The complaint states that Purdue "aggressively promoted OxyContin to doctors, nurses and consumers as a first-choice analgesic for treatment of a wide variety of pain symptoms" and that it "avoided and minimized the known risks of OxyContin abuse, addiction and diversion." It alleges that "Purdue’s goals have been to increase the number of doctors prescribing OxyContin, increase the number of patients taking OxyContin, and increase the OxyContin dosages prescribed by doctors, all in order to increase OxyContin sales and generate profits for Purdue." It further notes that Purdue promoted OxyContin "to a wide variety of doctors, without regard for their training or experience prescribing opioids," leading to "dramatic increases in OxyContin prescriptions."

The authors state: "In this study we investigated and evaluated strategies used by opioid manufacturers to encourage overprescribing, specifically focusing on oncology." They describe that manufacturers used techniques such as paid speaker programs, free meals, and honoraria to "build relationships with oncologists and normalize higher-dose and longer-term opioid prescribing." The paper concludes that these marketing strategies "were aligned with corporate goals to expand opioid sales" and that they contributed to "patterns of opioid overprescribing in oncology practice."

The introduction and marketing of OxyContin (a sustained-release formulation of oxycodone) in 1996 by Purdue Pharma was a commercial success but a public health tragedy. When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000. Purdue's aggressive marketing campaign significantly contributed to the increase in oxycodone use and to OxyContin becoming a leading drug of abuse. Purdue overstated the benefits and downplayed the risks of OxyContin, particularly its addiction risk, in its promotional campaigns.

Purdue admitted that it marketed and sold OxyContin to health care providers, even though it had reason to believe that those providers were diverting opioids to abusers. Purdue further admitted that it marketed its opioids as having lower addiction and abuse risks than they did. The company also admitted to paying kickbacks to health care providers to induce them to prescribe even more opioids, thereby increasing Purdue’s profits.

The first wave of the opioid crisis began in the 1990s with a dramatic increase in prescribing of opioid pain medications driven in part by aggressive marketing by pharmaceutical companies. Manufacturers promoted opioids for a wide range of pain conditions and downplayed addiction risk, despite limited evidence for long-term effectiveness. These marketing practices contributed to widespread overprescribing and massive increases in company revenues from opioid sales.

A legal analysis in the Journal of Law, Medicine & Ethics notes that "for opioids, though, government payment for excessive prescriptions under public insurance programs directly contributed to companies' profits" and that manufacturers, distributors, and pharmacies "had strong financial incentives to encourage sales of prescription opioids even when those sales were not medically necessary." The article discusses evidence that companies used aggressive marketing and misbranding to expand the market for opioids, including for chronic, non‑cancer pain, thereby increasing volume of prescribing and profits.

This cohort study of U.S. counties reports that "counties in which physicians received more opioid marketing were more likely to have higher rates of opioid prescribing and subsequently higher rates of overdose deaths." It finds that "the number of marketing interactions and the total dollar value of marketing were both associated with increased opioid prescribing." The authors conclude that "pharmaceutical industry marketing of opioid products to physicians is associated with increased opioid prescribing and elevated mortality from opioid overdoses," suggesting that marketing strategies contributed to patterns of overprescription.

The Commission concludes that the North American opioid crisis was precipitated by a confluence of factors, including unprecedented commercial promotion of prescription opioids. Manufacturers promoted opioids for chronic non-cancer pain with claims of low addiction risk that were not supported by high-quality evidence, while failing to adequately warn about dependence and overdose risks. These marketing practices drove a surge in opioid prescribing and generated billions of dollars in revenue for pharmaceutical companies.

The current opioid crisis ranks as one of the most devastating public health catastrophes of our time. It started in the mid-1990s when the powerful agent OxyContin, promoted by Purdue Pharma and approved by the Food and Drug Administration (FDA), triggered the first wave of deaths linked to use of legal prescription opioids.[5] One major conclusion is that the crisis represents a multi-system failure of regulation. OxyContin approval is one example—Purdue Pharma was later shown to have presented a fraudulent description of the drug as less addictive than other opioids. The profit motive of the pharmaceutical industry remains ever present, and post-approval it is usually left up to industry—not regulators—to educate and advise prescribers, a system that allowed aggressive promotion to prescribers to flourish.[5]

This study of U.S. counties reports that "In 2014, 1 in 12 physicians received opioid‑related marketing, totaling $39.7 million" and that "greater marketing of opioids was associated with greater opioid prescribing." The authors found that "each additional 3 payments to physicians in a county was associated with an 18% increase in opioid overdose deaths" over the following years, suggesting that marketing efforts contributed to higher prescribing volumes. They interpret this as evidence that industry promotion of opioids was "tied to financial incentives that align physician behavior with manufacturer profit goals."

We document that pharmaceutical companies targeted high-prescribing physicians with aggressive marketing of opioid painkillers. Using detailed marketing data, we show that increases in opioid marketing to physicians led to substantial growth in opioid prescribing and in overdoses. The marketing campaigns emphasized benefits while minimizing risks, and were highly profitable to manufacturers because each additional prescription generated revenue while the costs of marketing visits and payments to physicians were relatively small.

Describing a study in The Quarterly Journal of Economics, the article notes that Purdue Pharma was "eager to market its new drug OxyContin in 1996" and that internal Purdue documents described certain "triplicate states" as "important barriers to OxyContin prescribing, with lower expected returns from marketing spending" and recommended that "the product [OxyContin] should only be positioned to physicians in non-triplicate states." The research finds that the "introduction and marketing of Oxycontin explain a large share of the overdose deaths in the last 20 years" and that states with lower exposure to OxyContin’s launch and marketing would have had substantially fewer opioid overdose deaths, providing empirical evidence that the origins of the opioid crisis "lie in the marketing of OxyContin."

Owned by the Sackler family, the company is known for aggressively and deceptively marketing opioids—OxyContin in particular—to prescribing doctors.[1] After the 2015 lawsuit, Purdue Pharma significantly decreased spending to promote OxyContin. But the UW study shows the lawsuit had the opposite effect on competing pharmaceutical companies: Competitors increased their spending instead, promoting opioids to physicians previously pursued by Purdue Pharma, including in counties where the opioid crisis was known to be severe.[1] Researchers found that competitor spending on marketing to these prescribers increased by 160% from 2016 to 2017, and the increase occurred regardless of whether prescribers’ counties were above or below the national median in opioid overdose deaths per capita, suggesting marketing was driven by commercial opportunity rather than public health concerns.[1]

Purdue Pharma aggressively marketed OxyContin as a safe pain medicine. As sales and profits increased, so did the number of patients addicted to painkillers.[2] Purdue and its sales team convinced doctors of the safety of OxyContin and claimed to have reduced the dangerous side effects and addictive qualities of oxycodone. Officers and employees of Purdue Pharma seem to have consciously profited the company and themselves by pushing OxyContin as a pain killer with no significant side effects. Purdue incentivized its sales force to convince doctors to maximize sales, unethically encouraged doctors to prescribe the drug, and ignored evidence it had regarding ‘pill mills.’[2]

Stanford professor Keith Humphreys explains that pharmaceutical companies "heavily pushed the use of opioids as a humane treatment option, often using paid physician consultants" to promote them. He notes that companies promoted opioids for many kinds of pain beyond severe cancer pain, helping to normalize widespread prescribing and expand the market, and that these marketing strategies were financially lucrative for manufacturers.

Summarizing a Strategic Management Journal study, this piece reports that after Kentucky’s 2015 settlement with Purdue, "Purdue’s competitors intensified promotional spending specifically targeted at OxyContin prescribers and prescribers previously targeted by Purdue sales representatives." It notes that competitors’ marketing spending to these doctors rose from $911,000 to $2.4 million (a 160% increase) in the two years after the settlement, while Purdue cut its own spending. The authors state that the case "created a revenue opportunity" and that "the prospect of capturing profit from Purdue appeared to outweigh any heightened fear of litigation among competing drug companies."

In this CDC‑authored MMWR article, researchers state that "pharmaceutical industry marketing of opioids to physicians is associated with increased opioid prescribing and elevated mortality from overdoses" at the county level. They document that counties receiving more marketing payments per capita had "significantly higher" opioid prescribing and subsequent overdose deaths. The report emphasizes that such marketing is undertaken "to promote sales of opioid products" and that aligning prescribing with marketing can have "population‑level adverse health outcomes."

A congressional investigative report on Purdue Pharma and the Sackler family states that internal company documents show Purdue pursued a "blizzard of prescriptions" strategy to drive sales of OxyContin. The report cites evidence that Purdue executives pushed for higher dosages and longer use and targeted high‑volume prescribers despite warning signs of abuse and diversion, with the goal of increasing revenue and shareholder profits.

A systematic review on industry payments and opioid prescribing concludes that "accepting industry payments is associated with increased opioid prescribing." The authors report that across multiple studies, physicians who received pharmaceutical company payments related to opioids wrote more opioid prescriptions and at higher doses, indicating that promotional spending and financial incentives from manufacturers are linked to higher levels of prescribing.

This House Oversight Committee report finds that Purdue and its owners "aggressively pushed to grow OxyContin sales even after the company became aware of significant abuse, misuse, and diversion" and that the company "pursued a marketing strategy to increase the number of high‑dose prescriptions" because those doses were more profitable. The report states that internal documents show Purdue executives "calculated how much revenue could be generated by addicting new patients" and that the company’s actions were driven by a desire to "maximize profits" despite mounting evidence of harm.

Johns Hopkins researchers describe that pharmaceutical companies "spent millions of dollars marketing opioids to physicians" and that their study found "counties where opioid marketing payments to physicians were more frequent had higher rates of opioid prescribing and subsequently more overdose deaths." They note that marketing included speaker fees, meals and travel, and that these promotional activities were intended to boost prescribing of specific branded opioids.

An article in The BMJ observes that the opioid crisis was "precipitated by aggressive marketing of prescription opioids by the pharmaceutical industry," including minimizing addiction risks and promoting long‑term use for chronic non‑cancer pain. It notes that companies "used continuing medical education, key opinion leaders, and sales representatives" to encourage clinicians to prescribe more opioids, which substantially increased sales and profits for manufacturers.

An estimated 254 million opioid prescriptions were filled in 2010 alone, enough to medicate every adult in the U.S. for a month on a round-the-clock basis. In that same year, pharmaceutical companies generated revenues of $11 billion from opioid sales alone.[3] Over the course of two decades, these companies paved the way for opioids to become the go-to pain treatment medication using a wide range of marketing and advertising tactics… Companies such as Endo Pharmaceuticals, Purdue Pharma as well as Johnson & Johnson centered their marketing campaigns on the use of opioids as all-purpose pain treatment medications.[3] Pharmaceutical companies made widespread use of lobbyist groups and funded medical organizations to promote opioid prescribing practices and discourage regulations that would limit opioid use.[3]

Between 2019 and 2023, nearly all major U.S. opioid manufacturers and distributors, including Purdue Pharma, Johnson & Johnson, Teva, and others, agreed to large civil settlements with U.S. states, local governments, and tribal entities. In these lawsuits, plaintiffs alleged that the companies engaged in deceptive marketing that overstated benefits and understated addiction risks, and that they promoted higher-dose and long-term opioid prescribing to expand the market and maximize profits. While the companies often denied legal wrongdoing in civil settlements, many agreed to pay billions of dollars and to change their marketing practices as part of the resolutions.