When OxyContin was first made available by Purdue Pharma in 1996, it was widely advertised and sold. From $48 million in 1996 to roughly $1.1 billion in 2000, sales increased.
The FDA has little authority to regulate the marketing and promotion of controlled substances under present laws. The FDA’s increased ability to manage and oversee such promotion, along with fundamental changes in how the pharmaceutical industry promotes and markets restricted pharmaceuticals, could have a favourable impact on public health.
The benefits of OxyContin in comparison to other opioid formulations on the market were not what determined its economic success. In 2001, the Medical Letter on Drugs and Therapeutics came to the conclusion that oxycodone did not have any advantages over other powerful opioids taken in the proper dosage. Randomised double-blind studies compared the efficacy and safety of OxyContin administered every 12 hours to immediate-release oxycodone given four times daily for the treatment of cancer-related pain and chronic back pain.
Studies comparing OxyContin to controlled-release morphine for pain associated with cancer also revealed comparable efficacy and safety.
A recent trend in the liberalisation of the use of opioids in the treatment of pain, particularly for chronic non-cancer pain, coincided with the promotion and marketing of OxyContin. To encourage the use of opioids in general and OxyContin in particular, Purdue ran a “aggressive” marketing. The corporation invested $200 million in a variety of marketing and promotion strategies for OxyContin in just 2001.
The utilisation of sophisticated marketing data to affect physicians’ prescribing was one of the pillars of Purdue’s marketing strategy. In an effort to change doctors’ prescribing practises, drug companies build prescriber profiles on specific doctors that describe the prescribing tendencies of doctors countrywide. A pharmaceutical business can use these profiles to find the highest and lowest prescribers of specific medications in a given zip code, county, state, or the entire nation.
Targeting the doctors who wrote the most opioid prescriptions nationwide was a key component of Purdue’s marketing strategy for OxyContin. The resulting database would make it easier to find doctors who treat a lot of people with chronic pain.
In 2001, annual incentives ranged from $15,000 to approximately $240,000, with an average of $71,500 added to the average $55,000 annual income of sales representatives. In that year, Purdue gave its salespeople incentive bonuses of $40 million.
Purdue expanded their internal sales team from 318 to 671 sales people between 1996 and 2000, as well as its overall physician call list from roughly 33,400 to 44,500 to roughly 70,500 to 94,000 physicians. Purdue used a patient beginning coupon scheme for OxyContin through the sales representatives, which gave patients a free, temporary prescription for a 7–30 day supply.
According to the Drug Enforcement Administration, the delivery of branded promotional goods to medical personnel, including OxyContin fishing hats, stuffed animals, and music CDs, was unprecedented for a schedule II narcotic.
Purdue encouraged primary care doctors to prescribe opioids more liberally, especially sustained-release opioids. In 2003, over half of all doctors who prescribed OxyContin were in the primary care setting, as they started using the drug more frequently. Some experts expressed worry that primary care doctors had appropriate training in addiction treatment or pain management. Primary care doctors had the least time for examination and follow-up of patients with complicated chronic pain, especially in a managed care system with time limitations.
The market for non-cancer-related pain made up 86% of the overall opioid market in 1999, making it significantly larger than the market for pain caused by cancer. In contrast to the nearly tenfold increase in prescriptions for OxyContin for cancer-related pain during the same period, Purdue’s promotion of OxyContin for the treatment of non-cancer-related pain led to a nearly fourfold increase in prescriptions for this type of pain, from about 670,000 in 1997 to about 6.2 million in 2002.