From the Journals

OxyContin marketing push still exacting a deadly toll, study says



Aggressive marketing of OxyContin in the mid-1990s not only fueled the opioid crisis but also the spread of infectious diseases associated with injection drug use, a new analysis shows.

The uptick in rates of infectious diseases, namely, hepatitis and infective endocarditis, occurred after 2010, when OxyContin maker Purdue Pharma reformulated OxyContin to make it harder to crush and snort. This led many people who were already addicted to the powerful pain pills to move on to injecting heroin or fentanyl, which fueled the spread of infectious disease.

“Our results suggest that the mortality and morbidity consequences of OxyContin marketing continue to be salient more than 25 years later,” write Julia Dennett, PhD, and Gregg Gonsalves, PhD, with Yale University School of Public Health, New Haven, Conn.

Their study was published online in Health Affairs.

Long-term effects revealed

Until now, the long-term effects of widespread OxyContin marketing with regard to complications of injection drug use were unknown.

Dr. Dennett and Dr. Gonsalves evaluated the effects of OxyContin marketing on the long-term trajectories of various injection drug use–related outcomes. Using a difference-in-difference analysis, they compared states with high vs. low exposure to OxyContin marketing before and after the 2010 reformulation of the drug.

Before 2010, rates of infections associated with injection drug use and overdose deaths were similar in high- and low-marketing states, they found.

Those rates diverged after the 2010 reformulation, with more infections related to injection drug use in states exposed to more marketing.

Specifically, from 2010 until 2020, high-exposure states saw, on average, an additional 0.85 acute hepatitis B cases, 0.83 hepatitis C cases, and 0.62 cases of death from infective endocarditis per 100,000 residents.

High-exposure states also had 5.3 more deaths per 100,000 residents from synthetic opioid overdose.

“Prior to 2010, among these states, there were generally no statistically significant differences in these outcomes. After 2010, you saw them diverge dramatically,” Dr. Dennett said in a news release.

Dr. Dennett and Dr. Gonsalves say their findings support the view that the opioid epidemic is creating a converging public health crisis, as it is fueling a surge in infectious diseases, particularly hepatitis, infective endocarditis, and HIV.

“This study highlights a critical need for actions to address the spread of viral and bacterial infections and overdose associated with injection drug use, both in the states that were subject to Purdue’s promotional campaign and across the U.S. more broadly,” they add.

Purdue Pharma did not provide a comment on the study.

Funding for the study was provided by the National Institute on Drug Abuse. Disclosures for Dr. Dennett and Dr. Gonsalves were not available.

A version of this article first appeared on

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