'Dreamland' Journalist: Purdue Pharma Lawsuit Implies Not Much Changed — Except Awareness

When journalist Sam Quinones read the lawsuit Tennessee Attorney General Herbert Slatery filed against Purdue Pharma, unsealed at the end of June, he had a thought: More of the same.

Quinones wrote extensively about Purdue, maker of OxyContin and other drugs, in his 2015 book “Dreamland: The True Tale of America’s Opiate Epidemic,” reported over 2013-2014.

The pressure on sales reps to hit high volumes, even when doctors showed numerous “red flags” of being pill pushers. The culture that led to the prescribing of higher and higher doses in the name of staving off any pain at all costs. The marketing to vulnerable populations, telling doctors — and the public — that the drug was not addictive as long as patients had “real” pain.

More: Purdue Pharma pushed opioids as 'hope in a bottle,' records show

Quinones’ book covered all of that, including a 2007 agreement Purdue signed with the federal government after the company pleaded guilty to illegally misbranding OxyContin. In it, it promised to be “vigilant” for abuse, unscrupulous practitioners, and pills being sold or traded by the patient.

“It doesn’t seem from the lawsuit that they were abiding by the spirit, and in some instances the letter, of the agreement,” Quinones said in an interview with the News Sentinel after the lawsuit was unsealed. “They seemed not to take that seriously.”

Sam Quinones' third book is "Dreamland: The True Tale of America’s Opiate Epidemic." (Photo: Contributed photo)

Quinones, who continues to track the opioid epidemic, wrote two posts about the Tennessee lawsuit in his blog.

“I was startled” to read some of the information in it, he said, “because what seemed to me was that the culture that had grown up in the first few years after OxyContin was released — the aggressive sales, the new ways of marketing a narcotic — that culture didn’t really fade. It remained in place, I suspect due to dictates by the company.”

What Purdue says: Doctors, patients, drug dealers to blame for opioid epidemic

One of Quinones’ blog posts outlines the changes in pharmaceutical sales that are OxyContin’s legacy, the switch from “stodgy old guys with a background in medicine” and a history with the providers they visited to much younger, flashier reps with aggressive sales backgrounds and armloads of giveaways. While other drug companies used these tactics, he noted, Purdue was one of the few to use them to push a narcotic painkiller.

“What’s striking is that even after” the 2007 agreement, “from all accounts in the lawsuit, (Purdue) continued to very aggressively push doctors to prescribe and looked especially for those who were already doing so and pushed them to go to higher doses” — even, in some cases, after doctors were cited by the state medical boards or, in some cases, criminally charged.

“It makes me wonder what exactly was going on in the culture of this country,” Quinones said. “Why would that be OK?”

More: Purdue targeted nurse practitioners, PAs, but doctors had to sign off on all prescriptions

But he also noted something that has changed since the publication of “Dreamland”: the number of lawsuits against the makers of opioid painkillers. When he was writing the book, Quinones said, he remembers only three.

“This was a time when the issue was largely hidden, those affected largely silent,” he wrote in his blog. “Families were ashamed and wanted to obscure the truth of the addiction and manner of death of their loved ones. Thus, the media paid scant attention, and elected officials, outside those in a few states, paid less.”

More: For third year, federal government proposes cutting U.S. prescription opioid manufacturing

Over the past few years, however, as awareness has grown and state and local governments have borne the costs of addiction, the number of such lawsuits has skyrocketed, with most states and many cities, small towns and American Indian tribes suing the companies they allege created a “public nuisance” with drug marketing and sales tactics.

“A bunch of lawyers all across the country are now putting their minds to figuring out how to pry money (from pharmaceutical companies) to help pay for all these services: coroners, jails, foster children, county hospitals, courts,” Quinones said. “None has gone to court yet, so we’ll see what effect they actually have, how quickly they’re decided, and what kind of money comes out of it.”

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Journalist Sam Quinones, center, speaks to Tommy Farmer, left, and Bill Dunn, both attendees of a Metro Drug Coalition dinner at The Jackson Terminal in May 2016. Quinones is the author of "Dreamland: The True Tale of America's Opiate Epidemic." (Photo: Caitie McMekin/News Sentinel)

Quinones spoke here in 2016 at a Metro Drug Coalition event. He’ll return Nov. 14 for an event by Trinity Health Foundation, Leadership Tennessee and Blue Cross Blue Shield. Quinones’ talk at 9:30-11 a.m. will be followed by a community roundtable on the root causes of the opioid epidemic in East Tennessee, led by Jerry Askew. For information call 865-632-5678.

Quinones said wherever he speaks, he hears an abundance of stories from those dealing with the fallout from opioid addiction.

“People are not being silent anymore about this problem,” he said. “When you create noise and interest, and people come out of the shadows, you get new kinds of approaches to these problems.”

https://www.knoxnews.com/story/news/health/2018/08/19/opioid-epidemic-dreamland-book-sam-quinones-purdue-pharma-lawsuit/1012042002/