In the 1990s, Purdue created aggressive marketing campaigns to convince doctors and state regulators of the safety of a new class of timed-release opioid analgesics. Given their status as Schedule II controlled substances, Purdue faced potentially enormous pushback, especially at a time when the number of people incarcerated for drug offenses was reaching an all-time high. However, a major shift had taken place in regulatory policy a decade before that made this possible. In the 1980s, President Reagan initiated a radical program of corporate deregulation that opened the door to a new era of pharmaceutical mass marketing. Reagan’s “Second American Revolution” slashed government oversight, pushed through expedited review by the Food and Drug Administration (FDA), and for the first time allowed direct-to-consumer advertising for pharmaceutical drugs.
Amazingly, the deregulation of Big Pharma took place while the Reagan administration was launching a bombastic “second” War on Drugs that established a new standard for illicit drug prohibition, one his successors George H. W. Bush and Bill Clinton not only met but exceeded. This potent mix of racialized drug prosecution and corporate empowerment created the environment in which Purdue and other companies sought out new commercial strategies for marketing opioids.
So when Purdue introduced OxyContin in 1996, it proceeded with an awareness of both the opportunities and potential pitfalls. The company developed a number of marketing strategies to increase sales and to navigate the deeply segregated waters of drug consumption. In order to market OxyContin, a long-term release opioid that contains the active ingredient oxycodone, Purdue created an expansive network of sales representatives, doubling its internal sales force from 318 in 1996 to 671 in 2000. Driven by sophisticated data collection methods that revealed the highest and lowest prescribers in every zip code throughout the United States, Purdue identified medical practices with the largest numbers of pain patients and with physicians who were the least discriminate prescribers. Sales representatives received bonuses ranging from $15,000 to $240,000 a year for increases in opioid prescriptions in their coverage areas, and they visited doctors repeatedly, drawing them into an elaborate informational marketing campaign. Purdue offered doctors educational conferences in Sunbelt resorts, patient coupons, OxyContin-branded stuffed animals, and even CDs of the drug’s marketing jingle, “Get in the Swing of OxyContin.”
The company’s aggressive sales tactics convinced primary care physicians (PCPs) to prescribe opioids much more frequently for a wide range of patient complaints, including lower back pain and arthritis. By 2003 PCPs made up nearly half of OxyContin prescribers. Some experts at the time worried that PCPs lacked independent training in chronic pain management and addiction. Meanwhile the increase in the sale of OxyContin—from $48 million upon its introduction to $1.1 billion four years later—demonstrates the enormous scale of this enterprise.
According to public health scholars Helena Hansen and Julie Netherland, Purdue’s success hinged not only on this aggressive sales campaign, but also on racially bifurcated understandings of addiction. Drug sales representatives directed advertisement to overwhelmingly white suburban and rural areas to avoid the stigma of racially coded urban drug markets. By crafting a geographically distinct, white consumer base—understood as the antithesis of “hardcore” (nonwhite) urban drug users targeted by the Wars on Drugs and Gangs—the company both benefitted from and reinforced the racial ideology underwriting these punitive campaigns.