When OxyContin entered the market, it seemed almost too good to be true, and for valid reasons. Purdue Pharma, the pharmaceutical company behind the drug, marketed OxyContin as the world’s first “non-addictive” opioid for severe and moderate pain. Prescribing opioids for moderate pain was uncommon for physicians, making it a tough sell. Typically, opioids were reserved for post-surgical pain or patients with terminal illnesses like cancer.
OxyContin’s pill bottle label read, “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” Essentially, the label suggested that because the drug released its effects over a 12-hour period, it had a lower potential for abuse. Armed with this claim, Purdue Pharma deployed sales representatives nationwide, enticing physicians with kickbacks and false assurances regarding addiction risks.2
As OxyContin prescriptions surged, so did overdose rates. In 2003, the Food and Drug Administration (FDA) cautioned Purdue Pharma about their deceptive advertising.1 The company continued to market the drug so aggressively that even federal prosecutors started to take notice. In 2007, Purdue Pharma faced a court trial focused on their unethical marketing tactics, exposing how their sales team downplayed the drug’s addiction risks to convince physicians to prescribe it. At that time, OxyContin’s primary selling point was its purportedly “less than one percent addictive” nature compared to other opioids, despite lacking substantial evidence to support this claim.2 Purdue Pharma pleaded guilty to intentional fraud and deception and agreed to pay fines exceeding $634 million.3
While the lawsuit shed light on Purdue Pharma’s actions, the OxyContin crisis quickly escalated into an epidemic, claiming the lives of hundreds of thousands in the United States alone. Even after the guilty verdict, opioid prescriptions continued to rise alarmingly, coinciding with a peak in heroin overdoses around 2011. In 2016, fentanyl, a highly potent fully synthetic opioid, surpassed heroin overdoses.4 Unlike heroin, fentanyl can be legally prescribed by doctors, but its strength makes it prone to abuse. Illicit versions of fentanyl have often been mixed with street drugs, leading to fatal overdoses in unsuspecting individuals.
By 2017, the opioid crisis was officially recognized as a public health emergency, with over 140 Americans dying from opioid overdoses every day.5 In 2020, Purdue Pharma finally accepted responsibility for the epidemic after filing for bankruptcy the previous year. They pleaded guilty to three felonies and agreed to a settlement requiring them to pay fines exceeding $8 billion. Among the charges, Purdue Pharma admitted to violating an anti-kickback agreement between 2009 and at least 2017, paying doctors to prescribe their opioid products. The company also acknowledged obstructing efforts to combat the opioid epidemic by knowingly marketing their drugs to healthcare providers who sold them on the black market.6
In 2020, during the COVID-19 pandemic, more than 48,006 individuals experienced opioid overdoses.7It is too early to determine if the pandemic directly contributed to increased overdoses, but the closure of resources and social distancing measures likely impacted treatment accessibility by limiting in-person visits. Efforts to address these challenges have brought positive changes to addiction treatment delivery. For instance, methadone, which previously required frequent in-person visits at federally-certified opioid treatment programs, can now be taken home unsupervised due to relaxed rules during the pandemic.8 This change has benefited individuals affected by stay-at-home ordinances, providing them with greater access to life-saving medications and helping to reduce the death toll associated with the opioid epidemic.
1 Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse | FDA
2 The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy
3 OxyContin Addiction Case Yields Millions in Fines : NPR
4 Drug Overdose Death Statistics : Opioids, Fentanyl & More
5 Trump Administration Declares Opioid Crisis A Public Health Emergency : NPR
6 Justice Department Announces Global Resolution of Criminal and Civil Investigations with Opioid Manufacturer Purdue Pharma and Civil Settlement with Members of the Sackler Family | OPA | Department of Justice
7 Opioid Crisis Statistics : Prescription Opioid Abuse
8 The Opioid Epidemic During the COVID-19 Pandemic | Addiction Medicine