Purdue Pharma and the Opioid Epidemic: Writer Barry Meier Unveils OxyContin’s Pivotal Role

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

[Music]

Welcome to C onversations on Healthcare with Mark Masselli and Margaret
Flinter , a weekly show featuring the top thought leaders in health, innovation,
health policy, and the experts, who are shaping the healthcare system of the
future. This week’s guest is Pulitzer Prize winning writer, Barry Meier , a longtime
journalist for the New York Times and one of the first reporters to sound the
alarm on the opioid crisis. Mark and Margaret will talk with him about his new
book Pain Killer: An Empire Of De ceit and the Origin of America's Opioid
Epidemic . Lori Robertson also checks in, the award managing editor of
FactCheck.org . She looks at mis statements spoken about health policy in the
public domain, separating the fake from the facts and at the end with bright idea
highlighting innovations that are improving health and wellbeing in everyday life.
If you have comments, please e - mail us at chcradio @CHC1.com or find us on
Facebook or Twitter , w e love hearing from you . A lso do not forget to leave a
review and subscribe on iTunes or ever you listen to podcast s . Now, we
welcome Pulitzer Prize winning writer, Barry Meier in C onversations on
Healthcare.

Mark Masselli: We are speaking today with Barry Meier , Pulitzer prize winning
longtime reporter for the Ne w York Times and author of Pain Killer An Empire Of
Deceit and the Origin of America's Opioid Epidemic , which is a follow - up to his
2003 book Pain Killer: A “ Wonder ” Drug ’s T rail of A ddiction and D eath. Both of
which examine Purdue Pharma ’s aggressive mar keting of their blockbuster
opioid Oxy condone , while concealing the drug ’ s addiction dangers. Mr. Meier
recently left the New York Times which he joined in 198 9 and prior to that worked
for the Wall Street Journal in New York Newsday . Mr. Meier is a winn er of two
George Polk Awards for excellence in journalism at the intersection of business
and healthcare. Barry, welcome to Conversations on Healthcare.

Barry Meier: Well, thanks for having me on.

Mark Masselli: I just wanted to say reading your book, what a service you have
done to so many millions of American families , who we re just wondering what
happened and powerful in moving investigation into what Purdue Pharma’s role
in this crisis was . B ack into the 1990s , y ou dig deeply into this. You write th at
Oxy condone was not a wonder drug as the company claimed. It was a gateway
st
drug to the most devastating public health disaster in the 21 century and I
wonder if you could just take our listeners back to the beginning of the opioid
crisis and what y ou say was a methodical and illegal marketing campaign by
Purdue Pharma, privately held company, owned by one family , of the Sackler
family that ’s mushroomed into this deadly epidemic that we are grappling with
today .

Barry Meier: W e ’ re in the probably t he greatest public health crisis we face at the
moment with opioids and so , it ’ s very important to understand how it started . It

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

started actually sort of with good intentions, certainly on part of the medical
community. Pain is a pervasive problem. They were stigmas going back into the
late 1980s about using narcotics to treat pain, particularly when it came to even
cancer patients who were suffering terribly at the end of their lives. T here was a
movement by doctors to treat pain more aggressively part icularly at the end of
life and narcotics became principle tool to do so . P urdue Pharma had a drug that
it introduced in the mid 1980s called MS Contin, which was a time release form
of morphine that was used to treat cancer patients s o i t was very succes sful and
very useful for pain specialist to use . T hen as the pain management movement
grew and evolved into the 1990s, there was a thought that opioids have been
very successful in cancer pain treatment. There were millions and millions of
people who suf fered from chronic pain, so why do not we use it to treat other
types of pain ; back pain, arthritis, and Purdue developed OxyContin , which is a
time release form of the drug oxycodone to kind of pit this movement. It sort of
became a drug that became the principle tool for pain management activist , who
wanted to treat pain more broadly.

Margaret Flinter: Well, Barry we look back at the sort of the mid till late 1990s as
the time w hen treating pain as the fifth vital sign began to be a measure of quality
that you were held to in primary care, not just in the world of terminal patients or
hospice patients, but on the frontlines of primary care . T his became a standard
that you could treat pain to zero , which we now know is really kind of an illusion .
W e we re really thinking about how we could do better than we had relatively few
options and, as you say, part of the OxyContin marketing lure was the so - called
long acting effect which made it less prone to abuse . W hat’ s kind of remarkable
of course in retrosp ect is that the company match ed itself the FDA on that notion
which then gave Purdue Pharma a green light to market the drug as less
addictive than other narcotics . I doubt there i s a primary care provider in the
country who does remember the drug salesma n at their door with the peer
reviewed articles and the good housekeeping seal of approval . How were they
were so successful at marketing to the clinical community ? W hat was their
strategy and talk little bit about some of the kind of aggressive tactics that were
used ?

Barry Meier: Sure. What Purdue ’s o w n internal document show is they knew
that to make OxyContin successful to convince the general practitioner , the
family doctor the kind of frontline physician to use this drug they had to overcome
a sp ecific obstacle , and that obstacle wa s a longstanding concern among doctors
that the use of opioids would lead to abuse and addiction in their patients . T he
entire marketing campaign for OxyContin was built around overcoming what in
sales jargon they refe r to as objection s , the doctor would say well, wait a minute ,
I have see n patient s becoming addicted to the se kinds of drugs , so why should I
use this drug ? W hat they did is they took a couple of stu dies that really had
nothing to do with the longterm use of opioid s in pain treatment and portrayed
the se studie s as being supportive of the idea that there would be minimal or no
addiction with the use of OxyContin . T hen basically the FDA's approval of

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

OxyContin , the actual language that was used was that bec ause it was a ti m e
rel ease for m or long - acting form is believe to pose less abuse liability , s o that is
believe w as the language that is might be less prone. What Purdue did is it
basically took this unique claim , one that it had never been given to any d rug
bef or e and ran with it. T hey we re given a gift by the FDA . W hat they did was
they trained their salespeople to basically go out and lie and tell healthcare
professionals that it would produce less abuse and addiction . T here wa s an
internal decision made by this company t o basically deceive doctors and lie to
doctors.

Mark Masselli: Following up on that decei t , it’s hard to imagine how the
company ’s executives and owners ; the Sackler family , got away with t his cover -
up for so long and the f ederal pr osecutors actually had developed a case that
was very prosecutable bu t the Justice Department block this investigation and
so, what happen ed ?

Barry Meier: When I first started investigating Purdue’s marketing of OxyContin
and wrote the original version o f painkiller , Purdue had said we first became
aware of OxyContin ’ s growing abuse in early 2000. W h en I was originally
researching painkiller , I went back and I discovered articles in small town
newspapers about OxyContin abuse . A pattern began to form wh ich suggested
to me that this claim that they only became aware of th is in early 2000 was not
true , but could I do , I was just a reporter , I did not have subpoena power . Lo and
behold a year ago or so I received the report that was put together by the f ed eral
prosecutors who began investigating Purdue in late 2002 until mid 2006 . T hey
had an advantage to that I didn ’ t have , which was they ha d subpoena power and
they could go through all of Purdue’s documents , records , they could bring
people before grand jury . W hat these investigators concluded , there was no
doubt in their m ind that Purdue k new about the drugs abuse almost immediately
after it appeared on the market and that what the company and the se executives
did was engaging was essentially a corporat e cover - up .

I was shocked and stunned by the details a nd depth of the evidence that these
prosecutors had uncovered . T he three top operating executives of Purdue, they
had acted in such a fashion that they warranted being indicted on very serious
felony charges , and th is report ha d the support at least within the mid - levels of
the Justice Department . W hen it got up to the political levels to the h eads of the
Justice Department who had been appointed by the George W. Bush
administration , t hey essentially sh o t this down . I mean it was extraordinary to me
that folks who had powerful defense lawyers like Rudy Giuliani were basically
treated differently . I thought it was very important to bring these facts to li ght
because I think i t ’ s really vital as we go forward in dealing with t his epidemic that
anyone who is suspected of breaking the law , jeopardizing the public ’s health be
dealt with the same level of justice tha t any other American would face.

Margaret Flinter: Well, I think we ca n’t talk about the s tory with out talking about

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

the devastating tol l that the opioid epidemic has taken across the United States .
OxyContin alon e can be blamed for quarter of million deaths in this country and
that ’s just a fraction when you extra p olate it out to all the deat hs caused by
related conditions and particularly by the arrival of cheap synthetic narcotics like
fentanyl, which is cheaper , but far more lethal . Your reporting has put us into in
direct contact with the worst outcomes of the crisis and I think it would be a value
to our listeners for you to talk a bit about what it looks like on the ground .

Barry Meier: A public health crisis of epic proportion s, when I first started
reporting on this almost 20 years ago , I was stunned by the number of deaths
that ther e were . I was stunned by the social and public health chaos that one
drug alone OxyContin was creat in g. I mean I thought I exposed the problems
with th is drug and its marketing may b e th is whole thing is going to go a way. I
was like incredibly naïve, th e number of deaths has quadrupled . A s you
mention ed , we now have these counterfeit and illicit and unbelievably deadly
forms of fentanyl that have appeared on the market s. E ssentially we ’ re dealing
with a hydra , we’re dealing with a problem that has many causes that's going to
require many different kinds of solutions from corporate leaders t o community
leaders to law enforcement officials , o ne of the places though , however we do
need to focus on what may be the easiest part of problem and th en i t’ s a
que stion of how pain is treated . W e have to make more types of pain treatment
available, not simply opioid s , I mean this -- we ’ve been sort of pushed into this
method of pain treatment b y the profit motive s both the pharmaceutical industry
and the insurance industry so w e have to start looking at alternative pain
treatments . T hen we also have to look at addiction treatments , giving them other
supportive measures that will help them deal with and hopefully overcome their
addiction . I think w e need to focus o ur treatments , the people who are addicted
to the se drugs and the people who are affected with pain a s compassionately as
possible .

Mark Masselli: We are speaking today with Barry Meier, longtime New York
Times reporter, winner of the Pulitzer Prize and author of Pain Killer: An Empire
o f Deceit and the Origin s of America's Opioid Epidemic . Barry, a number of
States’ attorney generals have since filed class action suits against Purdue
Pharma’s executives and company o wners. Massachusetts level ed new cha r ge s
right after the release of your book and I am wondering if you could share with
our listeners w hat further legal challenges the compan y is facing .

Barry Meier: As state would have it I cover ed with the tobacco cases for the New
York Times back in th e early 2000.

Margaret Flinter: Good, excellent training .

Mark Masselli: Yeah .

Barry Meier: W ell, I ’ve seen this play a lot. I ’ve covered a lot of stories and

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

[inaudible 00: 13:30 ] kind of rushing into the bridge , settling case s. We ’ ve seen
this pla y out actually before with OxyContin because there were a slew of
lawsuits filed against Purdue Pharma 15 years ago that were quickly resolved .
They were s tate cases that were filed against Purdue Pharma that were quickly
resolved and settled. M aybe , it ’ s just a function of getting older and grouchier but
I think we need the truth to come out and I think it should be our guiding principle
going forward. Let’s not take the easy money, let’s force these companies to
disclose everything they knew , let's fin d out once and for all what the Sackler
family knew a bout marketing of this drug and the reports of abuse of OxyContin.
When I received th is Justice Department report that have been written a decade
ago ; that report contained the first concrete evidence t hat members of the
Sackler family were told about abuse both of OxyContin and i t s predecessor drug
MS Contin.

W e need to know what these companies knew . If we are going to see k
compensation for people who were affected by these drugs , I think we first ne ed
to know the depth of knowledge that both the company and the Sackler family
had. There ’s already been articles in The Times and elsewhere about how th is
judge in Ohio wants to resolve this case right away . Let’s not rush ther e ,
because those kind s of settlements really just enrich lawyers. I think a s a society
we have been so devastated by this epidemic we really owe it to ourselves to
know w ho knew what and when the y k new it.

Margaret Flinter: W e are seeing a decline in the number of prescriptions being
written for these drug s and yet at the same time the death toll continues to rise .
T he healthcare system remains pretty under - resourced to handle th e she er
magnitude of this public health crisis and the complexities of treating and
managing ad d ictio n. W hat more needs to be done ?

Barry Meier: Well, it ’s a question of resources and finances and underlying that I
believe it ’s also the issue of what pressure is going to be placed on insurers to
provide treatment services . H ere I see a great role that can be played by
employers , c orporate leaders have an obligation to their employees to make sure
that the health care they provide to their employees is the best possible
healthcare available . I would like to see the major leaders of corporations in this
country say we have employees , who may in fact become addicted and we are
going to insist if you as an in sure r want our business you are going to have to
provide our employees with the best possible service and get them back to w o r k
a s soon as possible .

Mark Masselli: I was thinking about the big tobacco settlements . While there
was a tremendous treasure trove of money t hat was received , many s tates
robbed those dollars that were supposed to go to tobacco cessation programs .
A lso corporate leaders how are servants of shareholders , and I ’ m just wondering
what you're seeing in the shareholder class action arena in terms of holding
people accountable ?

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

Barry Meier: Even speaking about the insurance companies , I mean they for
years would only fund the use of pain pills, if the doctor wanted to send someone
to physical therapy or to alternative forms of pain treatment t hey denied
cover age . I consider that completely unacceptable and they bear tremendous
responsibility for the vast increase in the use of the se pills over the past 20 years.
You have companies and insurers refusing to provide alternative services and
the only way to break that cycle is for a re f r aming of how we treat pain and how
we treat addiction. Addiction is a very , very complicated healt h condition, while
drugs like buprenorphine are very good in reducing cravings that individuals who
are afflicted also need other services as well , psychological counseling ,
behavioral counseling . I n the same way that we try to treat pain with thr owing
pi lls at people , w e can ’t think we a re going to get ourselves out of this addiction
problem by throwing pills at people . W e have to provide them with
comprehensive services and those comprehensive services are costly and we
a re going t o have to make th os e f unds available somehow.

Margaret Flinter: We ’ve been speaking today with Barry Meier, longtime reporter
for the New York Times , Pulitzer Prize winner and the author of Pain Killer: An
Empire o f Deceit and the Origin of America's Opioid Epidemic . Y ou can find the
book online a t barrymeierbooks.com or at your local bookstore and you could
follow him on T witter @BarryMeier. B arry , we want to thank you for your
tenacious reporting on this critically important story and for joining us on
Conversations o n Hea lthcare today .

Barry Meier: It was my great pleasure. Thank you so much.

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Mark Masselli: At Conversations on Healthcare, we want our audience to be
truly to know when it comes to the facts about healthcare reform and policy. Lori
Robertson is an award winning journalist and managing editor of F act C heck.org,
a nonpartisan, nonprofit consumer advocate for voters that aim to reduce the
level of deception in US politics. Lori, what you have got for us this week ?

Lori Robertson: Well, last week, we looked at the decline in opioid prescriptions
over the past 6 or 7 years and we noted that while dispensed prescriptions for
opioids have been declining, total deaths from opioids overdoses have continued
to increase. Let’s take a closer look at those figures . M ore than 42,000 people
died o f ov er doses related to prescription and illicit opioids in 2016, that’s five
times more than in 1999 according to the figures from the CDC and more than
those who died in car accident s in 2016. The CDC ’ s provisiona l numbers for
20 17 show a continued increase in opioid overdose deaths to 4 6, 0 41 for the 12
months ending in October 2017 . The CDC warn s though these numbers include
incomplete data , so the figure is likely hi gher. The continued increase has bee n
driven by illicit opioid use including heroin and synthetic opioids. As dispensed

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

prescriptions declined, the rise in yearly deaths related to prescription opioids
slowed . B etween 2 0 1 1 and 2015 , the number was relatively sta ble ; however ,
over dose deaths from il licit opioid s nearly tripled in th at same time period . The
NAS report said “ driven in part by a growing number of people whose use began
with prescription opioids.” Fentanyl, which is a prescription opioid , but can be
manufactured illegally is 50 to 100 times more potent than morphine. To be
clear, it's often difficult to pinpoint which dr ug caused fatal overdose because
people who have died often test positive for multiple drugs, that’s why expert say
deaths are opioid related a nd that’s my fact check f or this week . I'm Lori
Robertson's , Managing Editor of F act C heck.org.

[Music]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the Univ ersity of Pennsylvania. If you ha ve a fact that you ’d like
checked, e - mail us at www.chcradio.com , we’ll have FactCheck.org’s Lori
Robertson ; check it out for you here on Conversations on Healthcare.

[Music]

Mark Masselli: Each week, C onversations high lights a bright idea about how to
make wellness a part of our communities and to everyday lives. Currently some
30 million Americans have type 2 diabetes and that number is expected to climb
substantially in the coming decades . P atients who a re newly dia gnosed often
find it difficult to process the behavioral change required to keep their disease in
check . Amazon and pharmaceutical entity Merck teamed up to launch a
competition for developers to create a tool that would help folks better manage
their dia betes . T he winner, Sugar Pot d eveloped by Seattle - based startup
Wellpepper .

Anne Weiler : The challenge was how do you help someone newly diagnosed
with type 2 diabetes and we already had interactive care plans for people with
type 2 diabetes. They were mobile and then we thought well sure we can voice
enable those care plans . W e came up with about 20 different ideas and what we
thought that was the most interesting was this integrat ed care plan that included
a device which is a voice - powered scale and foot scanner that looks for diabetic
foot ulcers and we thought th e scale was a nice way of fitting into a routine that
someone already had in their day .

Mark Masselli: CEO, Anne Weiler says they were intrigued by the opportunit y to
incorporate Alex a’s V oice T echnology for coaching purposes along with some
simple technologies that exist .

Anne Weiler : The three components are voice - enabled scale and foot scanner, a
mobile care plan because voice is not always the best interface. Sometimes, you

Purdue Pharma and the Opioid Epidemic - Writer Barry Meier Unveils
OxyContin's Pivotal Role

are at wo rk and you don’t want to be talking to someone about your symptoms
and your side effects and then a voice interaction that could happen with any sort
of Alexa device.

Mark Masselli: Chief technology officer, Mike Van Snellenberg said creating a
user - frien dly interface was important , and they got great feedback from
consumers who said they quickly adapted to their Sugar Pot interface.

Mike Van Snellenberg : You need to have very low touch light - weight interactions
and things that do not interfere with a pe rson’s life and can kind of gently nudge
them in the right direction. I think voice is a great application for that.

Mark Masselli: Their Sugar Pot design is essentially an image scanner placed on
top of a scale with an Alexa speaker while weights are m easured and feet
photographed . Alexa offers suggestions for weight management and other
behaviors that will empower patient s to make lasting behavior changes. Sugar
Pot is simple constructed, Alexa enabled, weight and foot ulcer scanner that
empowers new ly diagnosed diabetes patients to shift their behavior to better
manage their disease, providing a flow of important clinical information for their
providers who can benefit from the real time monitoring of patient health data.
Now, that’s a bright idea.

[Music]

Mark Masselli : You have been listening to Conversations on Healthcare . I am
Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Peace and health.

[Music]

Conversations on Healthcare is recorded at WESU at Wesleyan Uni versity,
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