The Seeds of the Opioid Epidemic: An Eyewitness Account

By: Jill Mattingly, DHSc, MMSc, PA-C
Mercer University, Atlanta

The marketing and promotion of controlled drugs reveal public health risks when they are highly prescribed and aggressively promoted.

It was approaching noon hour, and I was finishing up documentation of my previous patient. Absorbed in this task, I did not look up to see who the physician was talking to in the hallway a few feet away. Then I was hit with a cloud of cologne, a sweet and pungent smell that heralded the clinic visitor. A smartly dressed young man came down the hall, smiling and confident. I identified this pharmaceutical sales representative by the scent of his cologne before I even looked up from my patient chart. He had come to the clinic several times in the past few months. In 1999, our rheumatology practice, full of patients suffering from varying levels of acute and chronic pain, was ground zero for his product. He knew that this was the place to put forward his best performance. Our salesperson was employed by Purdue Pharma, and he had cutting-edge pain medication to market to the providers; it was called OxyContin.

Purdue Pharma introduced OxyContin in 1996. Analyzing the techniques of OxyContin promotion and marketing, a sustained-release oxycodone preparation reveals that it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000. The high availability and overprescribing of OxyContin correlated with increased misuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States. The promotion and marketing of OxyContin occurred during the increased use of opioids in the treatment of pain, particularly for chronic, non–cancer pain. The company pursued a tireless campaign to promote the use of opioids in general, and in 2001 alone, they spent $200 million in marketing and promoting OxyContin.

He was a sharp salesperson with a smooth presentation, armed with invitations to expensive dinners, sports tickets, and theatre seats. The company had trained him to do his job well, and his confidence in his product was overwhelmingly persuasive. My colleagues and I would graciously listen to his presentations and consider his product for our patients. In hindsight, I can understand how providers wanted to help their patients, not put them at risk. However, once the seeds were planted, it was only a matter of time until the unfortunate harvest.

Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009;99(2):221-227. doi:10.2105/AJPH.2007.131714
OxyContin class-action suit to proceed. CMAJ. 2003;169(7):699.


See Jill Mattingly, DHSc, MMSc, PA-C  speak at the GAPA 2021 CME Conference.

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