
“We accept many health insurance plans. Get your life back in order, take a look at our residential program.”
What Happens Now?
As Cigna’s CEO said, it will take the efforts of EVERONE to end the opioid crisis in the United States. Federal agencies are doing their part, by issuing new prescribing guidelines and by empowering investigative task forces. State governments are doing their part by creating Prescription Monitoring Programs– provider-shared databases designed to eliminate fraudulent prescriptions and physician-shopping. The medical community is doing its part by cooperating with other agencies and by educating and self-policing healthcare professionals. Drug companies and manufacturers are doing their part by creating abuse-resistant formulations and by reversing decades of aggressive opioid marketing. Insurance companies are doing their part by setting strict limits on the kinds and amounts of opioid medications they will cover. As patients, there are also a number of things we can do:
- Always discuss non-opioid pain management options, such as:
- Physical therapy
- Music or Pet therapy
- Non-opioid/OTC medications
- Be proactive in revealing any personal or family history of substance abuse or mental illness of any kind
- Disclose any other medications or supplements
- If opioids MUST be prescribed, insist on the lowest dose and shortest duration possible
- Ask that your doctor schedule a follow-up evaluation before writing a refill
- Never take more of any medication than directed.
- Completely avoid alcohol when taking opioids
- Always watch out for any adverse drug interactions
- Do not share medications with anyone
- Properly dispose of any unused medications
- If you are placed on long-term opioid therapy, ask your doctor to also prescribe Narcan for accidental overdoses
Sometimes, pain medication is an absolute necessity. But that necessity also comes with added responsibility. If you find yourself becoming dependent on your opioid medication, immediately seek specialized professional treatment before it progresses to full-blown addiction.