ok so it was classified as being highly addictive decades before its clinical use.
And Purdue didn’t object to that classification nor try to get it moved to a lesser schedule because all the science showed it was highly addictive and thus fit the definition of schedule 2
Their argument was that the slow release formulation of oxycontin was less addictive than instant release oxycodone and injectable morphine products. They used favorable data and cherry picked studies which supported this marketing strategy. Further, they failed to indicate how easily very high doses of oxycodone could be liberated from time release formulations resulting in much higher doses of pure oxycodone HCL than say a oxycodone w/APAP 5/325 which was much more difficult to misuse (CWE was the primary way to alter it for concentrated doses w/o paracetamol which was fairly esoteric knowledge to the general pre-internet american). While the appropriate use of oxycontin (as prescribed, by mouth) is less compulsive than taking an equipotent dose of instant release oxycodone by mouth, and certainly less compulsive than taking it by more direct ROAs such as sublingual, nasal, or IV, it was incredibly easy to liberate from the time-release.
The marketing reps were trained to indicate that this was why it was okay to use oxycodone (formerly reserved for the management of severe pain related to things like post-operative analgesia, cancer, and other types of highly painful ailments) in the OC formulation in a much less restrictive way. Even as their reps began to notice that physicians were prescribing to many patients, and noticed that waiting rooms began to demonstrate the obvious signs of addiction with increasing frequency, those who chose to flag this to their managers at Purdue were placated, silenced, or transferred off of oxycontin. It wasn't until state and federal attorneys were contacted by former reps that this information began to go public at the end of the 90s.
The abatement settlements were not finalized until the early 2020s - nearly 2 decades later.
By targeting medical students, funding med schools, providing physicians with a very lucrative revenue stream in addition to added corporate perks, purdue was able to change the profession's belief that oxycodone's schedule II status was as severe as it should have been seen. I would also remind you that many providers routinely prescribe other schedule II drugs like methylphenidate, dextroamphetamine, and were familiar with the relatively moderately effective MS-Contin which had been much less widely misused owing to morphine's poor efficacy as an oral drug.
Did you know that the Sackler's first blockbuster drug was Valium (diazepam) in the early 1960s? That their next big drug was MS-Contin? They were acutely aware of the profits that could come from the most addictive drugs that were available for to prescribe. Since they stayed on the legal side of the federal register, they could follow the playbook of the cartels while avoiding legal consequences.
The drug had a big red C|| label on it since its first use. C|| means highly addictive.
There was no label on the bottle saying it wasn’t addictive - only a label on the bottle saying it was highly addictive.
On which bottle?
The package insert contained a black box warning which patients may or may not have looked at, and even if they did, contained instructions for how to make the drug more easily misused.
Further, corporate-owned pharmacies such as CVS, Walgreens, and Rite-Aid were also found liable for not doing enough to educate pharmacy patients about the risks of misuse and dependence, and failed to identify and prevent risks for diversion, misuse, or overprescribing among clients and prescribing providers. These lawsuits were settled in the late 2010s and have resulted in much stricter labelling on pharmacy bottles containing drugs like Oxycontin, as well as stricter protocols are patient monitoring, early refills, and using multiple prescribers. It was during the 2010s that the prescription monitoring program (PMP) came into widespread use, where pharmacies and prescribers were required to check a multistate database for the history of a patient's controlled substance prescriptions, and these checks must occur before prescribing by the provider, and before dispensing at the pharmacy.
Prior to PMP roll out, it was very easy to get multiple prescriptions filled for the same or similar drugs by using multiple prescribers, multiple pharmacies, and paying out of pocket, as insurance was one of the few checks that might pick up on therapeutic duplications.
I used to do this very thing back every month back in 2007 - I'd fill clonazepam, Ambien CR, suboxone, and Focalin (dexmethylphenidate) at CVS using my insurance, while I'd go to walgreens to fill lorazepam, generic zolpidem, and generic methylphenidate across the street. For nearly a year I was double dipping by using my buprenorphine doc to prescribe meds that my psychiatrist had been prescribing as well, and simply telling the bupe doc that she was who I saw for all of these medications. I never once got caught.
