The New Yorker Radio Hour - How OxyContin Was Sold to the Masses

Episode Date: April 2, 2019

Patrick Radden Keefe has reported on the Sackler family and their control of Purdue Pharma, the maker of OxyContin. Among the sources for his article “Empire of Pain” was a whistle-blower named Steven May, a former sales rep who joined Purdue during the heyday of OxyContin. In an interview for the New Yorker Radio Hour, May details how the company flooded the market with a powerful painkiller that it deceptively touted as being nearly as safe as Tylenol. Plus, two beloved cartoonists—Roz Chast and Liana Finck—talk shop. New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

From One World Trade Center in Manhattan, this is the New Yorker Radio Hour, a co-production of the New Yorker and WNYC Studios. Welcome to The New Yorker Radio Hour. I'm David Remnick. Go to any of the great museums of the world, and you'll notice the name of the Sackler family. The Sacklers have donated museum wings, whole museums even, and they've funded cancer research, medical schools, a long list of things. But in recent weeks, some of these institutions have said that they are no. longer taking donations from the Sacklers. That's because members of the Sackler family own Purdue Pharma, the maker of OxyContin. Oxicontin was first advertised as a breakthrough, an opioid that would manage pain better and would actually reduce the potential for drug addiction.

Two decades later, I hardly need to tell you, OxyContin is a name that's become infamous as one of the drivers of an opioid epidemic that has now cost over 200,000 lives. dozens of lawsuits have been filed. Just last week, Purdue Pharma settled with the state of Oklahoma for $270 million in damages. The New Yorker's Patrick Radden-Keefe has reported extensively on the company, and one of the people he spoke to was a former sales rep, a whistleblower who saw deep problems with Purdue's marketing of the drug. Stephen May started there in 1999 as sales of OxyContin were booming. Patrick spoke with him in 2017. Tell me, for starters, how did you, how did you first come to get into pharmaceutical sales? Well, actually, I actually had a neighbor

that lived near me back in the late 90s, who was a pharmaceutical sales representative, and I saw that he had a really successful career, and, you know, it was something that I personally wanted to get into. I mean, I knew. that the economic benefit was pretty good. So he helped me to get in with his company, which I did in 1998, and started working for a company that actually sold a combination opioid. So I was in the market of produce. I was very familiar with the Oxycontin product before even joining Purdue and knowing

the growth that they were having when there was an opportunity to join, you know, what was perceived to be the best company to work for in the industry. I basically jumped at it. And where were you exactly? Like, what region were you in? I was basically covering southwestern Virginia and parts of southern West Virginia. I see. And were there, there were certain kind of marketing, I know that in some of the early marketing campaigns, what they would say is that Oxycontin was the drug to start with and to stay with. Did you hear that when you were there? Oh, I use that quite frequently. Yeah, start with and stay with.

So basically, the idea is this. You've got a physician that is prescribing a lot of Lord Tab or Vicon, and those are the combination opiates with hydrocodone or percocet or oxycodone that the patient is taking every four to six hours. Well, doctor, if you recognize early on that they're going to have to take an opiate, why not just go ahead and start them on 10 milligrams of oxycontin twice a day instead of getting into that habit forming four or six times a day. So you could start with a low-dose 10 milligrams. If you think about it, 10 milligrams delivered over a period of 12 hours is the same

or even less than if a patient took five milligrams of hydrocodone or percocet every four or six hours. And at the same time, you're not getting that peak and then that trough and then that peak and then that trough. It's basically a much smoother delayed absorption of the product over a period of 12 hours. So that's so fascinating. So actually, part of the sale for you guys was that Oxycontin might be less prone to addiction and abuse than other drugs. Yeah, I think the word that was used more often would be habit forming in that case. I see. You know, it's habit forming to use something every four hours as opposed to 12 hours. Yeah. Though I mean, you can use something every 12 hours and have it be a habit as well. Exactly. But when you were talking to those physicians,

did you get the sense that some of them might be prescribing the drug more frequently, like on a more frequent dosing schedule to their patients? Yeah, I mean, you would have doctors tell you that they were doing that. And what was absolutely crucial as a sales rep to protect your own job, to, you know, is, well, you have to promote the product according to the label. I mean, we're talking about class two medications here. You can get in a lot of trouble. So it was always trying to get the doctor back to, hey, listen, this is a 12-hour drug. I know you said that your patients need to take it, you know, three times a day every eight hours, but it's a 12-hour drug.

That's the way it's supposed to be prescribed. And when they told you that, that in some of the time, you know, you know, that in some of the drug, you instances, maybe the patients needed it three times a day, and they would be prescribing it as that. Did it strike you at all that that's, that if that was what was happening, then the whole kind of marketing thrust that you only needed it twice a day might not actually be true? It's possible, yes. At the same time, we would also instruct the doctor if they're having to take it every eight hours versus every 12 hours, perhaps the patient needs to be titrated upwards on the drug to a higher dose.

I see. And so they would take it just twice a day, but with a higher dose each time. Exactly. Exactly. That would be the appropriate thing to do. Gotcha. I mean, it's interesting.

So you're going in there, you're meeting with doctors, you're showing them literature to support the drug. But you're not a doctor, right? You're not a clinician. How comfortable were you with the science of it? I mean, did you have to kind of prepare in advance

for questions that you might get from the doctors and know what types of answers you would give them? Well, that's part of the training that we go to. I mean, we spend three weeks literally not only learning about the product itself, but you learn about the background of the product. In this case, it was pain management. We learn about the history of pain management. And then you spend a lot of time going through common objectives that the doctors would give you.

What kinds of common objections? Well, I mean, I guess the most common objection that I heard after joining the company was, well, it's just too addictive. I mean, we've got too many problems in our community with, you know, overdose deaths. And so basically, a lot of time was spent trying to overcome the doctor's objections on that and trying to refocus them and saying, you know, yes, there's going to be people out there that are going to abuse or divert the drug. but basically we were trained let's focus on treating the legitimate pain patients and if we can focus

on treating those patients then we'll have the outcomes and the doctors will prescribe the products well that's I mean this is another thing I wanted to ask you about is so so you go out there

and the first and biggest objection that you're encountering is well geez you know aren't these things really addictive Did you believe that they weren't? Was the company telling you that they weren't? Were there studies or was there data that you could give to doctors to say, no, actually, you've got it wrong? This isn't addictive?

Well, I mean, early on, one of the biggest things that I would use, I mean, I memorized the specific line in the package insert that was later changed. by the FDA, and that was the delayed absorption of the OxyContin was believed to reduce the abuse liability of the drug. You know, that was one of the things that were trying to express to physicians. Now, I think that worked for a while, but it wasn't very long into my experience with the company that, well, if they crush up the medication, then that kind of destroys the long-acting delivery system. So, well, that argument's out of the door. and snorting them or or injecting them. Melting them, exactly, exactly. So there was ways to get around that.

And eventually, I think the FDA changed the labeling of that. And at some point, we were told that we could no longer use that particular language. So let me understand this. So you get recruited to go work at Purdue Pharma, which has this super elite sales force. It's got this blockbuster product. They're paying better than a lot of a lot of, a lot of, other pharmaceutical companies are. And then you actually get down there on the ground. And it sounds like already there's blowback because in the communities people realize that there's abuse and

addiction. So, I mean, that must have been kind of disillusioning for you, I would think. It was. I mean, I started seeing it early on. One of my experiences was I had, I think at the time, It was a representative who was either the previous national sales rep of the year or they were on track to becoming the national sales representative of the year. So they would come in to help train us, to watch them handle objections from physicians. So we went into a doctor's office in West Virginia and, you know, were pulled aside and advised that a family member of that particular doctor had died over as a result of an overdose of oxycontin. So that was a pretty significant blow that we both had. So I call that the day that it really hit really close to home for me. And, you know.

And what year was that roughly? Oh, that was within a month or two after me joining with the company. In 2000, yeah. And you stayed on for another five years. Yes. So what did you tell yourself? I mean, did you think these were just isolated incidents or? You know, quite frankly, I mean, what do you tell yourself?

I mean, you really believe that you're doing a righteous duty by trying to treat pain, you know, and you're trying to focus, trying to get physicians on using the product for legitimate pain patients to use the product the right way. I mean, that was my personal focus. And at the same time, it was still a good job. company to work for. There was more and more challenges. I think we really, as a company, first started seeing the challenges in West Virginia and southern West Virginia and parts of what anybody calls Appalachia. But you really feel like you're doing something good. And at the same time, you're recognizing that, hey, look, this is a company that I could work for for a long time.

They're going to have other products down the road. So you stay with it for that reason, because there's there's an opportunity for personal growth. I see. And were you feeling pressure from the company to keep growing the territory? Oh, absolutely. I mean, it was, you know, how do we turn the doctor's minds away from the bad news of what was happening in the community and get them focused on treating the legitimate chronic pain patients? So, yeah, there was a constant push on that.

And you eventually were part of a whistleblower lawsuit against Purdue. Is that right? That's correct. But it got dismissed. Yeah, it was dismissed. I mean, it had been in the court system for many years. It's not hard for anybody to look up any information about it. It's Radcliffe May v. Purdue.

We had specific allegations that the company had committed fraud, and eventually it was dismissed on a technicality. It was a procedural basis for dismissing it. That's my understanding, Kurt. Looking back now, a lot of observers feel that while there are obviously a bunch of companies that make prescription pain killers, which are abused, that Purdue Pharma played kind of an instrumental, special role in precipitating the opioid crisis because the company pushed really aggressively to destigmatize the long-term use. of strong opioids. How do you feel, looking back? I mean, do you feel as though Purdue has any culpability in getting us to where we are today

in the opioid crisis? I believe they were absolutely instrumental in it. The culpability is you can't turn a blind eye to the problems that you're creating in the community. And that's one of the things I want to say to the Sackler family, stand up, be responsible, be proud of your company. Okay, you built a great company, but also take some responsibility for the problems that has been caused by the way that your products are being promoted and how your products were being abused. And at the same time, you're still pushing the promotion of that product that's destroying communities today.

I mean, I can't say it any other way. Be accountable. And is there, I mean, is there any sense in which you, on a personal level, look back and feel any guilt or feel any, as though you personally have any culpability? I think as an individual, you're doing your job, you believe that you're doing it righteously. You don't want to do wrong. You want to help people. At the same time, looking back, you go, wow, perhaps I probably should have resigned from the company early on and just walked away from a situation that was growing bad.

But at the same time, you look, what was the information that I had at the time? Was there a way to turn this thing around? At the time, I believe there was. But looking back, it saddens me that I was a part of it. I'll say it that way. That was Stephen May, a former sales rep for Purdue Pharma, talking with the New Yorker's Patrick Raddenkeef. Patrick's piece about the selling of Oxycontent called Empire of Pain

was published in the New Yorker in 2017, and I spoke with him then. Now, Patrick, we just heard Stephen May lay blame for the consequences of opioid addictions on the Sackler family. The fact that Purdue is privately held by the descendants of two brothers, how is that affected how it does business now? Well, it's a very secret company. It always has been. If this was a publicly traded pharmaceutical company, you'd have shareholders, you'd have earnings calls, you'd have quarterly reports, and there would be a check, a kind of an outside check. But really, this company is the kind of private realm of this one family. And they own it, they control it, they're on the board, the profits all flow to the family. And what this means is when you get into some of these dicey questions about selling a very addictive substance to lots and lots of people, what means,

may be complicated ethical questions that normally you would be able to subject to a kind of a larger review in a publicly traded company. Really, they're just decided by the family, and we don't know what goes into that decision-making. What do you think their defense will be? David, I've wondered about that. And I thought to myself, you know, there might be a kind of libertarian case that could be made, which is essentially in the same way that if you own a firearms company, right? We put a product out there in the world. It's dangerous if used incorrectly, but ultimately this is a question of individual responsibility. A libertarian argument in the world of pharmaceuticals?

Can you imagine? We're seeing a staggering tragic number of deaths from overdoses because of this epidemic, especially from heroin, which is deadly and very cheap on the street. Oxycontin is legal, and it's regulated. So why is it such a problem? Well, here's the answer. For thousands of years, people have cultivated. poppies, and we've known about the therapeutic benefits of opium-related narcotics.

We've also known for thousands of years that they're really addictive, and this has always been the two sides of the coin. When Purdue Pharma and the Sackler family set out to sell Oxycontin, what they wanted to do is destigmatize strong opioids. The whole idea was, we've got doctors out there who were reluctant to prescribe these. How do we change their minds? And they set out to changed their minds, and they were incredibly effective. So the real issue with the heroin is that once the country is flooded with these opioids, you get a lot of people getting addicted. And once that genie is out of the bottle, it gets very hard to put it back. So Purdue Pharma, other companies, have tried to prevent their pills in more recent years from going to the black market, from getting

crushed, from being abused, but it's kind of too late. And in an awful paradox, the harder it gets for somebody who's already addicted to opioids to get access through their doctor to opioids, the more likely it is that they're going to be buying them on the street. It may be too expensive, and they end up buying heroin, which is cheaper. And this is where we get the spike in heroin. Did the Sackler family make any efforts to right or wrong? Well, they would tell you that they did in that Purdue Pharma reformulated OxyContin in 2010, making it harder to crush and snort.

But I talk to people who said, you really have to look at that. the timing of this because they reformulated Oxycontinent in 2010, but the patent on the drug was set to expire in 2013. This is something you actually typically find in the life cycle of a branded narcotic, is just as the exclusive patent is about to expire, you tweak the formula in some way so as to make it seem that much different. And then what happens is you reset the clock on your exclusive right to produce it. So they would tell you they had, what's interesting is if you look at their philanthropy, this is a family that gives to cancer research, they give to medical schools, they give to art museums, universities,

there's nothing for the opioid crisis, nothing for addiction treatment. If there is any sense in that family that they bear any moral culpability for where we are today, they're not acting on it. Patrick, it's an astonishing piece of journalism. I really appreciate it. Thank you. Thank you. Patrick Radden-Keefe's article about Purdue Pharma, from 2017, is called Empire of Pain.

And you can find it at New Yorker.com. The company is now facing dozens of lawsuits from states and municipalities, and there's even been talk that it may declare bankruptcy. This is the New Yorker Radio Hour. More to come. This is the New Yorker Radio Hour. I'm David Remnick. The list of cartoonists or household names is a very short list. But Raz Chast is certainly at the top of it. She's been publishing in The New Yorker since she was 24.

and her book, Can't We Talk About Something More Pleasant, was a finalist for the National Book Award in 2014. Her cartoons stand out for how personal they are. They're about marital tensions and the stress of dealing with your crazy parents and your even crazier children. And her drawings, everyone looks completely frazzled, even the animals. Hi, I'm Leanna Think. We are outside Raz Chast's house in Connecticut,

and I brought her some flowers that might be a bit too romantic. Leanna Fink grew up studying Roz's cartoons and she started contributing her own cartoons to the New Yorker a few years ago when she was 27. They share a certain stressed out

line and a love of birds. This is Jackie. She is a kayak. She's very unshigh. She looks like a Disney character. She has his big eyes. She's a little bit of a cartoon bird. I'm in following in love with Jackie. She's trembling while I pet her. I was a really shy kid and I've always felt

really comfortable with animals because they don't have, they don't do the things that I feel like I have to pretend to do like hold conversations that are really hard for me. I always feel connected to pigeons. I feel like there are these wild creatures in the city and I'm like that too. Jackie's a very good bird. This is my very neurotic and very sweet African gray. And she says many, many things. As you can see, she plucks. She looks like a lion because she has this plucked body and this regal head.

Hey, Eli, what's this? That's right. That's right. What a smart bird. What a smart, smart bird. This is a list of the things that she says, by the way. She says chirp. She says chirp, chirp, chirp.

Who cares? When she gets scared, sometimes she'll say to herself, it's okay, it's okay, it's okay, it's okay. You know, self-soothing kind of thing. Yeah, she knows. Yeah, I do too. Yeah, me too. Yeah, it's okay.

I say fearless. I sometimes I say like people do this, you know, like when I'm driving especially, because driving and I are not good friends. You had a cartoon about driving where you just tell the story of driving, but you call it sailing instead of driving? Yeah, it is. I thought maybe if I did a cartoon where I was comfortable with it, like somehow, like, I would actually become more comfortable. And, you know, gradually, I'm more, it's better than it was when I started, but, I mean, it worked, the cartoon worked.

But I still getting lost is, I mean, the GPS is good, but then I worry about the GPS going out. I read your work most deeply when I was in high school and college. I think that's why I love the New Yorker. I mean, I know it. I think I was 14 when I found your work. And we had just moved to this suburban kind of fancy kind of waspy town in New Jersey. And I related so much as this kind of outsider and as a person who drew and as a shy kid and as a Jew. Like, it just completely summarized my world.

And you got a lot of zeitgeisty stuff in there, too. Like, it was much more intense than rereading an old diary or looking at photographs or something. I feel like you really caught that era and caught my life. And how do you feel when you reread your work? Hmm. Sometimes it does bring me back because I guess so. a lot of my work is kind of personal. So, um, do you feel, like, do, what do you feel about your cartoons being the most

autobiographical ones in the New Yorker? Um, definitely, uh, there's a part of me that is that voice of sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry, you know, um, I mean, sometimes I, I wish that I did a whole different kind of work, you know, but, but. But I always think there's that Yiddish, you know, if my grandmother had wheels, she'd be a wagon. Yeah. You know, I mean, if I were a very different person, then I would do different cartoons. Are you terrified of people? Oh, yeah.

I'm, it's, and I know that everything that I say this afternoon, I'm going to rewind in my head and regret. Oh, no. And that is just what, I mean, I'm just almost, I wouldn't quite say used to it, but I just know that that's. I still regret some things that I've said to you like a year ago. And I probably won't be able to. It's just like a regretters festival. Well, I'm a very big fan of your work in the magazine too. Thank you.

I love seeing it and I love God finding all the prayers of mankind in his spam folder. I think it's just sensational. Thanks. I mean, I didn't care about them. I love working. I don't care if they're good. If I cared, I would be paralyzed. Well, do you have ways that you sort of trick yourself of kind of getting out of that?

Yeah. I think it might have been easier for me if I were a guy and encouraged to be assertive. Do you feel that like making jokes sometimes, like comedy is a way of being assertive and expressing anger that like you can be like very indirect about it? Yeah. Yeah. I never even thought of myself as funny, and I still don't. I think of myself as really needing to express myself, and I think for some people that's the same thing. I kind of think for you it's the same thing.

For me, it doesn't seem to work to deliberately, like, try to be funny. I mean, I might make something that then I think, well, that's really a pretty good joke. It's pretty funny, but it's not funny. Yeah. I remember drawing things that made me laugh when I was really little. Yeah. and that I liked that. I mean, I think when I got to be a certain age, it was like things came out funny,

and I didn't really want them necessarily to come out funny, but they came out funny, like, you know, drawing horses, and I could not draw horses. Because I don't, I'm not a horse. I didn't like, not like horses. When I wrote you some fan mail when I was 15, a lot of it was praising your horses. And then your magnificent letter that you wrote back to me

contained some drawings of horses. Yes. Well, it's... With their big teeth. Yes, they just, I just actually was drawing some horses the other day just for fun. And actually, I'll show them to you. Right here, I was just kind of, you know, just kind of... I was trying to explain to somebody, the horse drawings that I did when I was a kid. So it's a page of watercolor paper with 20 horses on it. And all of them have kind of hair that.

That was cool in the 90s, like sticking straight up and also this very game grin on their faces, kind of like bros. You know highlights for children? Oh, yes. Quasi educational magazine for children. It was often in dentists' offices and waiting rooms. Yeah. They had this thing, Our Own Page. And I wanted to get a drawing onto Our Own Page when I was around 10, and I noticed that most of the drawings that were accepted by

little girls who have horses or quite a number of them were. And so one day I decided I was going to, God damn it, I was going to learn to draw horses. I was going to make myself draw a horse after horse until I got it right. And I filled up this sketchbook with drawings of horses. And then I looked at them and I laughed so hard that I nearly like lost, you know, control of bodily functions. It was, they were just so terrible, but they were so funny. And, uh, hello, we hear you. What's it like when you get letters from young women, do you feel this huge responsibility? People like me probably send you very personal letters in which they maybe think that

you're their mom or something. Is it? What's it like? Well, I feel like women relate to each other differently from the way men, relate to each other and I don't know. I mean, when I give talks and stuff, it's mostly women in the audience, different ages, but mostly women, but guys too. I do think there's something different in how we're made, but I also wonder whether

there's so many more obstacles for a woman to become something like a cartoonist that may be the women who, and the obstacles are very insidious and invisible, such as I don't see anyone like me doing this so I'm not even going to try. So I wonder if the women who do make it are people who are really, really honest. And I wonder if like the way your cartoons are different is you happen to be a really honest person and you're not going to fall into a form that doesn't come from inside of you. I don't know. I don't know. I don't know how this relates to that exactly. but I think I felt like, well, you probably won't like me anyway, so I might as well do what I want to do.

Roz Chast is the author of countless great cartoons, and she's got a new book out next month, a collaboration with Patricia Marks. It's called, and you might want to write this down, Why don't you write my eulogy now so I can correct it, a mother's suggestions. Leanna Fink's latest book is called Passing for Human, And I'm David Remnick. That's the show for today. I want to thank you for listening,

and I hope you'll join us next time. The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbus of Tune Yards, with additional music by Alexis Quadrado. Our team includes Alex Barron, Emily Boutin, Ave Cario, Riannon, Jill Duboff, Karen Frillman, Callalia, David Krasnow, Caroline Lester, Louis Mitchell, Sarah Nix, and Stephen Valentino, with help from Emily Mann and Jessica Henderson.

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