PUSHING OXYCONTIN

Drug Maker's Rehabilitation Rings Hollow

It's often said that a picture is worth 1,000 words. Sometimes,
though, 1,000 words are unnecessary. Sometimes, just a few words are
enough to paint a revealing picture.

It could be a few words in the "call notes" a pharmaceutical sales
representative makes after a visit with a doctor or pharmacist.

"(G)et him to help push even more oxy," Purdue Pharma sales
representative Shane Foster wrote after leaving one doctor's office,
according to court documents in a lawsuit against the manufacturer of
the prescription pain medication OxyContin.

"(N)eeds to be pushed to use more," Foster wrote elsewhere. Other
self-exhortations in his notes included "keep him writing more"
prescriptions; "set plan for high use"; "dose higher."

It could also be a few words from a Purdue Pharma marketing
proposal.

Detailed weekly and monthly data on the prescription-writing habits of
individual doctors, provided to sales reps by the company, "must be
used to target the highest potential physicians," said a 1995
marketing plan.

That was followed a year later by a suggestion that the company
commission a Gallup poll on untreated pain to create a "media hook"
for news coverage of OxyContin in what the suggestion's promoters
called a "classic problem-solution strategy to create a need."

Or it could be the two words Scott Frederick, an attorney for the
plaintiffs in the class-action Ohio lawsuit, used to describe the
marketing and sales strategy for the prescription narcotic known as
"hillbilly heroin" because of its popularity among drug abusers in
Eastern Kentucky and other parts of Appalachia.

"Corporate pushing" is what Frederick called it in a court hearing
last year.

That's a strong description of Purdue Pharma tactics, which aren't all
that different from strategies of other pharmaceutical firms. But
perhaps not too strong. After all, Purdue Pharma was selling a highly
addictive narcotic, not the latest indigestion remedy.

As outlined by Herald-Leader reporter Charles B. Camp in stories
published last week, Purdue Pharma spent megabucks targeting doctors
with a history of prescribing large quantities of pain pills -- a
strategy that, by logical extension, also targeted people most prone
to dependency on and abuse of pain medication.

The company sent an army of well-paid -- and well-bonused -- sales
reps out to talk those doctors into prescribing OxyContin instead of
competing pain pills.

According to documents in the Ohio case and an unrelated Florida
investigation, Purdue Pharma's pitch to physicians exploited the
perception that OxyContin, made of the chemical oxycodon, was less
powerful than its predecessor MS Contin, which is made from morphine.
But one study, financed by Purdue Pharma itself, concluded that
oxycodon is twice as potent as an equal amount of morphine.

Once the company got its foot in the door with the doctors, sales reps
kept prodding them to prescribe more, more, ever more. Those
exhortations continued even after doctors and pharmacists began to
express concern about growing reports of addiction and death caused by
misuse of OxyContin.

To keep those physicians and druggists in the fold, Foster reminded
himself to offer a "pat on the back for doing the right thing" and
"help him feel comfortable using Oxy."

Only later, after the addiction and deaths and illegal trafficking in
the drug started attracting widespread public attention, did Purdue
Pharma change its approach.

Only then did the company tell its reps that they would get no bonuses
on sales involving doctors facing criminal charges for being, in
effect, "pill pushers."

Only then did the company counsel doctors on controlling abuse of
OxyContin.

Only then did it start doling out grants for law enforcement agencies
to use in fighting illegal drug activity.

But Purdue Pharma's transformation from the "corporate pushing"
mentality mentioned by Frederick to the concerned corporate citizen
and benefactor of law enforcement strikes us as being a
too-little-too-late reaction to the misery and death caused by abuse
of the company's "blockbuster" prescription narcotic.

A few words, from Purdue Pharma's own marketing plans and its sales
rep's notes, are enough to paint a picture strongly suggesting that
such gestures are an insufficient acknowledgement of corporate
responsibility for the tragic consequences OxyContin abuse has visited
on Eastern Kentucky and other parts of the nation.