Inside Purdue Pharma’s Media Playbook : How It Planted the Opioid “Anti-Story” — ProPublica
In 2004, Purdue Pharma was facing a threat to sales of its blockbuster opioid painkiller OxyContin, which were approaching $2 billion a year. With abuse of the drug on the rise, prosecutors were bringing criminal charges against some doctors for prescribing massive amounts of OxyContin.
That October, an essay ran across the top of The New York Times’ health section under the headline “Doctors Behind Bars: Treating Pain is Now Risky Business.” Its author, Sally Satel, a psychiatrist, argued that law enforcement was overzealous, and that some patients needed large doses of opioids to relieve pain. She described an unnamed colleague who had run a pain service at a university medical center and had a patient who could only get out of bed by taking “staggering” levels of oxycodone, the active ingredient in OxyContin. She also cited a study published in a medical journal showing that OxyContin is rarely the only drug found in autopsies of oxycodone-related deaths.
“When you scratch the surface of someone who is addicted to painkillers, you usually find a seasoned drug abuser with a previous habit involving pills, alcohol, heroin or cocaine,” Satel wrote. “Contrary to media portrayals, the typical OxyContin addict does not start out as a pain patient who fell unwittingly into a drug habit.”
The Times identified Satel as “a resident scholar at the American Enterprise Institute and an unpaid advisory board member for the Substance Abuse and Mental Health Services Administration.” But readers weren’t told about her involvement, and the American Enterprise Institute’s, with Purdue.
Among the connections revealed by emails and documents obtained by ProPublica: Purdue donated $50,000 annually to the institute, which is commonly known as AEI, from 2003 through this year, plus contributions for special events, for a total of more than $800,000. The unnamed doctor in Satel’s article was an employee of Purdue, according to an unpublished draft of the story. The study Satel cited was funded by Purdue and written by Purdue employees and consultants. And, a month before the piece was published, Satel sent a draft to Burt Rosen, Purdue’s Washington lobbyist and vice president of federal policy and legislative affairs, asking him if it “seems imbalanced.”
Purdue’s tactics are reminiscent of the oil and gas industry, which has been accused of promoting misleading science that downplays its impact on climate change, and of big tobacco, which sought to undermine evidence that nicotine is addictive and secondhand smoke is dangerous.
Media spinning was just one prong of Purdue’s strategy to fend off limits on opioid prescribing. It contested hundreds of lawsuits, winning dismissals or settling the cases with a provision that documents remain secret. The company paid leading doctors in the pain field to assure patients that OxyContin was safe. It also funded groups, like the American Pain Foundation, that described themselves as advocates for pain patients. Several of those groups minimized the risk of addiction and fought against efforts to curb opioid use for chronic pain patients.
She has become an influential voice on opioids, addiction and pain treatment. Her writings have been published in The Wall Street Journal, USA Today, The Atlantic, Slate, Health Affairs, Forbes, Politico and elsewhere. She frequently appears on panels, television shows and in newspaper articles as an expert on the opioid crisis and pain prescribing guidelines. “We’ve entered a new era of opiophobia,” she recently told The Washington Post.
Satel has been a resident scholar at the American Enterprise Institute since 2000. Among the notable figures who have spent time at AEI are the late Supreme Court Justice Antonin Scalia and former Trump national security adviser John Bolton. Current fellow Scott Gottlieb returned to AEI this year after serving as commissioner of the U.S. Food and Drug Administration, which approves and regulates prescription drugs like OxyContin.
Purdue said its annual payments of $50,000 to AEI were part of the institute’s corporate program. That program offers corporations the opportunity to “gain access to the leading scholars in the most important policy areas for executive briefings and knowledge sharing,” according to the institute’s website.
Purdue’s counterattack against an ambitious investigative series about OxyContin abuse may have contributed to that drop. An October 2003 series in the Orlando Sentinel, “OxyContin Under Fire,” found that Purdue’s aggressive marketing combined with weak regulation had contributed to “a wave of death and destruction.”
The series, however, was marred by several errors that were detailed in a front-page correction nearly four months later. The reporter resigned, and two editors on the series were reassigned. While acknowledging the mistakes, the newspaper did not retract the series, and its review upheld the conclusion that oxycodone was involved in a large number of the overdoses in Florida.
Dezenhall Resources, in an email, took credit for forcing the newspaper to issue the corrections. “Dezenhall’s efforts resulted in a complete front-page retraction of the erroneous 5-day, 19-part, front-page Orlando Sentinel series,” Hershow wrote in a 2006 email summarizing Dezenhall’s work for Purdue under the subject line “Success in Fighting Negative Coverage.”
Purdue officials and the company’s public relations agencies came up with a 13-point plan to generate media coverage of the errors. It included getting a doctor to talk about how the series “frightened and mislead (sic) the people of Florida” and having a pain patient write a newspaper opinion column on the subject. The Sentinel series, one Purdue official wrote to other company executives and Dezenhall’s Hershow, was an opportunity to let the country know about “all of the sensational reporting on OxyContin abuse over the past 4 years. The conclusion: this is the most overblown health story in the last decade!”
In the six years after Purdue challenged the Sentinel’s findings, the death rate from prescription drugs increased 84.2% in Florida. The biggest rise, 264.6%, came from deaths involving oxycodone. The state became a hotbed for inappropriate opioid prescribing as unscrupulous pain clinics attracted out of state drug seekers. The route traveled by many from small towns in Appalachia to the Florida clinics was nicknamed the “Oxycontin Express.”
In 2017, 14 years after the Sentinel series was published, the Columbia Journalism Review described it as “right too soon” and said it “eerily prefigured today’s opioid epidemic.”
Purdue also added Stu Loeser to its stable. The head of an eponymous media strategy company, Loeser was press secretary for Michael Bloomberg when he was mayor of New York City, and he is now a spokesman for Bloomberg’s possible presidential bid.
Soon after Loeser began representing Purdue, Satel wrote in a 2018 piece for Politico headlined, “The Myth of What’s Driving the Opioid Crisis,” about “a false narrative” that the opioid epidemic “is driven by patients becoming addicted to doctor-prescribed opioids.”
Loeser told Purdue executives in an email that “we are going to work with AEI to ‘promote’ this so it comes across as what it is: their thoughtful response to other writing.” His team was working to target the Satel story “to land in social media feeds of people who have searched for opioid issues and potentially even people who have read specific stories online,” he added.
Loeser said in an interview that he didn’t end up working with AEI to promote the story. He said Purdue is no longer a client.
Une belle bande d’ordures accoquinée avec une brochette de journaux peu regardants (quoique parmi les meilleurs du monde, ce qui est encore plus inquiétant).