Purdue Pharma and OxyContin
In “A 1980 Letter on the Risk of Opioid Addiction letter” article, identified were 608 citations of the index publication and noted a sizable increase after the introduction of OxyContin (a long-acting formulation of oxycodone) in 1995 (Figure 1). Of the articles that included a reference to the 1980 letter, the authors of 439 (72.2%) cited it as evidence that addiction was rare in patients treated with opioids (Oxycontin). Of the 608 articles, the authors of 491 articles (80.8%) did not note the patients who were described in the letter were hospitalized at the time they received the prescription. Some authors grossly misrepresented the conclusions of the letter (Section 3 in the Supplementary Appendix). Of note, affirmational citations have become much less common in recent years. In contrast to the 1980 correspondence, 11 stand-alone letters that were published contemporaneously by the Journal were cited a median of 11 times.
This particular bar chart details the citation of a letter sent to the NEJM in 1980 by Doctors Jane Porter and Herschel Jick about a Boston Collaborative Drug Surveillance Program at Boston University Medical Center, Waltham, MA. The verbiage of this letter can be found in the Supplemental Appendix (scroll down).
The published letter detail:
“Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”
The letter says, we used Opioids in a “hospital” setting and there was no evidence of addiction by patients except for one. From 1980 onward till 2015 the letter was cited 5 to 28 (1996) times per year affirming Opioids do not cause addition. The median number of citations of a letter in the NEJM is 11 times. There is nothing to indicate this letter had an impact until about 1997 when the numbers and rates of death due to Opioids doubled (see charts).
The bibliometric analysis of the citations and subsequent chart of the findings related to the Jick and Porter letter can be found in a subsequent 2017 letter to the NEJM entitled “A 1980 Letter on the Risk of Opioid Addiction,” dated June 1, 2017 authored by Doctors Leung, Macdonald, Dhalla, and Juurlink. This appearing and disappearing Supplemental Appendix which has the Jick and Porter Letter (cited) is a part of this article.
So why am I again writing about Purdue Pharma L.P? It appears Purdue Pharma may be going out of business. Much of this could be due to the issues it had opioids crisis experienced due to advertising stating there was evidence that addiction was rare in patients treated with opioids. “Opioid Use since 1968 and Why It’s Abuse Increased, “Angry Bear
On May 1, 2026, Purdue Pharma permanently ceased operations. Knoa Pharma, a new and different company, will distribute medicines formerly distributed by Purdue Pharma. Dean Baker will add to this story.
Purdue Pharma Bites the Dust: Can We Learn Anything? Dean Baker
Purdue Pharma (one of the drug companies at the center of the opioid crisis) was finally put to death as the result of lawsuits over its pushing of OxyContin. The allegation is that the company misrepresented the addictiveness of the drug in order to have it promoted more widely.
The money paid to the families of victims cannot compensate for the deaths of loved ones, but the other part of the story is that no one is asking how to make sure this sort of disaster does not happen again. And unlike the example I gave of an exploding oil refinery, we are talking about the death of hundreds of thousands, not hundreds.
AB: Dean states the incentive is large enough to cause companies to overextend due to government subsidies, For example:
The key issue being, “the incentives the government gave to Purdue Pharma and the other opioid manufacturers. It gave them patent monopolies allowing them to markup the price of their drugs by several thousand percent. Selling them at prices that were twenty or thirty times what they would sell for in a free market.
This sort of extraordinary profit gives drug companies an incentive to lie about the safety and effectiveness of their drugs, which they do routinely.”
AB: At any time, the FDA could have stepped in. It did not and for over the last 10 or 15 years, Purdue was left to itself
The consequences generally are not as disastrous as with the opioid crisis, but patients often end up taking drugs that are not best for them because drug companies misrepresented their products to researchers, doctors, and the public at large.
To be clear, companies always have incentive to sell their products widely. That’s the point of advertising. But they won’t go to the same length to sell a plastic cup or shovel, where they expect a profit of a dollar or two, as they will in selling a prescription on a patent-protected drug, where the profits can be hundreds or even thousands of dollars.
AB: Who owned Purdue Pharma? The company was owned by the families of the two brothers, Mortimer and Raymond Sackler. While having legal issues with OxyContin and the epidemic, the family withdrew over $10 billion from Purdue Pharma between 2008 and 2018. The withdrawal (nervy) led to significant personal wealth while the company faced lawsuits. Dean continues his piece discussing patent drugs and the high prices resulting from them
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(Dean) Patent monopolies are also the reason for high drug prices. Drugs are almost always cheap to manufacture and distribute; the reason they are expensive is the monopolies the government gives the drug companies.
This is the whole story of people struggling to raise the thousands or tens of thousands needed to pay for drugs to treat cancer or other serious illnesses. If these drugs were sold in a free market, paying twenty or thirty dollars for a prescription would not be a big deal, except for low-income people. And the government could afford to pick up the tab for them.
And patent monopolies are a big part of the story in redistributing income upward. While this is true in many areas, it is very striking in the case of pharmaceuticals. We will pay around $750 billion this year for drugs that would cost in the range of $150 billion in a free market. The savings of $600 billion comes to almost $5,000 per household.
That $600 billion is money that goes to drug companies and their shareholders. It has created many billionaires. In the case of the Covid vaccine alone, we created 5 Moderna billionaires.
Patent monopolies do provide an incentive for developing new drugs, but there are other ways to provide this incentive, most obviously paying people. If that sounds bizarre, the government already spends around $50 billion a year supporting biomedical research through the National Institutes of Health and other government agencies. We would have to triple or quadruple this sum to replace the patent-supported research, but we would still come out way ahead and wouldn’t have to worry about drug companies lying to us to push their drugs.
It is more than a bit bizarre that we have a large contingent of progressives focused on ways to tax back the wealth of the very rich, but who have no interest in restructuring the system in ways that don’t make them so rich in the first place. Just as a refinery explosion would be expected to lead to a renewed focus on industry safety, we might have expected the opioid crisis to lead to new thinking on the way we finance the development of drugs. But that has not been the case.
There is a bill put forth by Michigan Representative Rashida Tlaib that would be a big step in this direction. Unfortunately, it has received little attention to date. It would be great if something positive could come out of the opioid crisis, but that can’t happen until people at least can see the issue clearly. For whatever reason, that has not yet happened.
AB: After almost (or maybe it is) a couple of decades, we are still talking about the dangers of pharmaceuticals such as OxyContin. There still is a lack of enforcement and monitoring. Although the Sacklers had to give money back.
Some references:
“A 1980 Letter on the Risk of Opioid Addiction,” New England Journal of Medicine
“Supplementary Appendix;” nejmc1700150_appendix.pdf
“Purdue Pharma Bites the Dust: Can We Learn Anything?” Patreon, Dean Baker
“Supreme Court Overrules Purdue Pharma Opioid Settlement,” NCSL