Painful debate

In their letter,¹ Drs Jovey and Dubin assert that my statement “high prescribers ... were influenced by an intense and sustained pharmaceutical marketing campaign” is unsubstantiated. According to a US government report,² by 2000 Purdue’s OxyContin campaign employed almost 700 full-time sales representatives and a total “call list” of 70 000 to 94 000 physicians.

Sales representatives were directed to focus their efforts on physicians with high rates of opioid prescribing, and they received substantial bonuses for OxyContin prescriptions by doctors on their list. From 1996 to 2002, OxyContin had a speakers’ bureau of 2500 physicians and sponsored more than 20 000 educational programs on pain management.² This campaign was wildly successful; in the United States, OxyContin prescriptions for noncancer pain increased from 670 000 in 1997 to 6.2 million in 2002, accounting for $1 billion in annual sales.

The marketing campaign was based on several simple messages: addiction is rare in pain patients, controlled-release opioids are less addictive than immediate-release opioids, and opioids are much more effective and safer than alternatives. Unfortunately, these messages are not true. In 2007, Purdue pleaded guilty to felony misbranding of OxyContin and was fined $634.5 million.³

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