Percocet, oxycodone and acetaminophen. Fentanyl, usually administered through a skin patch. MS Contin, a long-acting morphine formulation. Sometimes researchers thought they’d found one that didn’t get you high, but there was an army of junkie scientists out there who would burn and dissolve and combine until they unlocked the narcotic trove. Then word would get around. Mix pentazocine with this drugstore antihistamine and you’ve got yourself a nice speedball. Or take a time-release morphine tablet, painstakingly peel off the outer coating, then crush, dissolve, and inject. There was always a way.
So the pharmaceutical companies kept the dosages small and typically cut their products with acetaminophen or aspirin, which discouraged addicts from ingesting massive doses. And doctors were trained to regard painkillers as a last resort. Which meant that many patients lived in pain. Too many, according to a new generation of doctors that began to emerge in the 1980s. Pain management specialists saw patients in agony, desperate for a cure and often unable to get medicine that would give them relief. Pain was real, they said, and it was destroying lives. These specialists began to wonder if physicians had become too reluctant to use the painkilling power of opioids.
By the early 1990s, as some doctors were reconsidering their approach to pain, a smallish, family-owned pharmaceutical company called Purdue Pharma was looking for ways to grow its customer base. Purdue was best known for an extended-release morphine drug called MS Contin. Unlike traditional morphine, which wore off within a few hours, these pills dissolved slowly and allowed cancer patients to sleep through the night. But Purdue’s patent on the formulation would expire soon, which meant that cheaper generic versions would soon be eating into its market share. The company was developing a new drug, an oxycodone pill it would call OxyContin.
Like MS Contin, OxyContin was a controlled-release pill. Swallowed, the dose broke down slowly in the digestive system, doling itself out over twelve hours. This meant Purdue could pack much more oxyco-done into each pill. Percocets contained doses of 5 or 10 milligrams of oxycodone. By contrast, OxyContin came in doses of 10 milligrams, 15 milligrams, 20 milligrams, 30 milligrams, 40 milligrams, 80 milligrams, and even the whopping 160-milligram horse pill, a midnight-blue oblong pebble nearly an inch long. The other thing was that OxyContin was pure. It wasn’t cut with acetaminophen or aspirin. The only active ingredient in the pill was oxycodone.
Purdue didn’t want simply to provide an alternative to MS Contin. That drug was used primarily to ease the suffering of cancer patients, a limited pool of consumers who typically either died or got better. Purdue wanted OxyContin to be prescribed to a much broader array of patients and for a longer period of time. The untapped marketplace was chronic pain, which could mean anything from backaches to arthritis to the crippling agony of trigeminal neuralgia. If Purdue could persuade a portion of that vast and varied market to take OxyContin, the drug would be a blockbuster.
To accomplish this, Purdue had to do no less than undertake a massive, multi-pronged hearts-and-minds campaign to change the way American doctors and the public felt about prescription narcotics. The company needed to train people to think of opioids as benign liberators, as long as they came in pill form and with a prescription.
Purdue leaders borrowed a page from the advertising industry: problem-solution marketing. They would market and publicize the problem of untreated pain. Then they’d promote the solution: OxyContin.
Over the following decade, Purdue Pharma created or funded a vast network of mouthpieces to promote and justify the use of heavy-duty narcotics to ease all kinds of pain. The company’s primary hurdle was to convince prescribers that their pain patients would not become addicted
So the pharmaceutical companies kept the dosages small and typically cut their products with acetaminophen or aspirin, which discouraged addicts from ingesting massive doses. And doctors were trained to regard painkillers as a last resort. Which meant that many patients lived in pain. Too many, according to a new generation of doctors that began to emerge in the 1980s. Pain management specialists saw patients in agony, desperate for a cure and often unable to get medicine that would give them relief. Pain was real, they said, and it was destroying lives. These specialists began to wonder if physicians had become too reluctant to use the painkilling power of opioids.
By the early 1990s, as some doctors were reconsidering their approach to pain, a smallish, family-owned pharmaceutical company called Purdue Pharma was looking for ways to grow its customer base. Purdue was best known for an extended-release morphine drug called MS Contin. Unlike traditional morphine, which wore off within a few hours, these pills dissolved slowly and allowed cancer patients to sleep through the night. But Purdue’s patent on the formulation would expire soon, which meant that cheaper generic versions would soon be eating into its market share. The company was developing a new drug, an oxycodone pill it would call OxyContin.
Like MS Contin, OxyContin was a controlled-release pill. Swallowed, the dose broke down slowly in the digestive system, doling itself out over twelve hours. This meant Purdue could pack much more oxyco-done into each pill. Percocets contained doses of 5 or 10 milligrams of oxycodone. By contrast, OxyContin came in doses of 10 milligrams, 15 milligrams, 20 milligrams, 30 milligrams, 40 milligrams, 80 milligrams, and even the whopping 160-milligram horse pill, a midnight-blue oblong pebble nearly an inch long. The other thing was that OxyContin was pure. It wasn’t cut with acetaminophen or aspirin. The only active ingredient in the pill was oxycodone.
Purdue didn’t want simply to provide an alternative to MS Contin. That drug was used primarily to ease the suffering of cancer patients, a limited pool of consumers who typically either died or got better. Purdue wanted OxyContin to be prescribed to a much broader array of patients and for a longer period of time. The untapped marketplace was chronic pain, which could mean anything from backaches to arthritis to the crippling agony of trigeminal neuralgia. If Purdue could persuade a portion of that vast and varied market to take OxyContin, the drug would be a blockbuster.
To accomplish this, Purdue had to do no less than undertake a massive, multi-pronged hearts-and-minds campaign to change the way American doctors and the public felt about prescription narcotics. The company needed to train people to think of opioids as benign liberators, as long as they came in pill form and with a prescription.
Purdue leaders borrowed a page from the advertising industry: problem-solution marketing. They would market and publicize the problem of untreated pain. Then they’d promote the solution: OxyContin.
Over the following decade, Purdue Pharma created or funded a vast network of mouthpieces to promote and justify the use of heavy-duty narcotics to ease all kinds of pain. The company’s primary hurdle was to convince prescribers that their pain patients would not become addicted
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