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Pain Killer.

Pain Killer Barry Meier Rodale 323 pp., $24.95

As trial lawyers, we are very familiar with stories of new, overpromoted pharmaceutical products in which highly predictable adverse events turn into public health disasters after the drugs hit the market. This account of OxyContin, by New York Times journalist Barry Meier, fits squarely into that story line.

OxyContin, an opioid painkiller, was introduced in 1996 by Purdue Pharma. The company, owned and operated by the philanthropic Sackler family, entered the pharmaceutical business by purchasing a small New York drug company, Purdue Frederick, in 1952. In the 1960s, owner Arthur Sackler, a physician and pioneer in direct-to-consumer advertising, helped create the marketing buzz for Librium and Valium, the greatest pharmaceutical successes of their era. In the 1990s, Purdue Frederick created Purdue Pharma to help market OxyContin.

The key active ingredient of OxyContin is oxycodone--the same substance used in Percocet, Percodan, and Tylox. Armed with questionable science and the FDA's approval, Purdue Pharma touted OxyContin as a less-addictive narcotic alternative to those more familiar products because of its novel formulation: a time release that would thwart those looking for a quick jolt. The claim of decreased addictiveness proved false.

While other oxycodone-based painkillers contained about 5 mg of oxycodone per tablet, the smallest dose of OxyContin contained twice that amount, with stronger dosages available at 20, 40, 80, and 160 mg per tablet. Meier writes, "In terms of narcotic firepower, OxyContin was a nuclear weapon."

By 1999, Purdue Pharma began receiving anecdotal reports that addicts were circumventing the time-release mechanism by crushing the tablet and snorting it to get a potent high that led to overdoses and, in some cases, death. Despite this, the company continued its aggressive promotional campaign, using the standard pharmaceutical-industry tactics of doctor-office giveaways and coupons for free samples. It also clung to its stated belief that OxyContin was less prone to abuse than other narcotics and began pitching it for chronic and more moderate pain, like backaches and arthritis.

On February 9, 2001, Meier wrote a special report for the New York Times about OxyContin, "Cancer Painkillers Pose New Abuse Threat." Although smaller papers had reported on both abuse of the drug and indictments against doctors for allegedly overprescribing it, Meier's article triggered a national interest in OxyContin. Over the next 13 months, he continued to explore the drug in articles that examined the battles waged by a concerned public, government regulators, and alarmed doctors against the drug company, which was eager to hold onto its market share at all costs.

Meier's reports of the OxyContin war up to mid-2003 culminated in this book. Indeed, it is an unfinished saga. Part crime thriller; part soap opera, part sociological history, part business expose, the book weaves together stories of a high school cheerleader's descent into addiction and her mother's frustrating attempts to find successful treatment, a doctor's battle to save his rural community from the ravages of this so-called hillbilly heroin, and the pharmaceutical company's response to the growing number of addictions and deaths traced to the drug.

Filled with fascinating details, Pain Killer discusses the broad social and legal issues that intersected to create the OxyContin crisis--pain-management advocates decrying the inadequate relief being offered to cancer and chronic pain sufferers; insufficient prescription monitoring by doctors, pharmacies, and d rug companies; and overpromotion by a too-zealous sales force anxious to increase its market share in the highly lucrative pain market.

Meier does not blame Purdue Pharma for failing to anticipate the serious drug-abuse problem its product created, but he does criticize it for failing to respond more quickly and forcefully to reports of OxyContin abuse. He suggests that the company put its annual billion-dollar revenue before its public health responsibilities.

Of particular interest to trial lawyers, Meier discusses a 1998 study published in the Canadian Medical Association Journal finding that drug abusers actively sought slow-release pain medication--and a related editorial warning against the misguided assumption that a slow-release mechanism would protect against recreational use.

Even lawyers who are already involved in cases over the drug OxyContin will find new information in this book, and those considering the litigation will find it provides an excellent overview of important facts. Unfortunately, there is little mention of the ongoing personal injury litigation, although it is now well under way.

Nevertheless, for readers who have been skeptical about the viability of OxyContin cases, the book may whet their appetite enough for another look.

DIANE FENNER handles mass tort and complex class action litigation in Bala Cynwyd, Pennsylvania.
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Author:Fenner, Diane
Article Type:Book Review
Date:May 1, 2004
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