How to Mislead the Public about Your Addictive Medication: A Step-by-Step Guide

A logo sign outside of a facility occupied by Purdue Pharma L.P., in Wilson, North Carolina on November 27, 2015. Photo by Kristoffer Tripplaar

Like hundreds of other cities, counties, states, hospitals, labor unions and even fire departments, the State of Tennessee has filed a lawsuit against one of the major manufacturers of opioid painkillers. In this case, the defendant is Purdue Pharma, a private company in Massachusetts responsible for patenting a time-release pain formula containing oxycodone. Their product is called OxyContin.

As many people have now learned, Purdue Pharma innovated an aggressive marketing campaign for this drug that set millions of people on a path toward addiction to painkillers. Some of these people sought out heroin when painkillers became hard to get. Hundreds of thousands of Americans have died from overdoses of painkillers, heroin or — when it began to hit the market in 2013 —an illicitly-manufactured version of the powerful opioid fentanyl.

Purdue’s sales tactics, revealed in the Tennessee lawsuit, practically constitutes a playbook on how to initiate a massive landslide of overprescribing for this addictive drug. And overprescribing is almost a guaranteed path to addiction. Let’s look at Purdue’s sales tactics that are exposed in this lawsuit.

  1. Train your sales staff to be aggressive. Teach them to “Always be closing,” a reference to the movie Glengarry Glen Ross, a film about intensely aggressive salesmen who pushed inferior real estate at high prices.
  2. Hire plenty of sales representatives. For the State of Tennessee, that meant as many as 87 sales reps, all of whom were aggressive marketers and none of whom were medically trained.
  3. Teach these reps to target medical providers who are overworked, serving poor communities, and have less medical training as these practitioners can be convinced to increase the number of prescriptions and the dosages prescribed for each patient.
  4. Call these less-trained, overworked practitioners “high value prescribers” for their susceptibility to the charms of sales reps.
  5. Compensate your sales reps lavishly for being top sellers. (In 2010, one sale’s rep’s base salary was about $110,000 but his bonuses exceeded $128,000).
  6. Give top sales staff free trips as well as money.
  7. Push your sales reps to make tons of sales calls. In 2016, the Purdue team made more than 52,000 sales calls in Tennessee, or six per hour.
  8. Formulate your pills into dosages as high as 160 mg of painkiller, despite the fact that 80 mg is 33% more than the maximum daily dosage recommended by the Centers for Disease Control and Prevention.
  9. Focus on doctors who don’t have enough time or pain management experience to adequately monitor their patients on opioids. (Between January 2007 and August 2017, this type of practitioner prescribed 65% of all the OxyContin in the state.)
  10. Teach your sales staff to assume that a doctor does not know how to prescribe medication.
  11. Also teach your sales staff how to overcome any objections a doctor or other practitioner might have to prescribing opioids, such as not wanting to hand out pills that could be abused or the fact that they don’t generally treat chronic pain patients. Convince these prescribers to rely on Purdue sales reps for the information they need to prescribe painkillers.
  12. Also convince prescribers to expand their definition of what an appropriate patient for opioids really is so that you can create more customers for OxyContin.
  13. Create staff training materials for your product with the headline, “We sell hope in a bottle.”
  14. Overstate the helpfulness of the abuse-deterrence features of your pills.
  15. Understate the risk of addiction. (One survey of a thousand painkiller patients revealed that only six out of ten were told that the pills were potentially addictive.)
  16. Make unsubstantiated claims that your opioid will improve a patient’s quality of life, function and sleep.
  17. Distribute marketing materials that target both prescribers AND patients themselves.
  18. Use celebrities like Naomi Judd and Jennifer Gray in your materials.
  19. Hire doctors to promote your products to other doctors and prescribers like registered nurses or physician’s assistants.
  20. Target vulnerable patients like veterans. Finance a publication called Exit Wounds that focuses on the needs to veterans with pain.
  21. Single out doctors who work with nursing homes or have a large number of elderly patients.
  22. If you promise someone you will stop pushing medical providers to prescribe high amounts of this medication for long periods, keep doing it anyway.
OxyContin, the drug that started the avalanche.

These are the claims of the State of Tennessee, expressed in a 272-page lawsuit. This is apparently how Purdue Pharma thought it was appropriate to act to increase their sales of an addictive medication. They have made billions from the sale of this drug while more than two million people have become addicted to them. But now there are hundreds of lawsuits directed at them and a handful of other pharmaceutical manufacturers and distributors. It will take months or even years for these lawsuits to be finalized. What do you think is the appropriate penalty for a pharmaceutical company that would behave in such a reckless manner?


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