Purdue's court filings understate its role in the opioid epidemic by 80%

Purdue Pharma (and its richer-than-the-Rockefellers owners, the Sackler family are increasingly being dragged into state courts to account for their role in the opioid epidemic, which has claimed more American lives than the Vietnam War.

The cornerstone of the Purdue/Sackler defense is to insist that the company — manufacturer of Oxycontin — was only a bit-player in the epidemic, and therefore it's unfair to hold them to account for the actions of their rivals who were the real villains of the crisis.

To this end, Purdue has repeatedly cited its analysis of FDA data that showed that the company only accounted for 3.3% of all opioid sales during the period.

However, a new analysis of the same data set, performed by Propublica and Stat (building on more limited work from the Washington Post), shows how Purdue massaged the data to produce a wildly misleading picture of its role in the epidemic.

The trick works like this: Purdue's analysis treats all opioids as being equivalent to its deadly widowmaker, Oxycontin. Thus, a 5mg Percocet is treated as equivalent to an 80mg Oxy (Propublica: "It's analogous to measuring alcohol sales by equating a 12-ounce glass of 100 proof whiskey with a similar-sized can of light beer").

When the data are reanalyzed with the doses taken into account, Purdue's contribution quintuples to more than 16%, and Purdue becomes the nation's third-largest peddler of opioids during the crisis. What's more, these figures are even worse for Purdue in some states: for example, Purdue told a judge in Massachusetts that it sold 4.6% of the opioids in the state. The true figure is 20.5%; the company is also responsible for 31.2% of opioid sales in Rhode Island; 28.5% in Connecticut; and more than 20% in 14 other states, including Ohio, which has the highest overdose level in the country.

The significance isn't just volume, it's kind: Purdue sold the highest-dose opioids with the highest risk of overdose, and in formulations that were easy to crush and snort.

But the volume also matters: Oxy wasn't just deadly, it was incredibly profitable: Purdue and the Sacklers had 28% of the gross market for opioids from 2008-2018, with more than $35B in sales, and at least $8b funnelled to the Sacklers during this time.

By minimizing OxyContin's market share, the per-pill sales data that Purdue prefers also muffles the drug's outsized impact in certain states, especially in the Northeast. For example, Purdue's lawyer told the Massachusetts judge that the company sold just 4.6% of the prescription pain pills in the state from 2006 through 2012. But when the total amount of opioid ingredient in each pill is considered, Purdue's market share in the state is actually more than four times higher at 20.5%.

In some states, when sales are adjusted for potency, Purdue sold more painkiller medication than any other company: Purdue was the top seller in Rhode Island, with 31.2% of the opioid market, as well as in Connecticut, where it had 28.5%. In Ohio, which has consistently ranked among states with the highest rates of overdoses, Purdue had one-fifth of the market. In 13 states, Purdue was responsible for 20% or more of retail opioid painkiller sales.

The market share nationally of some companies dropped when potency was considered. SpecGx, which has 37.7% of the market on a per pill basis, fell to 29%. Actavis declined from 34.6% of the total pill market to 30.4% in the ProPublica analysis.

Data Touted by OxyContin Maker to Fight Lawsuits Doesn't Tell the Whole Story [David Armstrong and Jeff Ernsthausen/Propublica and STAT]