Purdue records detail push to create addicts

The marching orders for Purdue Pharma’s 87 Tennessee opioid marketers from their bosses each day were simple: “Sell hope in a bottle” and “always be closing,” newly revealed internal records show.

A lawsuit unsealed this week in Knox County Circuit Court filed on behalf of Tennessee taxpayers accuses Purdue Pharma — a family-owned firm that has turned OxyContin into a Forbes-rating fortune — of intentionally fueling the opioid epidemic that has claimed thousands of lives.

The lawsuit, filed by Tennessee Attorney General Herbert H. Slatery III, uses Purdue’s own company records and its staffers’ own words to show the firm’s founders and executives pushed medical providers to prescribe increasingly high doses of OxyContin for longer periods — even after Purdue promised the state it would stop.

It lays bare a marketing campaign that was highly regimented and highly profitable, built upon a foundation of lies and trickery, and specifically targeted Tennessee’s most vulnerable medical providers and patients, including the elderly and veterans.

‘We sell hope in a bottle’

“Purdue summarized the marketing for its opioid products with the tagline, ‘We sell hope in a bottle’ in one of the company’s hiring guides for incoming marketing employees,” the lawsuit revealed.

Purdue employed as many as 87 sales representatives in Tennessee for the past decade. None were medical professionals. All, though, were aggressive marketers — trained, records show, to treat the deadly opioid like real estate.

“Purdue trained its sales representatives to be aggressive in sales calls with providers,” the lawsuit stated. “Tennessee sales representatives were expressly trained to ‘ABC,’ — ‘Always be closing’ — a well-known phrase from ‘Glengarry Glen Ross,’ a play and movie about highly aggressive salesmen who use deceptive tactics to sell undesirable real estate at inflated prices.”

Purdue told its sales staffers to target medical providers who were overworked, serving poor communities in Tennessee and had less training, calling them “high value prescribers” who could be easily persuaded to increase prescriptions and dosages of OxyContin.

Purdue Pharma released a statement Friday saying, “We share the Attorney General’s concern about the opioid crisis. We are disappointed, however, that in the midst of good faith negotiations with many states, Tennessee has decided to pursue a costly and protracted litigation process. While our opioid medicines account for less than 2 percent of total prescriptions, we will continue to work collaboratively with the states toward bringing meaningful solutions to address this public health challenge.”

“We vigorously deny the state’s allegations. The Attorney General claims Purdue acted improperly by communicating with prescribers about scientific and medical information that FDA has expressly considered and continues to approve. We believe it is inappropriate for the state to substitute its judgment for the judgment of the regulatory, scientific and medical experts at FDA.”

‘Follow the money’

The firm’s literature — obtained by Slatery’s office as part of a 2007 lawsuit settlement the state now alleges Purdue violated — shows staffers were told it was a “strategic imperative” to target primary care, family practices and clinics employing nurse practitioners and physician assistants.

“Follow the money,” one “call note” from a sales representative stated.

Assume the doctor “does not know med,” another read.

The strategy, the lawsuit alleges, worked.

“Between January 2007 and August 2017, these providers prescribed 65 percent of all OxyContin tablets in Tennessee,” the lawsuit stated.

Sales staffers’ bonuses were tied to how well they pushed “super core” providers — the Tennessee prescribers handing out OxyContin prescriptions at a rate guaranteed to cause fatal overdoses — to keep pushing the drug on their patients.

The firm even had a “toppers club” for sales staffers who pushed the most OxyContin, awarding them trips and cash, the lawsuit stated.

“Purdue expressly told its sales representatives to focus on physicians who would give the best return on investment and high potential prescribers,” the lawsuit stated.

‘Buy-in’

Sales staffers were trained to position themselves as medical experts and then supply providers with carefully scripted lies about the addictive and deadly properties of OxyContin, the internal records show.

“Do (providers) believe (in) me on info?” one sales staffer wrote. “Buy-in … (Provider) buys me first.”

Purdue sales representatives made over 300,000 sales calls to medical providers throughout Tennessee in seven years, often in person and always bringing literature from fake advocacy groups touting the safety of opioids and labeling the growing opioid epidemic as “pseudoaddiction” that would level off if providers simply prescribed more OxyContin.

Sales staffers were trained to teach providers that the best way to keep patients from addiction was “to actually prescribe more and higher doses” until the “symptoms” of addiction went away, the lawsuit stated.

‘Unlikely to become addicted’

At the same time Purdue staffers were lying to medical providers, corporate executives and even family members of company founders were using OxyContin profits to pay doctors to give lectures, intentionally lying about the opioid’s dangers and addictive properties.

One of those doctors coined the “pseudoaddiction” phrase that became widely accepted as truth in Tennessee and elsewhere, the records showed.

The firm funded the creation of advocacy groups with names such as the American Pain Society and American Pain Foundation, and pamphlets, videos and social media campaigns to convince Tennesseans that OxyContin was a wonder drug — even as the number of fatal overdoses tied to it began to skyrocket.

The firm specifically targeted veterans with a web campaign titled “Exit Wounds,” and called OxyContin the “gold standard” for pain treatment.

“Long experience with opioids shows that people who are not predisposed to addiction are unlikely to become addicted to opioid medications,” veterans were told. “When used correctly, opioid pain medications increase a person’s level of functioning.”

‘Is that a bad thing?’

The lawsuit reveals Purdue’s sales staffers were instructed to ignore police warnings, indictments and overdose deaths involving Tennessee medical providers and to continue to call on them to hand out high-dose OxyContin — the firm’s most profitable brand — so long as they still had prescription pads.

The lawsuit and Purdue’s internal records link the firm’s sales staffers to some of Tennessee’s most notorious pill mill doctors, including one of the largest such operations in East Tennessee.

Purdue staffers called one medical provider, who is not identified in the lawsuit, 48 times — after law enforcement told the firm the provider had prescribed fatal doses of OxyContin and was running a cash-for-pills clinic.

Sales staffers also were ordered to fend off resistance from medical providers leery of prescribing OxyContin, call notes showed.

When a “Knoxville-area pain medicine specialist” told a sales staffer he didn’t use OxyContin as his “first line” of patient pain care because “he feels once a patient is put on OxyContin, they never will try anything else because they like the drug,” the staffer responded, “Is that a bad thing?”

Another staffer wrote a Dickson pharmacy technician who complained OxyContin was “a bad drug” had to be “corrected,” telling the technician, “Good drug, bad people abusing it.”

Lessons unlearned

The lawsuit spans 272 pages and includes a slew of internal records from Purdue.

Lawsuits are being filed against Purdue and other Big Pharma drugmakers and distributors across the country and in smaller communities, including several in East Tennessee.

But Tennessee’s lawsuit appears to be the first that cites internal records from Purdue.

Tennessee is one of the hardest-hit states in the nation’s opioid epidemic, and one of Purdue’s most profitable.

Tennessee already had sued Purdue a decade ago for failing to police its sales force. Purdue promised to create a program to ensure OxyContin prescriptions went down and over-prescribing medical providers were reported to authorities.

As part of that settlement, Purdue was required to turn over internal documents to the Tennessee attorney general.

The current lawsuit alleges Purdue did nothing to curb the opioid epidemic and, in fact, only grew more aggressive in its marketing tactics. Slatery is now using records generated in the 2007 settlement as a basis for the new lawsuit.

The News Sentinel will be examining the internal records in the coming days for further reporting.