By Lina Moskaleva, 2022

Background

Up until the mid-1990s, prescription opioid drugs were prescribed by medical professionals with extreme caution and only to patients with cancer and other terminal illnesses due to the potential for opioid abuse and addition (Marks 2020). This posed a problem for pharmaceutical companies, such as Purdue Pharma, because it curbed their sales of opioid medications by limiting the patient market, the length of time for the prescription, and the level of dose prescribed. The focus of this case study is Purdue Pharma’s pro-opioid campaign in the United States, from 1995 to the early 2000s.

Goals and Strategies

Purdue Pharma’s goal was to increase their sales of opioid medications, in particular OxyContin. Their objective was to expand the market of patients using opioids and encourage the prescription of opioids for longer periods of time and at higher doses. They aimed to do this by downplaying the risks of addiction and stigmatizing those who became addicted and the doctors who raised concerns (Marks, 2020).

The strategy for Purdue Pharma was to change the public, political, and medical discourse about prescription opioid drugs. The campaign began in 1996, when OxyContin was created, and involved a multitude of tactics.

Messaging

In 1995, with permission from the US Food and Drug Administration, Purdue Pharma made an unsubstantiated claim that OxyContin’s novel slow-release formulation was less appealing to drug abusers (Meier, 2018). This claim helped OxyContin’s popularity until it became apparent by the early 2000s that the drug was just as easy to abuse as other painkillers.

In order to humanize their brand and expand their market, Purdue claimed that their product helped “the untreated patient in severe pain who is mobilized and given his life back” (Chakradhar & Ross, 2019).

Lastly, in an internal company email from 2001, the owner of Purdue Pharma wrote “We have to hammer on the abusers in every way possible… They are the culprits and the problem. They are reckless criminals” (Joseph, 2019). This email exemplified another message for the public; “regular people don’t abuse OxyContin, only criminals and long-term drug addicts do.”

Using Opinion Leaders

Purdue Pharma created “webs of influence” by building relationships with a variety of stakeholders, including physicians, civil society groups, and research universities (Marks, 2020). These groups are opinion leaders to a majority of the public and so they helped Purdue to effectively disseminate their message.

One node of the web was the medical community, which was influenced through pharmaceutical representatives and promotional events. Perdue Pharma’s representatives distributed informational materials (literature, audiotapes, brochures, and videotapes) and gifts to the physicians. Jonathan Marks (2020) noted that physicians who met with Purdue reps were 10 times more likely to have a patient die of a prescription opioid overdose. Further, between 1996 and 2001, Purdue conducted more than 40 national pain-management conferences attended by medical professionals (Van Zee, 2009). Lastly, on at least one occasion, Purdue hired an opinion leader to speak to hospital staff about addiction (Armstrong, 2019).

The medical research and education field made up the next node. Purdue’s infiltration of the field was described in a STAT News article (2019). In 1999, the owners of Purdue helped to start a graduate program at Tufts University in Pain Research, Education, and Policy. As well, Tufts University School of Medicine received millions in funding from the Purdue owners and hired a Purdue staff member as an adjunct associate professor to give lectures about pain and opioid use (Joseph, 2019). In 2002, the company helped to create the Massachusetts General Hospital Purdue Pharma Pain Program.

Another node was civil society groups, such as patient advocacy organizations (PAOs), professional societies, and other health-related NGOs. Purdue funded groups included the Academy of Integrative Pain Management and the American Pain Society. These groups are important because they represent the interests of medical professionals and patients in the policymaking processes. However, no matter how earnest the groups are, donations influence them to act in ways aligned with the interests of the major donors (Marks, 2020).

Influencing the Public through Media

The larger public became exposed to Purdue’s message through the media. Purdue funded think tanks used for expert commentary, aided the creation of positive articles, without affiliation disclosure, and deterred or challenged negative coverage of their product or actions (Armstrong, 2019).

David Armstrong’s article (2019) details the work of Sally Satel, a psychiatrist who had worked for a Purdue-funded organization. Later, Satel would work directly with Purdue after being recruited by their PR company, Dezenhall Resources. Satel had several pro-opioid articles published in some of the country’s biggest news media publications, such as The New York Times. In one article, she blamed concerned people for having “opiophobia.”

To help increase the exposure to their message, Purdue created a website, “In the Face of Pain,” which encouraged patients to “overcome” their “concerns about addiction” (Massachusetts v. Purdue, 2019). Testimonials of alleged personal experiences on the website were written by Purdue consultants (Massachusetts v. Purdue, 2019).

Outcomes

The campaign’s success can be measured by the sales of the drug and the market composition following the campaign. Purdue Pharma’s sales of OxyContin increased by almost 10 times between 1997 and 2002, and, by 1999, patients with non–cancer-related pain accounted for 86% of the total opioid market (Van Zee, 2009).

Evaluation

Purdue Pharma’s campaign helped them achieve their goal of increasing opioid sales, as evidenced by the outcomes. From a PR perspective, the campaign was successful because they set their objective for expanding their market, researched their audiences (high-prescribing doctors, civic groups needing funding, agreeable universities), built relationships with stakeholders, used opinion leaders, and ultimately changed the narrative about their product.

Consequences

In 2007, Purdue Pharma pleaded guilty for “misbranding” OxyContin (Meier, 2018) and, in 2020, made a settlement of $8.3 billion in a case with the US Department of Justice for their role in the opioid crisis. The company has stopped its practice of promoting sales through sales representatives (Purdue Pharma, n.d.).

Key Learning Points

What PR professionals can learn from this case study is the power of strategically funding and recruiting opinion leaders to spread a message. Critically, Purdue Pharma used a variety of opinion leaders who would be trusted by the government, the medical community, and the general public, which increased the credibility of their message. The audience is naturally skeptical of the message when delivered by an entity that stands to benefit from the audience believing it. However, opinion leaders who are perceived to be impartial are interpreted as being genuine and trustworthy, thereby making the audience more likely to accept the message.

However, this takeaway needs to be qualified by emphasizing that Purdue’s success was largely achieved by deliberately misinforming their audiences and using aggressive and unethical marketing strategies. Purdue succeeded in creating harmful, but lucrative, narratives about opioids and opioid abuse, which have stuck with the public and shaped the opioid crisis for the worse.

While the campaign achieved its goals in the short-term, the ethically problematic behaviour—which should be seen as especially troubling in a field that demands strict adherence to ethical codes—was catastrophic to the company in the long-run.

References

Armstrong, D. (2019). Inside Purdue Pharma’s media playbook: How it planted the opioid “anti-story”. ProPublica. https://www.propublica.org/article/inside-purdue-pharma-media-playbook-how-it-planted-the-opioid-anti-story

Chakradhar, S., & Ross, C. (2019). The history of Oxycontin, told through unsealed Purdue documents. STAT. https://www.statnews.com/2019/12/03/oxycontin-history-told-through-purdue-pharma-documents/

Commonwealth of Massachusetts v. Purdue (2019). First amended complaint and jury demand. https://www.documentcloud.org/documents/5715954-Massachusetts-AGO-Amended-Complaint-2019-01-31

Joseph, A. (2019). ‘A blizzard of prescriptions’: Documents reveal new details about Purdue’s marketing of Oxycontin. STAT. https://www.statnews.com/2019/01/15/massachusetts-purdue-lawsuit-new-details/

Marks J. H. (2020). Lessons from corporate influence in the opioid epidemic: Toward a norm of separation. Journal of Bioethical Inquiry, 17(2), 173–189. https://doi.org/10.1007/s11673-020-09982-x

McCoy, M. S., & Kanter, G. P. (2018). Campaign contributions from political action committees to members of congressional committees responding to the opioid crisis. JAMA, 320(14), 1489–1491. https://doi.org/10.1001/jama.2018.11338

Meier, B. (2018). Origins of an epidemic: Purdue Pharma knew its opioids were widely abused. The New York Times. https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html

Purdue Pharma. (n.d.). Open letter. https://www.purduepharma.com/news-media/perspectives/open-letter/

Van Zee, A. (2009). The promotion and marketing of oxycontin: commercial triumph, public health tragedy. American Journal of Public Health, 99(2), 221–227. https://doi.org/10.2105/AJPH.2007.131714

Willmsen, C. (2019, April 25). How Oxycontin’s maker sought to influence Mass. legislators. WBUR News. https://www.wbur.org/news/2019/04/25/purdue-pharma-state-house-lobbying