Patrick Radden Keefe on How the Marketing of OxyContin Helped Create the Opioid Epidemic

Summary

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Podcast Summary | The Political Scene | The New Yorker

Episode: Patrick Radden Keefe on How the Marketing of OxyContin Helped Create the Opioid Epidemic
Date: October 30, 2017
Featured Guests: Patrick Radden Keefe (The New Yorker), Stephen May (former Purdue Pharma sales rep), David Remnick (host)

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Episode Overview

This episode explores Purdue Pharma's aggressive marketing of OxyContin and how it contributed to the opioid epidemic in the United States. Patrick Radden Keefe, a journalist who has reported extensively on Purdue and the Sackler family, interviews former Purdue sales representative Stephen May. The discussion delves into the sales tactics used to push OxyContin, the response to growing evidence of abuse and addiction, and personal and corporate culpability. The episode also examines the role and responsibility of the Sackler family, who privately own Purdue Pharma.

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Key Discussion Points & Insights

1. Getting Into Pharmaceutical Sales (02:24 – 03:23)

• Stephen May joined the pharmaceutical industry in the late 1990s, initially motivated by the career success he saw in a neighbor.
• He started with a company selling combination opioids and soon moved to Purdue, then considered the best in the industry.
• May covered southwestern Virginia and southern West Virginia, regions heavily affected by the opioid crisis.

2. The Core OxyContin Sales Pitch (03:35 – 05:14)

• Sales reps consistently promoted the mantra: “Start with and stay with” OxyContin for pain management.

  “I use that quite frequently. ... 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?” – Stephen May (03:48)

• The pitch framed OxyContin's twice-daily dosing as less habit-forming than shorter-acting opioids, despite the fact that dependency risks remained.

3. Addressing Addiction Concerns (07:33 – 09:28)

• Doctors often objected to OxyContin, citing its addictiveness and links to overdose deaths in their communities.
• Reps were trained to counter this by focusing on “legitimate” pain patients and by referencing drug literature claiming reduced abuse risk due to delayed absorption.

  “The delayed absorption of the OxyContin was believed to reduce the abuse liability of the drug.” – Stephen May (08:51)

• May notes that reps later learned these claims became invalid once the pills were crushed and misused—the delivery mechanism could be circumvented.

4. Experiencing the Human Cost (10:18 – 12:21)

• May recounts a pivotal moment visiting a doctor in West Virginia who had just lost a family member to an OxyContin overdose.

  “We were pulled aside and advised that a family member of that particular doctor had died as a result of an overdose of OxyContin. So that was a pretty significant blow that we both had. ... I call that the day it really hit close to home for me.” – Stephen May (10:18)

• Despite this, both economic opportunity and a belief in helping legitimate pain patients kept him at Purdue for several more years.

5. Pressure and Whistleblowing (12:26 – 14:05)

• Sales reps faced ongoing pressure from Purdue management to expand their territories and maintain focus on prescriptions for chronic pain, turning doctors’ attention away from community harm.
• May later participated in a whistleblower lawsuit concerning fraudulent practices, which was dismissed on procedural grounds.

6. Culpability and Corporate Responsibility (14:05 – 15:58)

• May strongly asserts Purdue’s—and specifically the Sackler family’s—instrumental role in the opioid epidemic.

  “You can’t turn a blind eye to the problems that you’re creating in the community. … Be accountable.” – Stephen May (14:05)

• Personally, May expresses regret and wrestles with his own role, though at the time, he believed he was acting righteously:

  “Looking back, it saddens me that I was a part of it. I’ll say it that way.” – Stephen May (15:58)

7. The Sackler Family’s Secrecy and Business Model (16:28 – 18:16)

• Patrick Radden Keefe and David Remnick discuss the Sackler family's control of Purdue, shielded from public scrutiny by its private ownership.

  “If this was a publicly traded pharmaceutical company ... there would be a check, a kind of outside check. But really, this company is the kind of private realm of this one family.” – David Remnick (16:28)

• The Sacklers’ preference for public philanthropy over visible involvement in Purdue is highlighted.

  “My favorite example ... at the Tate Modern in London, there is Sackler Escalator ... But if you go to the website of Purdue Pharma ... it’ll take you a while to actually find the Sackler name.” – David Remnick (17:49)

8. The Ongoing Opioid Crisis and Sackler Accountability (18:37 – 21:18)

• Keefe and Remnick discuss potential legal risks for the Sacklers, who have largely avoided direct ties to Purdue in public.
• Remnick frames the opioid crisis as a problem exacerbated by the marketing push to destigmatize strong opioid prescriptions.
• Remnick notes the company’s 2010 reformulation of OxyContin (designed to deter abuse) occurred conveniently as their patent was about to expire, suggesting business motivations.

  “This is something you actually typically find ... you tweak the formula in some way so as to make it seem that much different. ... you reset the clock on your exclusive right to produce it.” – David Remnick (20:15)

• Despite vast philanthropic contributions, the Sacklers have not donated to opioid treatment or addiction solutions, prompting further questions about their sense of responsibility.

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Memorable Quotes

• On the mindset of sales reps:

  “You believe that you’re doing it righteously. You don’t want to do wrong. ... looking back, it saddens me that I was a part of it.”
  – Stephen May (15:58)

• On corporate responsibility:

  “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. … Be accountable.”
  – Stephen May (14:05)

• On marketing reality vs. community impact:

  “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 ... yeah, there was a constant push on that.”
  – Stephen May (12:33)

• On family secrecy and absence of accountability:

  “The profits all flow to the family. ... When you get into some of these dicey questions about selling a very addictive substance ... they're just decided by the family.”
  – David Remnick (16:28)

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Important Timestamps

• 02:24-03:23: Stephen May describes entering pharmaceutical sales and his coverage region.
• 03:35-05:14: Explanation of “start with and stay with” sales tactics for OxyContin.
• 07:33-09:28: Training to address addiction objections; use of deceptive literature.
• 10:18-12:21: May’s first personal encounter with the epidemic's impact.
• 14:05-15:58: Stephen May on Purdue and Sackler family culpability, and his personal reckoning.
• 16:28-18:16: Discussion of the Sackler family's secrecy and corporate governance.
• 20:15-21:18: Remnick and Keefe on the timing of OxyContin’s reformulation and the Sacklers’ philanthropic choices.

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Tone and Style

The conversation is measured, probing, and at times deeply personal. Stephen May’s perspective illuminates the conflict between corporate messaging and reality on the ground, while Keefe and Remnick offer critical context on the Sackler family’s evasions and the broader implications for public health. The mood shifts between procedural analysis, moral questioning, and moments of marked regret.

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This summary offers a comprehensive snapshot of the episode’s core revelations about the intersection of pharmaceutical marketing, addiction, and responsibility without requiring prior listening.

Transcript

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[Stephen May]

On today's Politics and More podcast, the New Yorker's Patrick Radden Keefe talks to Stephen May over a former salesman at Purdue Pharma, the company that manufactures OxyContin. May explains how the aggressive marketing of the drug may have contributed to the opioid crisis.

[Patrick Radden Keefe]

When the drug OxyContin first came into the market in 1995, it was advertised as a breakthrough, an opioid that would manage pain better and would actually reduce the potential for addiction. But just two decades later, OxyContin is a name that's become almost infamous in American life as the opioid crisis reaches truly awful proportions. The New Yorker's Patrick Radden Keefe has been reporting on Purdue Pharma, the company that developed OxyContin, and the Sackler family, which controls it. One of the people Patrick spoke with was a man named Stephen May, an insider who saw exactly how the company's marketing worked. May is a former sales rep for Purdue, and he started there in 1999 as sales of OxyContin were booming.

[David Remnick]

Tell me, for starters, how did you first come to get into pharmaceutical sales?

[Stephen May]

Well, actually, I had a neighbor that lived near me back in the late 90s who was a pharmaceutical sales representative. And, and I saw that he had a really successful career and 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.

[David Remnick]

And where were you exactly? What region were you in?

[Stephen May]

I was basically covering southwestern Virginia and parts of southern West Virginia.

[David Remnick]

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 Lortabicin, 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 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.

[David Remnick]

But 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, I see it's habit forming to use something every four hours as opposed to 12 hours.

[David Remnick]

Yeah. Though I mean, you can use something every 12 hours and have it be a habit as well.

[Stephen May]

Exactly.

[David Remnick]

But when you were talking to those physicians, did you get the sense that 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 to, you know, is, 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, you know, three times a day, every eight hours, but it's a 12 hour drug. That's the way it's supposed to be prescribed.

[David Remnick]

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 drug to a higher dose.

[David Remnick]

I see. 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.

[David Remnick]

Gotcha. I mean, it's interesting. So you're, 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.

[David Remnick]

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, you know, 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, you know, 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.

[David Remnick]

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, aren't these things really addictive? 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, 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 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, that we're trying to express to physicians now that 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.

[David Remnick]

Well, because people were crushing the pills and snorting them or injecting them, melting them.

[Stephen May]

Exactly, exactly. There was ways to get around that. 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.

[David Remnick]

Let me understand this. You get recruited to go work at Purdue Pharma, which has this super elite sales force. 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 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 we were pulled aside and advised that a family member of that particular doctor had died 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.

[David Remnick]

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.

[David Remnick]

And you stayed on for another five years?

[Stephen May]

Yes.

[David Remnick]

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 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 legitimate pain patients who use the product the right way. I mean, that was my personal focus. And at the same time, it was. 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.

[David Remnick]

I see. And were you feeling pressure from the company to keep growing the territory?

[Stephen May]

Oh, absolutely. I mean, it was. 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.

[David Remnick]

And you eventually were part of a whistleblower lawsuit against Purdue, is that right?

[Stephen May]

That's correct.

[David Remnick]

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 technical.

[David Remnick]

It was a procedural basis for dismissing it.

[Stephen May]

That's my understanding, Kurt.

[David Remnick]

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.

[David Remnick]

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]

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.

[Patrick Radden Keefe]

That was Stephen May, a former sales rep for Purdue Pharma, talking with the New Yorker's Patrick Raden Keefe. Patrick just published a piece in the New Yorker called Empire of Pain about the selling of OxyContin. 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?

[David Remnick]

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 kind of 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.

[Patrick Radden Keefe]

What do you think's ahead for the Sackler family? Do you think they face investigation, whether it's congressional or law enforcement?

[David Remnick]

Well, they've been incredibly successful over the years at distancing themselves from the company that has made them all this money. So this is a family that, according to Forbes, is worth about $14 billion. And a lot of people don't necessarily realize the connection. They just know that there are these nice wealthy people that they meet in New York or in London who give money to museums and universities.

[Patrick Radden Keefe]

Right? Their name is plastered all over any number of museum wings and buildings and all the rest. And yet not so much on the.

[David Remnick]

Not on the company. No, this is a family that has a kind of a mania for putting their name on things. My favorite example of this is if you go to the Tate Modern in London, there is Sackler Escalator, an escalator named after the Sackler family. But if you go to the website of Purdue Pharma, the company that they own, which is really the source of most of their wealth in recent decades, you can search and search and it'll take you a while to actually find the Sackler name.

[Patrick Radden Keefe]

What do you think their defense will be, David?

[David Remnick]

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.

[Patrick Radden Keefe]

A 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?

[David Remnick]

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 mind. 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 in 2017 to get access through their doctor to opioids, the more likely it is that they're gonna 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 the spike in heroin.

[Patrick Radden Keefe]

Did the Sackler family make any efforts to right or wrong?

[David Remnick]

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 addiction 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.

[Patrick Radden Keefe]

Patrick, it's an astonishing piece of journalism. I really appreciate it. Thank you.

[David Remnick]

Thank you. That was Patrick Radden Keefe talking to.

[Stephen May]

Stephen May.

[Patrick Radden Keefe]

Right now. We are living through some of the most tumultuous political times our country has ever known. I'm David Remnick, and each week on the New Yorker Radio Hour. I'll try to make sense of what's happening alongside politicians and thinkers like Cory Booker, Nancy Pelosi, Liz Cheney, Tim Waltz, Ketanji Brown Jackson, Newt Gingrich, Robert F. Kennedy, Jr. Charlemagne, tha God, and so many more. That's all in the New Yorker Radio Hour, wherever you listen to podcasts.

[David Remnick]

From prx.