New scrutiny for Purdue donations By Paul Schott

Nonprofit recipients have fought curbs on opioid prescriptions

STAMFORD — OxyContin maker Purdue Pharma ranked as the top donor among a group of five pharmaceutical companies that poured millions of dollars during the past five years into prominent nonprofits supporting large-scale opioid use, according to a new report from U.S. Sen. Claire McCaskill.

The contributions’ size and opacity have compromised the independence of advocacy groups focusing on pain management, the report argues, and may have led to the promotion of polices that helped to stoke the opioid crisis. But many of those nonprofits dispute the study’s findings, saying their policies are not influenced by their funding sources.

“These advocacy organizations’ influence is based upon perceived objectivity and a commitment to scientific knowledge,” said Robert Bird, a professor of business law at the University of Connecticut. “These donations do create tensions for these groups because the donations give the appearance that these organizations could be influenced by Purdue and these other companies.”

In a statement, Stamford-based Purdue neither disputed nor endorsed the report’s findings.

“We have supported thirdparty organizations, including with annual dues and unrestricted grants, that are interested in helping patients receive appropriate care,” the statement said.

The company did not make any executives available for an interview.

Major contributions

Purdue and four other companies — Janssen, Mylan, Depomed and Insys — provided at least $8.86 million in funding to 14 outside groups working on chronic pain and other opioid-related issues between January 2012 and March 2017, according to the “Fueling an Epidemic” report.

With $4.15 million in payments, Purdue accounted for almost half of the companies’ total contributions. The Lenexa, Kan.-based Academy of Integrative Pain Management comprised its largest recipient, receiving about $1.1 million.

The Middletown-based U.S. Pain Foundation ranked as the largest recipient among the 14 nonprofits surveyed in the report, taking in about $2.9 million, including about $359,000 from Purdue.

Since August 2013, the five firms have also given a total of about $1.6 million to individuals such as executives and board members who are affiliated with

the nonprofits.

The data came as part of an investigation by McCaskill’s office into the five companies, which the report said manufactured the five top-selling opioids worldwide in 2015.

“The financial relationships between these groups and opioid manufacturers should be clear to the general public,” McCaskill, the top-ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee, said in a statement. “We passed a law ensuring the public had information on payments to doctors by pharmaceutical companies, and I can’t imagine why the same shouldn’t be done in this space.”

Earlier this month, Purdue announced it would stop marketing opioids to medical professionals.

Concerns about transparency

The report flagged a number of issues with the nonprofits’ disclosure practices. None of them provides an online list linking donors, their specific donations, and the projects or events benefiting from each donation, the study said.

“Transparency is important for both the regulator and the regulated,” Bird said. “The resolution of the opioid crisis should be based on objective science and policies — not because one donor speaks louder than the other.”

The report also cited discrepancies between payment information and data provided by the advocacy groups. Purdue, for instance, failed to report $40,000 in corporate roundtable dues to the American Geriatrics Society Health in Aging Foundation, according to the report.

“If Purdue wants to have a legitimate reputation as a health promotion organization, then it’s in their best interests to be completely transparent moving forward and not have to respond to multiple requests for information in order to give the public the full story,” said Laura Willis, an assistant professor of health and strategic communication at Quinnipiac University.

Undue influence?

Many of the recipients have supported pharmaceutical firms’ promotion of opioids, including by issuing guidelines and policies that minimized the risk of opioid addiction and endorsed narcotics to treat chronic pain, according to the report.

Several groups also lobbied to change laws intended to limit opioid use, strongly criticized 2016 Centers for Disease Control and Prevention guidelines on prescribing opioids and challenged legal efforts to hold physicians and industry executives accountable for overprescribing and misbranding, the report said. In a number of statements, Purdue has said it supports the CDC opioid standards.

A proliferation of painkillers is widely linked to the explosion of opioid abuse in recent years. From 1999 to 2016, more than 200,000 people in the U.S. died from overdoses related to prescription opioids, according to the CDC. Overdose deaths involving prescription opioids in 2016 totaled five times the toll in 1999, while sales of those drugs quadrupled, the CDC said.

Among Purdue’s recipients, the Academy of Integrative Pain Management partnered with the American Cancer Society Cancer Action Network on opioidrelated lobbying in 18 states as of 2016; the advocacy included efforts to block limits on opioid prescribing, according to the report.

AIPM officials disputed the report’s suggestion that corporate donations shaped their policy positions.

“We take great pains to avoid letting the sources of our funding influence our policy efforts,” AIPM Executive Director Bob Twillman said in an email. “We determine our policy advocacy positions on the basis of an annual survey of our members and other stakeholders — i.e., other professional groups and patient advocacy groups, not our funders.”

Purdue’s contributions helped support AIPM’s annual meeting, which included education on pain management, an educational e-newsletter and advocacy for state policies related to an integrative approach to pain management, Twillman said.

U.S. Pain Foundation officials said in a statement they accept funding from pharmaceutical companies to help support their programming but that they do not promote specific treatments or brands. They said they allocated $2.5 million of the $2.9 million they received for a large co-pay assistance program for cancer patients in pain.