Driving home from a hunting trip in 2008, Johnny Sullivan called his wife to say he was having trouble staying awake.
It was early afternoon, but Mary Lou Sullivan wasn't surprised. Her husband was a long-time user of the narcotic painkiller OxyContin (oxycodone) and frequently dozed off as a side effect, sometimes in the middle of chewing his food.
About 10 years earlier, Sullivan and six other chronic pain sufferers had been featured in a Purdue Pharma promotional video for the drug, which Purdue makes. In the video, Sullivan stood at a construction site and talked about how the powerful narcotic eased his back pain and enabled him to run his company again.
But a few years after being prescribed OxyContin, Sullivan became addicted to it and other prescription opioids, his family said. That afternoon in 2008, Sullivan, 52, fell asleep while driving and flipped his truck on a country road in North Carolina.
"I told my sons one day 'that medicine is going to kill him,'" his widow said.
Expanding the market
Purdue Pharma's marketing of OxyContin in the late 1990s marked the beginning of the industry's push to promote narcotic painkillers for treatment of chronic pain -- an indication for which both safety and efficacy remain unproven.
The first decade of the 21st century has been a good one for makers of prescription painkillers as sales quadrupled from 1999 through 2010, but even in a growth industry OxyContin stands out -- ringing up sales of nearly $3 billion a year.
Meanwhile, health officials and regulators have declared a national epidemic as addictions to prescription painkillers have skyrocketed and fatal overdoses have more than tripled in the past decade.
A U.S. Senate investigation -- prompted in part by Journal Sentinel/MedPage Today reports -- is probing financial relationships of drug companies and the doctors and organizations that have advocated for use of the drugs.
Against that background, the Purdue promotional video emerges as a case study of marketing running ahead of science in the pursuit of the bottom line.
The video, made 14 years ago, showcased ordinary people who spoke glowingly of their experiences with OxyContin.
· Two of the seven patients died as active opioid abusers.
· A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose.
· Three patients still say the drug helped them cope with their pain and improved their quality of life.
· A seventh patient declined to answer questions.
The doctor who not only played a starring role but also recruited his patients for the video now concedes some of his statements caught by the camera went too far.
In the video, the doctor, Alan Spanos, MD, a paid specialist in North Carolina, urged doctors to consider prescribing opioids more often.
Spanos, who was once a paid promotional speaker for Purdue, now says the video was meant to be one teaching aid used in lectures by experienced doctors.
But it was unclear then, and remains unclear now, what percentage of patients benefit from the drugs.
"We don't know whether success stories like this are one in five, one in 15, one in 100, one in a thousand", Spanos said in an interview. "They may be quite rare."
Nonetheless, the video was distributed to 15,000 doctors as part of a marketing campaign in which Purdue claimed, among other things, that the drug was less addictive and less subject to abuse than other drugs.
That wasn't true, and in 2007 The Purdue Frederick Co., an affiliate of Purdue Pharma, agreed to pay $634.5 million in penalties for misbranding the drug as part of a U.S. Justice Department investigation.
The sanctions didn't stop the pharmaceutical industry from promoting OxyContin and other narcotics for people with chronic, long-term pain -- a much larger group of potential customers than just those being treated with opioids for intense short-term pain caused by cancer and end of life pain or acute pain caused by severe injuries or surgery.
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