How Did The Opioid Epidemic In NC Begin?

How Did The Opioid Epidemic In NC Begin?

How Did The Opioid Epidemic In NC Begin?

Opioid abuse has hit an all-time high in NC. Over recent months, North Carolina Attorney General Josh Stein has been highlighting the issue, but how did we get here? How did we get to the point of abuse before we realized the problem existed in the first place? How did the North Carolina opioid epidemic begin?

A painfully successful decade

In the 1990s, pain management advocacy organizations argued that the United States was facing an epidemic of “untreated pain”. Indeed, while the American Pain Society was seeking recognition of pain as “the fifth vital sign”, OxyContin was being hailed for its ability to treat chronic pain. Then, in 1996, amidst the growing disenchantment toward the effectiveness of pain management services, Purdue Pharma began manufacturing OxyContin in the US.

To successfully launch its new product, the company’s marketing professionals and sales representatives carried free samples, passed out gifts, and invited primary care physicians on all expenses paid trips to symposia around the country. These and other grassroots efforts helped Purdue Pharma sell approximately 670,000 prescriptions just one year after starting production.

Once OxyContin established itself in the marketplace, Purdue scrambled to sustain the exponential growth it enjoyed in year one. To do so, the pharma giant developed a sophisticated campaign which used market data to influence the prescription decisions of individual physicians. Here’s how it worked: Using prescribing data, Purdue was able to determine down to the zip code which primary physicians were most likely to prescribe opioids. Armed with this behavior data, Purdue blitzed physicians with relevant marketing messages and promotional items like fishing hats, toys, and even music CDs titled “Get in the swing with Oxy”.

Purdue coupled the marketing initiative with an attractive bonus system for OxyContin sales representatives – paying out a total of $40M in bonuses over one fiscal year. Such an aggressive and zealous campaign was unheard of for a schedule II opioid like OxyContin.

Sales of OxyContin increased from $48M in 1996 to over $1B by the millennium. And by 2002, annual prescriptions had reached 6.2 million; all this despite the fact that no studies showed any increased success in using opioid medication to treat chronic pain.

Were the doctors fooled?

Of course, many primary care physicians were worried about the risk of addiction when all this started. But Purdue was prepared. To combat suspicion, Purdue’s sales reps would deemphasize the risk by telling physicians that addiction rates were “less than one percent”. The available evidence base, however, tells us that non-cancer pain management addiction risk is closer to 25%. Some studies even reflect an addiction rate as high as 45%!

Where we are today

By consistently embellishing the benefits of opioids for pain management, and by specifically misrepresenting the risks associated with their use, Purdue Pharma was able to downplay and even eliminate physicians’ apprehension with the drug. This led to increases in prescriptions and helped Purdue achieve dramatic increases in revenue from OxyContin sales in a relatively short period of time.

Conversely, it left the state of North Carolina with problem on its hands. In the early 2000s, people began to abuse OxyContin as a way to get high. The abuse spread like wildfire because the drug was so widely available. Those with leftover pills from a prescription were selling their extras at a large profit to any and everyone, and just like that the opioid epidemic took off. Now, nearly two decades since widespread abuse began, state health officials call the opioid epidemic the “number one health crisis in North Carolina.”

Who is to blame?

Often it is not only the manufacturers who the courts have held responsible for opioid addiction, but physicians, pharmacies, and other entities involved in the consumer funnel have also been deemed liable in certain cases.

If you or someone you love has been injured or killed by opioid addiction, you could be entitled to legal compensation. Our firm has handled these cases for years, and we can bring our experience to bear for you. Contact the Law Office of D. Hardison Wood today to speak to an opioid overdose lawyer today. Your initial consultation is free of charge.


Maxwell, JC. The Prescription Drug Epidemic in the United States, Drug and Alcohol Review. May 2011.

Van Zee, Art. The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, American Journal of Public Health. February 2009.


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