MILWAUKEE — Driving home from a hunting trip in 2008, Johnny Sullivan called his wife to say he was having trouble staying awake.

It was early afternoon, but Mary Lou Sullivan wasn’t surprised. Her husband was a longtime user of the narcotic painkiller OxyContin and frequently dozed off as a side effect, sometimes in the middle of chewing his food.

About 10 years earlier, Sullivan and six other chronic pain sufferers had been featured in a promotional video for OxyContin that was put out by the drug company Purdue Pharma. In the video, Sullivan stood at a construction site and talked about how the powerful narcotic eased his back pain and enabled him to run his company again.

But a few years after being prescribed OxyContin, Sullivan became addicted to it and other prescription opioids, his family said.

Minutes after calling his wife that afternoon in 2008, Sullivan, 52, fell asleep while driving, flipped his truck and died instantly.

“Purdue used Johnny to sort of speak like a poster child,” Mary Lou Sullivan said. “He was really promoting that OxyContin.”

Purdue Pharma’s aggressive marketing of OxyContin in the late 1990s marked the beginning of the industry’s push of narcotic painkillers to treat long-term chronic pain — an area where the drugs’ safety and effectiveness remain unproven.

Sales of OxyContin have reached nearly $3 billion a year, making it the top-selling prescription pain pill in the country. Sales of all prescription opioids have quadrupled from 1999 to 2010.

Health and regulatory officials have declared a national epidemic, as addictions to prescription painkillers have skyrocketed and fatal overdoses have more than tripled in the past decade. A U.S. Senate investigation — prompted in part by Milwaukee Journal Sentinel/MedPage Today reports — is probing financial relationships of drug companies and the doctors and organizations that have advocated for the drugs’ use.

The story of the video is an example of how marketing trumped science and helped fuel the rapid increase in opioid use throughout the country.

The subjects who spoke glowingly of their experiences with OxyContin in the video 14 years ago offer a case history of sorts.

Two of the seven patients were active opioid abusers when they died. A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose. Three patients still say the drug helped them cope with their pain and improved their quality of life. A seventh declined to answer questions.

The doctor who enlisted his patients for the video and played a starring role now says some of the statements went too far.

In the video, Alan Spanos, a pain specialist in North Carolina — a paid speaker for Purdue Pharma at the time — urged doctors to consider prescribing opioids more often.

He says now the point of the video was to explain that some patients could take opioids and not turn into “classic drug addicts.”

But it was unclear then, and remains unclear now, what percentage of chronic pain patients benefit from the drugs.

The video was meant to be one teaching aid used in lectures by experienced doctors, Spanos says today. But it was distributed to 15,000 doctors in a marketing campaign by Purdue, which claimed, among other things, that the drug was less addictive and less subject to abuse than other drugs.

That wasn’t true, and in 2007 The Purdue Frederick Co., an affiliate of Purdue Pharma, agreed to pay $634.5 million in penalties for misbranding the drug, as part of a U.S. Justice Department investigation.

The sanctions didn’t stop the pharmaceutical industry from promoting OxyContin and other narcotics for people with chronic, long-term pain — a much larger group of potential patients than just those being treated with opioids for cancer and end-of-life suffering, as well as short-term pain.

At the time the video was produced, many doctors were reluctant to prescribe narcotic drugs for chronic pain, fearing the risk of addiction and having little evidence of the drugs’ long-term safety and effectiveness.

That changed as Purdue Pharma and other opioid companies began funding promotional talks and courses that doctors could take to fulfill education requirements for medical license renewals. At the same time, the organizations and associations that write treatment guidelines began endorsing opioids for chronic pain. Many of the people writing those guidelines had financial ties to drugmakers.

Over time, doctors began writing more and more prescriptions for opioids — including OxyContin, Vicodin and Percocet — for more and more chronic conditions, such as back pain, fibromyalgia and arthritis.

Part of OxyContin’s appeal was that it was a time-release version of the generic painkiller, oxycodone. Patients had to take only two pills a day, instead of getting up at night to take more medicine.

In the 1998 video, Spanos said opioids “don’t wear out,” meaning patients won’t need stronger doses over time.

However, experts say it’s common for opioid drugs to lose their painkilling effect as patients develop tolerance, leading doctors to increase doses.

“Humans develop tolerance to opioids and — pharmacologically and physiologically — this is a well-known fact that was also well-known in the 1990s,” said Beth Darnall, president of the Pain Society of Oregon and an associate professor at Oregon Health & Science University.

Consider Lauren Cambra, one of the seven patients in the video. She was in her mid-40s and suffering from severe low-back pain until she went to see Spanos, who prescribed OxyContin.

It worked well at first.

“I was pain-free,” she said in an interview with the Journal Sentinel and MedPageToday. “I was able to get up. I could walk up a flight of stairs. I was very happy with the therapy.”

Then her dose had to be doubled. Eventually it was doubled again.

She lost her job in the dot-com collapse and could no longer afford the $600 a month she needed for OxyContin. When she tried to do without, she spent days on the couch curled up with horrible withdrawal symptoms.

“The next month, I knew I was going to figure out how to get the money,” she said.

Instead of paying her bills or her mortgage, Cambra bought OxyContin. She lost her car and her home. She filed for bankruptcy.

Eventually, over a period of months, she weaned herself off the drug.

“I thought that if I didn’t stop doing this, if I didn’t get off this medicine, I’d probably end up dead,” she said.

In an email, Purdue spokesman James Heins said that OxyContin labels have always included warnings about side effects and tolerance, and they’re updated when new medical evidence emerges.

He noted the video was made 14 years ago and has not been shown in a decade.

Heins said statements made in the video reflected the medical consensus regarding opioids at the time. He said he regretted it if doctors got the wrong message.

 


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