Recent research has found that Purdue Pharma focused its Oxycontin marketing in states with lighter regulation.
A paper from the National Bureau of Economic Research (NBER) found this led to distribution and misuse of Oxycontin being much higher in states with lighter regulation. The paper relied on unsealed lawsuit documents acquired through Freedom of Information Act requests.
The documents demonstrated that Purdue focused on marketing Oxycontin in states without “triplicate prescription programs.” Oxycontin prescribers in states with triplicate programs were mandated to produce three copies of every prescription. The prescriber retained one copy, the pharmacy retained one and the third was forwarded to a state agency. Prescribers in these states ended up being concerned about law enforcement scrutiny because of the mandated forwarding to state agencies.
Purdue focus groups found that triplicate programs reduced the prescribing of certain drugs by around 60 percent in the states with the programs.
The NBER paper found that, in 2000, states without triplicate programs saw 250 percent more Oxycontin use per person. The paper estimated that there would have been 44 percent less opioid overdose deaths in states without triplicate programs had they used triplicate programs from 1996 to 2017. The paper estimated that 65 percent of opioid overdose death rate growth during this time span could be attributed to Oxycontin.
Recent research has also found that Oxycontin’s reformulation in 2010, intended to reduce abuse of the medication, had unintended and devastating consequences. The reformulation involved making sure Oxycontin pills did not turn into powder which could be snorted when it was crushed. An unintended consequence of this is that many abusers of Oxycontin then turned to heroin.
The rate of heroin overdoses increased by more than three times in the years after Oxycontin’s reformulation. Research has showed that the states with the most pre-reformulation Oxycontin abuse saw the largest increases in post-reformulation heroin abuse, attributing as much as 80 percent of the heroin abuse increase to the Oxycontin reformulation. Research has shown the reformulation failed to reduce total opioid-related mortality. It simply shifted the cause of mortality from Oxycontin to heroin.
Research has also found that 76 percent fewer cases of hepatitis C and 53 fewer cases of hepatitis B from 2011 and 2015 would have occurred without the reformulation. Hepatitis C and B are often contracted by injection drug users. States with above-median pre-reformulation Oxycontin abuse rates saw a 222 percent increase in hepatitis C infections post-reformulation.