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)

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.

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.

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)

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.

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.

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.