Revealed: tricks used by opioid giant to mold doctors’ minds

Newly released internal documents from opioid giant Mallinckrodt unveil a meticulously orchestrated campaign to mold medical attitudes toward pain medicine, as the company grappled with growing hesitancy among frontline prescribers amid an escalating addiction crisis. The more than 1.3 million documents, made public by court order, provide a rare glimpse into the tactics employed by the pharmaceutical industry to manage physician and public opinion.

In an analysis published today in The BMJ, researchers Sergio Sismondo and Maud Bernisson pored over nearly 900 contracts, exposing Mallinckrodt’s multifaceted approach to reframing concerns about addiction as a phobia and muddling the concept of dependence as “pseudoaddiction.” The company even went so far as to cast opioids as preventive medicine for chronic pain.

Blurring the Lines Between Marketing and Education

Mallinckrodt’s strategy involved recruiting physicians to serve as influencers, planting articles in scientific journals, coordinating conference presentations, and developing continuing medical education (CME) courses. To many busy physicians, these messages would have appeared as trustworthy scholarship and evidence-based guidance, Sismondo and Bernisson explain.

The documents reveal a Mallinckrodt regulatory expert describing how its CME program “underscores Mallinckrodt’s credibility with the FDA as a company that cares about … safe opioid prescribing,” while a sales manager’s exhortation in a 2013 email to his reps states: “You have only 1 responsibility, SELL BABY SELL!”

Distorting Terms and Distracting Physicians

Adriane Fugh-Berman, professor of pharmacology & physiology at Georgetown University, who has been researching the marketing tactics of the pharmaceutical industry for thirty years, adds that “creating the term pseudoaddiction and distorting the terms tolerance and dependence were strategies that distracted physicians from noticing their patients were addicted.”

Despite settling with the US government for lax handling of its opioid supply and later being ordered to pay $1.7 billion over accusations of misleading and deceptive marketing practices to boost opioid sales, Mallinckrodt continues to sell opioids today, with sales of some $262 million in 2023, up 25% from the year before.

“It’s like they used every trick in the book,” says Robert Steinbrook, director of the Health Research Group of the advocacy organization Public Citizen.

The unsealed documents shed light on the pharmaceutical industry’s extensive efforts to shape the narrative surrounding opioids, blurring the lines between marketing and education. As the opioid crisis continues to ravage communities across the United States, the revelations from Mallinckrodt’s internal communications serve as a stark reminder of the challenges faced by physicians and public health officials in navigating the complex landscape of pain management and addiction.

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