
Patrick Radden Keefe has reported on the Sackler family and their control of Purdue Pharma, the maker of OxyContin. Among the sources for his article “Empire of Pain” was a whistle-blower named Steven May, a former sales rep who joined Purdue during the heyday of OxyContin. In an interview for the New Yorker Radio Hour, May details how the company flooded the market with a powerful painkiller that it deceptively touted as being nearly as safe as Tylenol. Plus, two beloved cartoonists—Roz Chast and Liana Finck—talk shop.
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David Remnick
From one World Trade center in Manhattan. This is the New Yorker Radio Hour, a co production of the New Yorker and WNYC studios.
Welcome to the New Yorker Radio Hour. I'm David Remnick. Go to any of the great museums of the world and you'll notice the name of the Sackler family. The Sacklers have donated museum wings, whole museums even, and they've funded cancer research, medical schools, a long list of things. But in recent weeks, some of these institutions have said that they are no longer taking donations from the Sacklers. That's because members of the Sackler family own Purdue Pharma, the maker of OxyContin. OxyContin was first advertised as a breakthrough, an opioid that would manage pain better and would actually reduce the potential for drug addiction. Two decades later, I hardly need to tell you OxyContin is a name that's become infamous as one of the drivers of an opioid epidemic that has now cost over 200,000 lives. Dozens of lawsuits have been filed. Just last week, Purdue Pharma settled with the state of Oklahoma for $270 million in damages. The New Yorker's Patrick Radden Keefe has reported extensively on the company. And one of the people he spoke to was a former sales rep, a whistleblower who saw deep problems with Purdue's marketing of the drug. Stephen May started there in 1999 as sales of OxyContin were booming. Patrick spoke with him in 2017.
Patrick Radden Keefe
Tell me, for starters, how did you first come to get into pharmaceutical sales?
Stephen May
Well, actually. Actually, I had a neighbor that lived near me back in the late 90s who was a pharmaceutical sales representative. And I saw that he had a really successful career. And, you know, it was something that I personally wanted to get into. I mean, I knew that the economic benefit was pretty good. So he helped me to get in with his company, which I did in 1998, and started working for a company that actually sold a combination opioid. So I was in the market of Purdue. So I was very familiar with the OxyContin product before even joining Purdue and knowing the growth that they were having, when there was an opportunity to join what was perceived to be the best company to work for in the industry, I basically jumped at it.
Patrick Radden Keefe
And where were you? Exactly? What region were you in?
Stephen May
I was basically covering Southwestern versus Virginia and parts of southern West Virginia.
Patrick Radden Keefe
I see. And there were certain kind of marketing. I know that in some of the early marketing campaigns, what they would say is that OxyContin was the drug to Start with and to stay with. Did you hear that when you were there?
Stephen May
Oh, I use that quite frequently. Yeah. Start with and stay with. So basically the idea is this. You've got a physician that is prescribing a lot of Lortab or Vicin, and those are the combination opiates with hydrocodone or Percocet or Oxycodone that the patient is taking every four to six hours. Well, doctor, if you recognize early on that they're going to have to take an opiate, why not just go ahead and start them on 10 milligrams of oxycontin twice a day instead of getting into that habit forming four or six times a day. So you could start with a low dose, 10 milligrams. If you, if you think about it, 10 milligrams delivered over a period of 12 hours is the same or even less than if a patient took 5 milligrams of hydrocodone or percocet every four or six hours. And at the same time, you're not getting that peak and then that trough and then that peak and then that trough. It's basically a much smoother delayed absorption of the product over a period of 12 hours.
Patrick Radden Keefe
So that's so fascinating. So actually, part of the sale for you guys was that OxyContin might be less prone to addiction and abuse than other drugs?
Stephen May
Yeah, I think the word that was used more often would be habit forming in that case.
Patrick Radden Keefe
I see.
Stephen May
You know, it's habit forming to use something every four hours as opposed to 12 hours.
Patrick Radden Keefe
Yeah, though, I mean, you can use something every 12 hours and have it be a habit as well.
Stephen May
Exactly.
Patrick Radden Keefe
But when you were talking to those physicians, did you get the sense that some, some of them might be prescribing the drug more frequently, like on a more frequent dosing schedule to their patients?
Stephen May
Yeah, I mean, you would have doctors tell you that they were doing that. And what was absolutely crucial as a sales rep to protect your own job? Well, you have to promote the product according to the label. I mean, we're talking about class two medications here. You can get in a lot of trouble. So it was always trying to get the doctor back to, hey, listen, this is a 12 hour drug. I know you said that your patients need to take it three times a day, every eight hours, but it's a 12 hour drug. That's the way it's supposed to be prescribed.
Patrick Radden Keefe
And when they told you that in some instances maybe the patients needed it three times a day and they would be prescribing it as that. Did it strike you at all that if that was what was happening, then the whole kind of marketing thrust that you only needed it twice a day might not actually be true?
Stephen May
It's possible, yes. At the same time, we would also instruct the doctor, if they're having to take it every eight hours versus every 12 hours, perhaps the patient needs to be titrated upwards on the, on the drug to a higher dose.
Patrick Radden Keefe
I see. And so they would take it just twice a day but with a higher dose each time.
Stephen May
Exactly, exactly. That would be the appropriate thing to do.
Patrick Radden Keefe
Gotcha. I mean, it's interesting. So you're going in there, you're meeting with doctors, you're showing them literature to support the drug, but you're not a doctor. Right. You're not a clinician. How comfortable were you with the science of it? I mean, did you have to kind of prepare in advance for questions that you might get from the doctors and know what types of answers you would give them?
Stephen May
Well, that's part of the training that we go to. I mean, we spend three weeks literally, not only learning about the product itself, but you learn about the background of the product. In this case, it was pain management. We learn about the history of pain management. And then you spend a lot of time going through common objections that the doctors would give you.
Patrick Radden Keefe
What kinds of common objections?
Stephen May
Well, I mean, I guess the most common objection that I heard after joining the company was, well, it's just too addictive. I mean, we've got too many problems in our community with overdose deaths. And so basically a lot of time was spent trying to overcome the doctor's objections on that and trying to refocus them and saying, yes, there's going to be people out there that are going to abuse or divert the drug. But basically, we were trained. Let's focus on treating the legitimate pain patients, you know, and if we can focus our, you know, focus on treating those patients, then we'll have the outcomes and the doctors will prescribe the products.
Patrick Radden Keefe
Well, that's. I mean, this is another thing I wanted to ask you about is. So you go out there and the first and biggest objection that you're encountering is, well, geez, you know, aren't these things really addictive? Did you, like, did you believe that they weren't? Was the company telling you that they weren't? Were there studies or was there data that you could give to doctors to say, no, actually, you've got it wrong, this isn't addictive?
Stephen May
Well, I mean, early on, one of the biggest things that I would use, I mean, I memorized the. The specific line in the package insert that was later changed by the FDA, and that was the delayed absorption of the OxyContin was believed to reduce the abuse liability of the drug. That was one of the things that we're trying to express to physicians now. I think that worked for a while, but it wasn't very long into my experience with the company that, well, if they crush up the medication, then that kind of destroys the long acting delivery system. So.
Patrick Radden Keefe
Well, because people were crushing the pills and snorting them or injecting them, melting them.
Stephen May
Exactly, exactly. So there was ways to get around that. And eventually I think the FDA changed the labeling of that. And at some point we were told that we could no longer use that particular language.
Patrick Radden Keefe
So let me understand this. So you get recruited to go work at Purdue Pharma, which has this super elite salesforce. It's got this blockbuster product. They're paying better than a lot of other pharmaceutical companies are.
And then you actually get down there on the ground and it sounds like.
Already there's blowback because in the communities, people realize that there's abuse and addiction. So, I mean, that must have been kind of disillusioning for you. I would think.
Stephen May
It was. I mean, I started seeing it early on. One of my experiences was I had, I think at the time it was a representative who was either the previous national sales rep of the year or they were on track to becoming the national sales representative of the year. So they would come in to help train us, to watch them handle objections from physicians. So we went into a doctor's office in West Virginia and, you know, we were pulled aside and advised that a family member of that particular doctor had died over as a result of an overdose of OxyContin. So that was a pretty significant blow that we both had. So I call that the day that it really hit really close to home for me.
Patrick Radden Keefe
And what year was that roughly?
Stephen May
Oh, that was within a month or two after me joining with the company in 2000. In 2000, yeah.
Patrick Radden Keefe
And you stayed on for another five years?
Stephen May
Yes.
Patrick Radden Keefe
So what did you tell yourself? I mean, did you think these were just isolated incidents or.
Stephen May
You know, quite frankly, I mean, what do you tell yourself? I mean, you really believe that you're doing something, you're doing a righteous duty by trying to treat pain, you know, and you're trying to focus, trying to get physicians on using the product for legitimacy, legitimate paying patients who use the product the right way. I mean, that was my personal focus. And at the same time, it was still a good company to work for. There was more and more challenges. I think we really as a company first started seeing the challenges in West Virginia and southern West Virginia and parts of what anybody calls Appalachia. But you really feel like you're doing something good and at the same time you're recognizing that, hey, look, this is a company that I could work for for a long time. They're going to have other products down the road. So you stay with it for that reason because there's an opportunity for personal growth.
Patrick Radden Keefe
I see. And were you feeling pressure from the company to keep growing the territory?
Stephen May
Oh, absolutely. I mean, it was, you know, how do we turn the doctors minds away from the bad news of what was happening in the community and get them focused on treating the legitimate chronic pain patients? So, yeah, there was a constant push on that.
Patrick Radden Keefe
And you eventually were part of a whistleblower lawsuit against Purdue, is that right?
Stephen May
That's correct.
Patrick Radden Keefe
But it got dismissed.
Stephen May
Yeah, it was dismissed. I mean, it had been in the court system for many years. It's not hard for anybody to look up any information about it. It's Radcliffe May v. Perdue. We had specific allegations that the company had committed fraud and eventually it was dismissed on a technicality.
Patrick Radden Keefe
It was a procedural basis for dismissing it.
Stephen May
That's my understanding, Kurt.
Patrick Radden Keefe
Looking back now, a lot of observers feel that while there are obviously a bunch of companies that make prescription painkillers which are abused, that Purdue Pharma played kind of an instrumental, special role in precipitating the opioid crisis because the company pushed really aggressively to destigmatize the long term use of strong opioids. How do you feel looking back? I mean, do you feel as though Purdue has any culpability in getting us to where we are today in the opioid crisis?
Stephen May
I believe they were absolutely instrumental in it. The culpability is you can't turn a blind eye to the problems that you're creating in the community. And that's one of the things I want to say to the Sackler family. Stand up, be responsible, be proud of your company. Okay, you built a great company. But also take some responsibility for the problems that has been caused by the way that your products are being promoted and how your products are being abused. And at the same time, you're still pushing the promotion of that product that's destroying communities today. I mean, I can't say it any other way. Be accountable.
Patrick Radden Keefe
And is there I mean, is there any sense in which you, on a personal level, look back and feel any guilt or feel any as though you personally have any culpability.
Stephen May
Left? I think as an individual, you're doing your job. You believe that you're doing it righteously. You don't want to do wrong. You want to help people. At the same time, looking back, you go, wow, perhaps I probably should have resigned from the company early on and just walked away from a situation that was growing bad. But at the same time, you look, what was the information that I had at the time? Was there a way to turn this thing around? At the time, I believe there was. But looking back, it saddens me that I was a part of it. I'll say it that way.
David Remnick
That was Stephen May, a former sales rep for Purdue Pharma, talking with the New Yorker's Patrick Radden Keefe. Patrick's piece about the selling of OxyContin called Empire of Pain, was published in the New Yorker in 2017. And I spoke with him then. Now, Patrick, we just heard Stephen May lay blame for the consequences of opioid addictions on the Sackler family. The fact that Purdue is privately held by the descendants of two brothers. How has that affected how it does business now?
Patrick Radden Keefe
Well, it's a very secret company.
It always has been. If this was a publicly traded pharmaceutical company, you'd have shareholders, you'd have earnings calls, you'd have quarterly reports, and there would be a check, a kind of an outside check. But really, this company is the kind of private realm of this one family, and they own it, they control it, they're on the board. The profits all flow to the family. And what this means is when you get into some of these dicey questions about selling a very addictive substance to lots and lots of people, what may be complicated ethical questions that normally you would be able to subject to a larger review in a publicly traded company. Really, they're just decided by the family, and we don't know what goes into that decision making.
David Remnick
What do you think their defense will be, David?
Patrick Radden Keefe
I've wondered about that, and I thought to myself, you know, there might be a kind of libertarian case that could be made, which is essentially in the same way that if you own a firearms company, right. We put a product out there in the world, it's dangerous if used incorrectly. But ultimately, this is a question of individual responsibility.
David Remnick
Libertarian argument. In the world of pharmaceuticals, can you imagine, we're seeing a staggering, tragic number of deaths from overdoses because of this epidemic, especially from heroin, which is deadly and very cheap on the street. OxyContin is legal and it's regulated. So why is it such a problem?
Patrick Radden Keefe
Well, here's the answer. For thousands of years, people have cultivated poppies, and we've known about the therapeutic benefits of opium related narcotics. We've also known for thousands of years that they're really addictive. And this has always been the two sides of the coin. When Purdue pharma and the Sackler family set out to sell oxycontin, what they wanted to do was destigmatize strong opioids. The whole idea was, we've got doctors out there who are reluctant to prescribe these. How do we change their minds? And they set out to change their minds, and they were incredibly effective. So the real issue with the heroin is that once the country is flooded with these opioids, you get a lot of people getting addicted. And once that genie is out of the bottle, it gets very hard to put it back.
So Purdue Pharma, other companies, have tried.
To prevent their pills in more recent years from going to the black market, from getting crushed, from being abused, but it's kind of too late. And in an awful paradox, the harder it gets for somebody who's already addicted to opioids to get access through their doctor to opioids, the more likely it is that they're going to be buying them on the street. It may be too expensive, and they end up buying heroin, which is cheaper. And this is where we get spike in heroin.
David Remnick
Did the Sackler family make any efforts to right or wrong?
Patrick Radden Keefe
Well, they would tell you that they did in that Purdue Pharma reformulated OxyContin in 2010, making it harder to crush and snort.
But I talked to people who said you really have to look at the timing of this because they reformulated OxyContin in 2010, but the patent on the.
Drug was set to expire in 2013.
This is something you actually typically find.
In the life cycle of a branded.
Narcotic, is just as the exclusive patent is about to expire, you tweak the formula in some way so as to make it seem that much different. And then what happens is you reset.
The clock on your exclusive right to produce it, so they would tell you they had. What's interesting is if you look at their philanthropy, this is a family that gives to cancer research, they give to medical schools, they give to art museums, universities. There's nothing for the opioid crisis, nothing for addict treatment. If there is any sense in that family that they bear any moral culpability for where we are today. They're not acting on it.
David Remnick
Patrick, it's an astonishing piece of journalism. I really appreciate it. Thank you.
Patrick Radden Keefe
Thank you.
David Remnick
Patrick. Raden Keefe's article about Purdue Pharma from 2017 is called Empire of Pain, and you can find it@newyorker.com the company is now facing dozens of lawsuits from states and municipalities, and there's even been talk that it may declare bankruptcy. This is the New Yorker Radio Hour. More to come. This is the New Yorker Radio Hour. I'm David Remnick. The list of cartoonists who are household names is a very short list, but Roz Chast is certainly at the top of it. She's been publishing in the New Yorker since she was 24, and her book Can't We Talk About Something More Pleasant? Was a finalist for the national book Award in 2014. Her cartoons stand out for how personal they are. They're about marital tensions and the stress of dealing with your crazy parents and your even crazier children. In her drawings, everyone looks completely frazzled, even the animals.
Liana Fink
Hi, I'm Liana Fink. We are outside Roz Chast's house in Connecticut and I brought her some flowers that might be a bit too romantic. I made it. Oh, my God, you're beautiful.
Roz Chast
Thank you so much. Come on in.
David Remnick
Liana Fink grew up studying Roz's cartoons and she started contributing her own cartoons to the New Yorker a few years ago when she was 27. They share a certain stressed out line and a love of birds.
Roz Chast
This is Jackie. She is a kaik. She's very un shy.
Liana Fink
She looks like a Disney character. She has these big eyes.
Roz Chast
She's a little bit of a cartoon bird.
Liana Fink
I've been falling in love with Jackie. She's trembling while I pet her. I was a really shy kid and I've always felt really comfortable with animals because they don't do the things that I feel like I have to pretend to do, like hold conversations that are really hard for me. I always feel connected to pigeons. I feel like there are these wild creatures in the city and I'm like that too. He's a very good bird.
Roz Chast
This is my very neurotic and very sweet African great. And she says many, many things. As you can see, she plucks.
Liana Fink
She looks like a lion because she has this plucked body and this regal head.
Roz Chast
Hey, Eli, what's this?
Stephen May
That's water.
Roz Chast
That's right. That's right. What a smart bird. What a smart Smart bird. This is a list of the things that she says, by the way. She says chirp, she says chirp, chirp, chirp. Who cares? When she gets scared, sometimes she'll say to herself, it's okay, it's okay, it's okay. Which is, you know, self soothing kind of thing. Yeah, she knows. Yeah, I do. Yeah, I do too. I mean. Yeah, me too. Yeah, it's okay.
Liana Fink
I say fearless.
Roz Chast
I sometimes I say, like, people do this, you know, like when I'm driving, especially because driving and I are not good friends.
Liana Fink
You had a cartoon about driving where you just tell the story of driving, but you call it sailing instead of driving.
Roz Chast
Yeah, it is, it is. I thought maybe if I did a cartoon where I was comfortable with it, like, somehow, like I would actually become more comfortable and, you know, gradually I'm more. It's better than it was when I started. But, I mean, it worked. The cartoon worked, but I still getting lost is. I mean, the GPS is good, but then I worry about the GPS going out.
Liana Fink
I read your work most deeply when I was in high school and college. I think that's why I love the New Yorker. I mean, I know it. I think I was 14 when I found your work. And we had just moved to this suburban, kind of Fancy, kind of WASPy town in New Jersey. And I related so much as this kind of outsider and as a person who drew and as a shy kid and as a Jew, like, it just. It just completely summarized my world. And you got a lot. You got a lot of zeitgeisty stuff in there too. Like, it was much more intense than rereading an old diary or looking at photographs or something. I feel like you really cut that era and cut my life. And how do you feel when you reread your work?
Roz Chast
Hmm, Sometimes it does bring me back because I guess a lot of my work is kind of personal.
Liana Fink
So do you feel like. What do you feel about your cartoons being the most autobiographical ones in the New Yorker?
Roz Chast
Definitely. There's a part of me that is that voice of, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry, sorry. You know, I mean, sometimes I wish that I did a whole different kind of work, you know, but I always think there's that Yiddish, you know, if my grandmother had wheels, she'd be a wagon. You know, I mean, if I were a very different person, then I would do different cartoons.
Liana Fink
Are you terrified of people?
Roz Chast
Oh, yeah, it's. And I know that everything that I say this afternoon, I'm going to rewind in my Head and regret. Oh, no. And that is just what I mean. I'm just almost. I wouldn't quite say used to it, but I just know that that's.
Liana Fink
I still regret some things that I've said to you, like a year ago. And I probably won't think about it all the time.
Roz Chast
It's just like a regretters festival.
Liana Fink
Yeah.
Roz Chast
Well, I'm a very big fan of your work in magazine, too. Thank you. I love seeing it and I love God. Finding all the prayers of mankind in his spam folder, I think is just sensational.
Liana Fink
Thanks. I mean, I didn't care about them. I love working. I don't care if they're good. If I cared, I would be paralyzed.
Roz Chast
Well, do you have ways that you sort of trick yourself of kind of getting out of that?
Liana Fink
I think it might have been easier for me if I were a guy and encouraged to be assertive.
Roz Chast
Do you feel that, like, making jokes sometimes, like, comedy is a way of being assertive and expressing anger that, like, you can be, like, very indirect about it?
Liana Fink
Yeah. Yeah. I don't. I never even thought of myself as funny, and I still don't. I think of myself as really needing to express myself. And I think for some people, that's. I kind of think for you it's the same thing.
Roz Chast
For me, it doesn't seem to work to, like, deliberately, like, try to be funny. I mean, I might make something that. Then I think, well, that's really a pretty good joke. That's pretty funny, but it's not funny.
Liana Fink
Yeah.
Roz Chast
I remember drawing things that made me laugh when I was really little.
Liana Fink
Yeah.
Roz Chast
And that I liked that. I mean, I think when I got to be a certain age, it was like things came out funny, and I didn't really want them necessarily to come out funny, but they came out funny like, you know, drawing horses. And I could not draw horses. I don't. I'm not a horse. I did not like horses.
Liana Fink
When. When I wrote you some fan mail when I was 15. A lot of it was praising your horses. And then your magnificent letter that you wrote back to me contained some drawings of horses.
Roz Chast
Well, it's.
Liana Fink
With their big teeth.
Roz Chast
Yes. They just. I just actually was drawing some horses the other day just for fun, and actually, I'll show them to you right here. I was just trying, you know, just kind of. I was trying to explain to somebody the horse drawings that I did when I was a kid.
Liana Fink
So it's a page of watercolor paper with 20 horses on it, and all of them have Kind of hair that was cool in the 90s, like, sticking straight up. And also this very game grin on their faces. Kind of like bros, you know, highlights for children. Oh, yes.
Roz Chast
Quasi educational magazine for children. It was often in dentists offices, waiting rooms. And, yeah, they had this thing, our own page. And I wanted to get a drawing onto our own page when I was around 10. And I noticed that most of the drawings that were accepted by little girls, rough horses, or quite a number of them were. And so one day I decided I was gonna. God damn it, I was gonna learn to draw horses. I was gonna make myself draw horse after horse until I got it right. And I filled up this sketchbook with drawings of horses. And then I looked at them and I laughed so hard that I nearly, like, lost control of bodily functions. They were just so terrible, but they were so funny and. Hello.
Liana Fink
We hear you. What's it like when you get letters from young women? Do you feel this huge responsibility? People like me probably send you very personal letters in which they maybe think that you're their mom or something. Is it. What's it like?
Roz Chast
Well, I feel like women relate to each other differently from the way men relate to each other. And I don't know, I mean, when I give talks and stuff, it's mostly women in the audience. Different ages, but mostly women, but guys, too.
Liana Fink
I do think there's something different in how we're made. But I also wonder whether there's so many more obstacles for a woman to become something like a cartoonist that maybe the women who. And the obstacles are very insidious and invisible, such as, I don't see anyone like me doing this, so I'm not even going to try. So I wonder if the women who do make it are people who. Who are really, really honest. And I wonder if, like, the way your cartoons are different is you happen to be a really honest person and you're not going to fall into a form that doesn't come from inside of you.
Roz Chast
I don't know. I don't know. I don't know how this relates to that exactly, but I think I felt like, well, you probably won't like me anyway, so I might as well do what I want to do.
David Remnick
Roz Chass is the author of countless great cartoons, and she's got a new book out next month, a collaboration with Patricia Marks. It's called. And you might want to write this down. Why don't you write my eulogy now so I can correct it? A Mother's Suggestions. Leanna Fink's latest book is called Passing for Human and I'm David Remnick. That's the show for today. I want to thank you for listening and I hope you'll join us next time.
The New Yorker Radio Hour is a co production of WNYC Studios and the New Yorker. Our theme music was composed and performed by Meryl Garbus of Toon Yards, with additional music by Alexis Quadrado. Our team includes Alex Barron, Emily Botin, Ave Carrillo, Rhiannon Corby, Jill Duboff, Karen Frillman, Kalalea, David Krasnow, Caroline Lester, Louis Mitchell, Sarah Nix and Steven Valentino, with help from Emily Mann and Jessica Henderson. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.
Episode: How OxyContin Was Sold to the Masses
Date: April 2, 2019
Host: David Remnick
Guests: Patrick Radden Keefe (The New Yorker journalist) and Stephen May (former Purdue Pharma sales rep/whistleblower)
This episode delves into Purdue Pharma's aggressive and controversial marketing of OxyContin, a prescription opioid painkiller widely implicated in spurring the opioid epidemic in the United States. Host David Remnick introduces reporting from Patrick Radden Keefe, including a revealing interview with Stephen May, a former Purdue sales rep turned whistleblower. The discussion examines the drug’s origins, marketing strategies, internal pressures, personal and corporate responsibility, and the ongoing consequences of OxyContin’s proliferation.
"When there was an opportunity to join what was perceived to be the best company to work for in the industry, I basically jumped at it." — Stephen May (01:42)
Sales reps, including May, were trained to suggest OxyContin as a first-line opiate for pain management—starting patients directly on OxyContin rather than milder opioids—touting its longer-acting formula as less habit-forming.
"Oh, I used that quite frequently. Yeah. 'Start with and stay with.'" — Stephen May (02:58)
The selling point was the steady release of the drug, allegedly reducing the risk of habit formation compared to drugs taken every few hours.
Early marketing relied on FDA labeling that suggested OxyContin’s delayed absorption “was believed to reduce the abuse liability of the drug.”
“I memorized the specific line in the package insert...that delayed absorption of the OxyContin was believed to reduce the abuse liability of the drug.” — Stephen May (08:00)
The claim lost credibility as it became clear that pills could be crushed for immediate release, undermining safety assurances.
May encountered entrenched skepticism from doctors who saw addiction and overdose in their own communities, sometimes among their own families.
"We were pulled aside and advised that a family member of that particular doctor had died over as a result of an overdose of OxyContin. So that was a pretty significant blow that we both had. So I call that the day that it really hit really close to home for me." — Stephen May (09:14)
Despite witnessing these issues, May remained at Purdue for five years, wrestling with his sense of duty and the apparent opportunity for both treating pain and personal growth.
Reps were trained to redirect concern about addiction toward “legitimate pain patients”, while finding ways to counter objections.
"A lot of time was spent trying to overcome the doctor's objections on that and trying to refocus them and saying, yes, there's going to be people out there that are going to abuse or divert the drug. But basically, we were trained, let's focus on treating the legitimate pain patients." — Stephen May (06:46)
Sales quotas and company pressure were relentless—reps were pushed to “turn the doctors’ minds away from the bad news… and get them focused on treating the legitimate chronic pain patients.” (11:43)
May participated in a whistleblower lawsuit (Radcliffe May v. Purdue), alleging company fraud, but it was dismissed on a technicality.
Looking back, May holds Purdue and the Sackler family “absolutely instrumental” in precipitating the opioid crisis.
“The culpability is you can’t turn a blind eye to the problems that you’re creating in the community. And that’s one of the things I want to say to the Sackler family. Stand up, be responsible… But also take some responsibility for the problems that has been caused by the way that your products are being promoted and how your products are being abused.” — Stephen May (13:14)
May expresses regret for his role:
“Looking back, it saddens me that I was a part of it. I'll say it that way.” — Stephen May (14:14)
“The profits all flow to the family. And what this means is when you get into some of these dicey questions... they’re just decided by the family, and we don’t know what goes into that decision making.” — Patrick Radden Keefe (15:45)
Keefe speculates the Sacklers may use a libertarian defense, likening themselves to gun manufacturers: “We put a product out there… but ultimately this is a question of individual responsibility.” (16:35)
He outlines the ancient dichotomy: opiates are effective painkillers, but always carry high addiction risk.
“Once that genie is out of the bottle, it gets very hard to put it back.” — Patrick Radden Keefe (17:13)
Stephen May on Reality vs. Training (09:14):
“I call that the day that it really hit really close to home for me.”
— after learning that a doctor’s family member died from OxyContin.
On Company Pressure (11:43):
“How do we turn the doctors minds away from the bad news of what was happening in the community and get them focused on treating the legitimate chronic pain patients?”
On Responsibility (13:14):
“The culpability is you can’t turn a blind eye to the problems that you’re creating in the community…"
Patrick Radden Keefe on the Family’s Power (15:45):
“…when you get into some of these dicey questions about selling a very addictive substance to lots and lots of people… they’re just decided by the family, and we don’t know what goes into that decision making.”
On Moral Culpability (19:06):
“…if there is any sense in that family that they bear any moral culpability for where we are today, they’re not acting on it.”
This episode provides an intimate and critical look at the rise of OxyContin and the marketing strategies that fueled an American public health catastrophe. Through Stephen May's testimony and Patrick Radden Keefe’s analysis, listeners gain insight into the ethical blindness, corporate pressures, and downstream societal damage involved—making clear the enduring impact of Purdue Pharma and the Sackler family on the opioid epidemic.