It was easier for Purdue to infiltrate states with less restrictive prescribing guidelines.
Recent research performed by economists from the University of Pennsylvania, the University of Notre Dame and the RAND Corporation shows Purdue Pharma, the giant pharmaceutical company run by the Sackler family and manufacturer of OxyContin, marketed its addictive product to states with more relaxed prescription regulations. Even as Purdue introduced a ‘new version’ of its opioid painkiller meant to curtail the effects of the original, studies show the invention caused widespread devastation, including an increase in heroin overdoses as well as hepatitis C and other infections.
The published studies, which drew upon unsealed documents from settled lawsuits and investigations involving Purdue Pharma in Florida, West Virginia, and Washington State, discovered OxyContin distribution was twice as high in states where regulations made it easier to market to consumers. Misuse of the drug was also higher.
The studies showed that the company steered away from marketing in states with “triplicate prescription programs” which required prescribers of Schedule II opioids to produce three copies of each prescription, making it harder to maintain profitability. In such programs, the three copies include “one to be retained by them, one by the pharmacy, and one forwarded to a state agency.” Previous studies, reported out by Purdue’s own employees, had shown a vast reduction in the amounts of addictive opioids prescribed in these states – not conducive to the drug company’s margins.
Purdue, amid scrutiny of the harmful effects of OxyContin, discontinued the original formulation of the drug in 2010 and released a replacement aimed at reducing abuse. When crushed, the new formula would not turn into a powder to be snorted or injected easily by addicts. The new pill, however, had the unintended consequence of many turning to heroin instead. The heroin overdose rate more than tripled after the first few years of the drug been introduced, researchers found.
Three economists produced findings in the American Economic Journal: Economic Policy showing the “highest rates of original OxyContin misuse had the largest increases in heroin deaths after reformulation.” They found that “as much as 80 percent of the threefold increase in heroin mortality between 2010 and 2013 could be attributed to the introduction of abuse-deterrent OxyContin.”
Another study in Health Economics contended that “had OxyContin not been reformulated, there would have been 76 percent fewer cases of hepatitis C and 53 percent fewer cases of hepatitis B between 2011 and 2015.” And, a study in Health Affairs found “in states with above-median rates of OxyContin misuse before the new formulation, there was a 222 percent increase in hepatitis C infections after reformulation. But in states with below-median misuse rates, the increase was 75 percent.”
“These results show that efforts to deter misuse of opioids can have unintended, long-term public health consequences,” said David Powell, the Health Affairs study’s lead author and a senior economist at RAND. “As we continue to develop policies to combat the opioid epidemic, we need to be careful that new approaches do not make another public health problem worse.”
“Even with recent advancements in the treatment for hepatitis C, the dramatic increase in infections represents a substantial public health concern that can have tremendous long-term costs if infected people are not identified and treated,” said Rosalie Liccardo Pacula, a study co-author, and co-director of the RAND Opioid Policy Tools and Information Center and the RAND Drug Policy Research Center.
It seems, no matter what efforts were taken, Purdue and the Sacklers contributed to a long-term public health crisis.