After a 20-year run, is the prescription opioid OxyContin on the way out?
The pharmaceutical company behind the commonly used opioid says it will stop marketing the drug to doctors in the United States.
In a statement last week, Purdue Pharmaceuticals announced, “We have restructured and significantly reduced our commercial operation and will no longer be promoting opioids to prescribers.”
In an email to Healthline, Purdue officials said they have been directing providers for the past two years to the guidelines from the Centers for Disease Control and Prevention (CDC) on prescribing opioids for chronic pain.
Among those guidelines is the emphasis that opioids aren’t routine therapy for chronic pain and a recommendation that extended relief or long-lasting opioids shouldn’t be prescribed for acute pain.
In addition, Purdue executives are also pointing providers toward the Surgeon General’s Turn the Tide Rx guidelines.
The policy change is causing the layoff of 200 employees, roughly half of Purdue’s U.S. salesforce.
Purdue’s announcement comes at a time when OxyContin is also proving less profitable.
According to Bloomberg, the drug generated $1.8 billion in sales for the company in 2017, significantly down from $2.8 billion five years earlier.
Part of the decline is attributed to the emergence of generic drugs.
All this might give credence to the notion that OxyContin’s star is fading quickly.
However, experts say it’s too early to tell what impact the change in Purdue’s marketing strategy will have.
After all, the company isn’t going to stop selling OxyContin.
Pharma’s role in the opioid crisis
The Purdue announcement comes amid intense scrutiny on the pharmaceutical industry’s role in the United States opioid epidemic, which reportedly claimed the lives of 64,000 people in 2016.
Experts anticipate those numbers will increase when 2017 mortality rates are announced.
Many critics have attributed the beginning of the current epidemic to the introduction of OxyContin in 1995. The opioid has reportedly brought in $35 billion in revenue for Purdue since then.
Oxycodone, the sole active ingredient in OxyContin, is a semisynthetic opioid first introduced in 1917. So while the drug itself wasn’t novel, by all accounts the manner in which it was marketed to doctors was.
“If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative at Brandeis University, recently told The New Yorker.
According to an investigation by the Los Angeles Times, Purdue spent $207 million to launch the drug and doubled its sales department to 600 people. The company touted the drug’s ability to provide 12 hours of pain relief with easy two-dose-per-day instructions.
The L.A. Times investigation concluded that those claims were inaccurate and led to addiction and abuse of the drug.
About 7 million Americans have abused OxyContin in the past 20 years, according to the National Survey on Drug Use and Health.
Now, as the opioid epidemic continues, the question is whether Purdue’s recent announcement is “too little, too late.”
Purdue in particular has been in the crosshairs of litigators.
The company paid out $600 million a decade ago when executives of the company pleaded guilty to charges of misleading the public about the dangers and addiction risk of OxyContin. Since then, more lawsuits have followed.
A nationwide lawsuit against the company, including seven cities in Maine, a state hit hard by the opioid epidemic, is ongoing. Earlier this month the state of Alabama initiated a lawsuit against the company for deceptive marketing practices.
“It will take years to undo the damage but an important first step we must take is to hold the parties responsible for this epidemic legally liable for the destruction they have unleashed upon our citizens,” Alabama Attorney General Steve Marshall said in a statement.
However, others are leery of casting so much blame on the pharmaceutical industry as a whole.
“Our time isn’t well spent trying to figure out who is to blame and who is trying to save face at this point because a lot of that is going on right now,” Dr. Patrick Marshalek, an associate professor in addiction services at West Virginia University, told Healthline. “I think it draws attention away from the problem.”
For its part, Purdue has championed itself for attempting to fight back against OxyContin abuse.
“As we continue to fight the prescription opioid and illicit substance abuse crisis, we are applying our resources and our best scientific minds to discover and develop new, non-opioid pain medicines for patients,” the company said in an open letter.
In 2010, Purdue introduce a new formulation of OxyContin that the U.S. Food and Drug Administration (FDA) approved of as an “abuse deterrent.” When crushed, the pills no longer turned into a powder, but a gummy substance, making them harder to snort and inject.
What is most problematic about the opioid epidemic is that the drugs now running rampant in drug cabinets across the country actually serve a purpose.
As painkillers, they do their job exceedingly well.
For those suffering from severe or chronic pain, including those living with cancer, opioids may be the only solution at the moment.
But, according to Marshalek, doctors often must walk a tightrope in their prescribing behavior that balances between the benefits and risks of novel and potent drugs.
“I’m worrying more about the busy clinician that’s trying to do what’s right,” he said.
“One thing we can learn from the previous marketing of opioids is the fact that they were marketed as being safer than they actually were,” said Marshalek, “Marketing can go a long way to doing good or bad.”
Everyone is part of the solution
Marshalek says the solution to the opioid crisis must be undertaken by all parties involved, from Purdue on down to patients.
“Everyone could potentially help with solutions. If everyone was a problem to some extent, from the drug makers to the distributors and wholesalers, the pharmacies, the doctors, the patients, and so on, then they all hopefully will bear some part in helping this get better,” he said.
He emphasized that clinicians themselves must bear their own responsibility and have “a healthy degree of skepticism” when it comes to medications being marketed to them.
Meanwhile, legislative action has also begun taking effect in different states across the United States. Among the innovations, 17 states, including Maine, have implemented prescribing limits for opioids.
Other policymakers have championed prescription drug monitoring programs. These are databases that track the prescriptions of drugs liable for abuse.
The system is designed to prevent doctor “shopping,” in which a patient may visit multiple doctors to secure opioid prescriptions.
However, these safety systems vary widely from state to state and haven’t been implemented on a national scale.
Some believe that the opioid epidemic may be following in the footsteps of Big Tobacco lawsuits, which culminated in the Master Settlement Agreement in 1998, resulting in the payout of hundreds of billions of dollars.
“There are some excellent similarities [between opioids and tobacco litigation],” James Hodge, JD, a professor of public health law and ethics at Arizona State University, previously told Healthline. “It’s a product that’s been proliferated, that’s extensive, that’s been pushed and marketed.”
“I think what’s happening with opioids is exactly the same thing. We are chipping away at this industry,” he said.