A program to give naloxone overdose-antidote kits and training to front-line officers. Funding for pill disposal boxes in pharmacies, clinics and police stations across North Carolina. A radio campaign in Connecticut warning of the dangers of opioid abuse. A new medicine to treat opioid-induced constipation.
The money behind these efforts to combat the opioid epidemic and its side effects comes from a perhaps unlikely sponsor: Purdue Pharma, the Stamford, Conn.-based company that makes the top-selling opioid, OxyContin.
After years of aggressively promoting OxyContin as a safe and effective way to combat pain, the company is — equally aggressively — recasting itself as a fundamental player in the response to a crisis that many experts say it helped to create. Such efforts come amid hundreds of lawsuits claiming that Purdue fueled the opioid epidemic by deceptively marketing OxyContin, as well as new government efforts to regulate opioids.
In February, Purdue announced that it would stop promoting its opioid drugs to physicians. At the same time, Purdue is looking to partner with other companies and expand its portfolio into areas such as oncology and sleep medicine. OxyContin accounted for more than 94% of Purdue's sales in 2012 and was still over 82% as of last year, according to Symphony Health.
While patient groups and communities have been quick to accept money for programs they could otherwise not afford, families who have lost loved ones to opioids are not easily placated.
When Sue Kruczek heard the Purdue-sponsored radio ad on her local station, warning of the dangers of opioid addiction, she was so appalled that she said she "almost had to pull over."
"It's sickening. It makes me feel sick. I hold Purdue personally responsible for this epidemic," said Kruczek, who lost her son Nick to an opioid overdose in 2013, just a week shy of his 21st birthday. "It's blood money at this point."
Kruczek said she was also unimpressed by the full-page ads Purdue placed in major newspapers in December, touting its "abuse-deterrent" OxyContin formulation and support for the Centers for Disease Control and Prevention guidelines for safe prescribing.
Greg Williams, executive vice president of Facing Addiction, a nonprofit group that advocates for people struggling with addiction, noted that the ads were published just months after a coalition of 41 states' attorneys general subpoenaed records from major opioid manufacturers, including Purdue.
"The timing of this recent blitz is not an accident — they were quiet for a long time," he said of the ads and donations, calling them a tactic to avoid paying more later. "They're spending millions of dollars to do this when they owe billions."
Purdue said it is wrong to blame the company for the opioid crisis, which resulted in 42,000 overdose deaths in 2016. The Council of Economic Advisers estimated that the crisis cost $504 billion in 2015, or 2.8% of GDP.
"Pointing fingers isn't a way to get the resolution we need," Robert Josephson, a spokesman for Purdue, said in an interview. "Pointing to one company and one product that never constituted more than 3.6% of total prescriptions really misses the mark."
The advertisements all end with the phrase: "We want everyone engaged to know you have a partner in Purdue Pharma. This is our fight, too."
Some programs that have benefited from Purdue's donations say they were unaware that the drugmaker had provided the funding — though in the midst of a crisis they were nonetheless grateful.
As part of Purdue's partnership with the National Sheriffs' Assn., the sheriff's department in rural Wood County, Ohio, received about 60 doses of naloxone for officers to carry. So far, the department has used about seven doses to revive people experiencing an overdose.
Sheriff Mark Wasylyshyn said that when he received the kits he was not aware that Purdue had provided the funds. But, he said, it would not have affected his decision to accept them.
"I think whoever wants to do it, it's wonderful," he said. "If they wouldn't have done it, I wouldn't have had it to save those seven lives."
Fred Wells Brason II, president and chief executive of Project Lazarus in North Carolina, which partnered with Purdue to install pill disposal boxes across the state, said the organization had received little pushback for accepting the donation. The drug companies "are not going to go away. We need them, and patients need them. We just want to make sure prescribing is safe and responsible," he said.
Jodi Barber of Orange County, who lost her 19-year-old son to a prescription drug overdose in 2010, made a similar point.
"We need them to be on our side and help us," she said of pharmaceutical companies. "They need to put the money they do earn — the millions and billions of dollars — into recovery, to get people help."
OxyContin sales have been dropping in recent years, to $1.7 billion in 2017 from $2.8 billion in 2012, in part because of competition from generics. Unlike other opioid manufacturers such as Johnson & Johnson, which makes hundreds of products, Purdue is known almost exclusively for its opioid drugs.
That is partly why it is soliciting business partnerships to diversify its portfolio. But one of the first of the new products feels to some like an affront: Acquired through a partnership with Japanese company Shionogi Inc. and approved last year, Symproic is a pill to treat opioid-induced constipation — a common malady of people taking the pain meds. It costs about $350 a month.
Purdue's recent promise to cut half its sales staff and stop marketing OxyContin to physicians altogether is unlikely to have much of an effect, especially since there are already generic versions of the drug, said Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University.
"Once drug companies have generic competition, they often stop promoting anyway," he said, adding that OxyContin is still being marketed aggressively in other countries through Purdue's international arm, called Mundipharma.
Although OxyContin is still protected by a Purdue patent, it is available in multiple generic equivalent forms, sold by generic drug companies with Purdue's permission.
The company's approach is nothing new, said Mike Moore, a former attorney general of Mississippi who is currently consulting on several major cases against Purdue.
"They have had a history of tiny half-steps every time someone begins looking at them," Moore said. In 2002, Moore recalled, Purdue gave Florida $2 million for education and prevention programs to combat opioid abuse. "That's like pennies in a coffee can. It doesn't do anything."
Any global settlement with Purdue and other opioid manufacturers would need to be at least $100 billion to seriously address the opioid crisis, Moore said.
Even as Purdue has cut back its sales force and has been spending on harm reduction, it continues to promote prescribing of opioids.
From 2012 to 2017, for example, Purdue gave $4.15 million in funding to patient advocacy organizations and professional societies such as the Academy of Integrative Pain Management and the American Academy of Pain Medicine, a recent U.S. Senate investigation found. Many of the groups, in turn, issued statements and guidelines that minimized the risk of long-term use of opioids to treat chronic pain, according to the Senate's report.
In 2007, Purdue pleaded guilty in federal court to misleading doctors and patients about OxyContin's risk of addiction and potential for abuse, and agreed to pay $600 million in fines. The period under investigation, however, ended in mid-2001.
Since then, Purdue spokesman Josephson said, Purdue has learned from its mistakes and has an excellent track record. "We as a company have been addressing prescription drug abuse for 15 years," he said.
Thus far, critics note, Purdue's efforts have not included methods that would significantly reduce or limit sales of OxyContin, the company's blockbuster high-dose opioid drug. In statements about opioid misuse, for example, Purdue avoids the term "addiction" and instead focuses on "abuse" of drugs.
"There's a real sense that they're saying, 'We're not the drivers of the problem, the addicts are the drivers of the problem. We're going to try to help, but really it's the addicts and the people trafficking in this illegally that are the problem,'" said W. Timothy Coombs, a professor of crisis communications at Texas A&M University.
Said Adriane Fugh-Berman, who studies pharmaceutical marketing practices at Georgetown University Medical Center: "If they were really sincere, they would be looking for ways to sell fewer opioids. We're not seeing that."