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Wednesday, October 17 Business

Purdue shift in opioid marketing garners mixed responses

STAMFORD — Doctors and public officials have welcomed OxyContin maker Purdue Pharma’s announcement that it is ending opioid marketing to medical professionals, but they warn further measures will be needed to combat the opioid crisis.

“They certainly have come to the table late in making this decision, but better late than never,” said Dr. Jeff Gordon, immediate past president of the Connecticut State Medical Society and a specialist in cancer-pain management. “It’s fine to decrease marketing, but you really want them to put their money where their mouth is and work more strongly with everyone. Actions will speak louder than words.”

The new strategy cuts the Stamford-based company’s salesforce by more than 50 percent, to a total of about 200. Remaining sales representatives will focus on Symproic, which treats opioid-induced constipation in adult patients with non-cancer chronic pain, and other potential non-opioid drugs.

In a letter Monday to prescribers, Purdue framed the decision as one that reflected its “continued efforts to support responsible opioid utilization.” Prescribers’ questions and requests for information about opioids such as OxyContin will now be handled by Purdue’s medical affairs department.

Many medical experts say aggressive — and often misleading — painkiller marketing in recent years by Purdue and other pharmaceutical firms helped catalyze the explosion of opioid abuse. From 1999 to 2016, more than 200,000 people in the U.S. died from overdoses related to prescription opioids, according to the Centers for Disease Control and Prevention. Overdose deaths involving prescription opioids in 2016 totaled five times the toll in 1999, while sales of those drugs quadrupled, the CDC said.

“Purdue's announcement demonstrates how many are now starting to acknowledge the significant role that prescription opioids have played in contributing to the national opioid epidemic,” Dr. Mark Chrostowski, an anesthesiologist at Greenwich Hospital, said in an email. “We now know, without a doubt, that giving opioid as a first-line pain medication is often not best practice, especially for acute pain. There are various non-opioid medications or therapies that should be first line.”

OxyContin, which went on the market in 1996, brings in annual revenues of billions of dollars as Purdue’s top-selling drug.

The company’s annual spending for OxyContin advertising jumped from about $700,000 in 1996 to approximately $4.6 million in 2001, according to a 2003 federal Government Accountability Office report. Powered by the heavy promotion, OxyContin’s annual sales surpassed $1 billion by 2001, making it the most-prescribed brand-name narcotic of its kind in the U.S., the report said.

By 2000, nearly 700 Purdue sales representatives had a total call list of approximately 70,500 to 94,000 physicians, according to the report. At that time, each representative was expected to make about 35 physician calls per week and typically called on each physician every three to four weeks.

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In its most-severe penalty to date for marketing violations, Purdue pleaded guilty in federal court in 2007 to illegally misbranding OxyContin to mislead and defraud physicians and patients. The company agreed to pay some $600 million in criminal and civil penalties and other payments. At the same time, three executives pleaded guilty, as individuals, to misbranding and incurred close to $35 million in fines. None of the three currently works for the company.

Tackling the crisis

Amid the marketing changes, Purdue remains the target of an ever-growing list of lawsuits from cities, counties and states from around the country for alleged deceptive marketing of its opioids.

Ohio Attorney Gen. Mike DeWine, who sued the company last year, said in a statement Sunday that Purdue’s announcement represented a “victory for everyone” and that he was “happy they are stopping the lies.”

But he also described the change as “too little, too late” and a move that should have been made years ago by Purdue and other opioid makers. Their actions had “fundamentally changed the prescribing culture of doctors,” led to tens of thousands of deaths and cost the country billions of dollars, he said.

“If they are truly serious about this, they could lead the way in cleaning up the mess they created and pay their fair share to fund desperately needed treatment, prevention education, naloxone, and expansion of the foster care system,” DeWine said. “They have an obligation to now re-educate the American public and the medical community about the real dangers of these drugs.”

Purdue officials counter that the company has sought for years to take on the epidemic of opioid abuse.

Among its initiatives, Purdue said it has directed prescribers for the past two years to the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain. The company said it has also referred prescribers to an open letter from Dr. Vivek Murthy, published when he was the U.S. surgeon general, urging medical professionals to join him in efforts to mitigate the crisis.

“Purdue's decision is important, but it alone will not be enough to significantly alter practitioner prescribing patterns,” Chrostowski said. “Prescribers need more education about the national opioid epidemic and the role of prescription opioids. They also need to become aware of all the other non-opioid regimens that are available. Without this knowledge, any change in prescribing patters will not be as significant as it should be.”

pschott@scni.com; 203-964-2236; twitter: @paulschott

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