Purdue Pharma has sold more than $27 billion worth of the powerful painkiller… (Liz O. Baylen, Los Angeles…)
Two state senators on Monday called on the maker of OxyContin to turn over the names of California physicians it suspects recklessly prescribed its pills to drug dealers and addicts.
The lawmakers were responding to an article in The Times on Sunday that described a decade-long effort by Purdue Pharma to identify potentially problematic prescribers of its potent and addictive drug. The Connecticut-based company amassed a database of some 1,800 doctors who showed signs of dangerous prescribing.
Purdue has not alerted authorities to its concerns about the vast majority of those doctors, referring only 154 cases to law enforcement or medical regulators since the program began in 2002. An attorney for Purdue said the decision of whether to refer a doctor was "essentially a judgment call" made on a case-by-case basis after an internal review.
Andrew Kolodny, a New York addiction doctor who is leading an effort to curb narcotic painkillers, said such decisions should not be made by a pharmaceutical company.
"That judgment needs to be made by state medical boards, not a corporation that benefits from overprescribing," he said. "Purdue should make the list available to state medical boards so that physicians on the list can be investigated."
A company spokesman, reached after hours Monday, did not have an immediate comment.
State Sen. Ted Lieu (D-Torrance) said he sent a letter to Purdue on Monday asking the company to disclose the names of California doctors in its database.
"If Purdue Pharma is going to sell a highly potent, highly addictive narcotic in California, then the company has a duty to inform authorities in California of those doctors the company believes may be irresponsibly prescribing OxyContin," Lieu wrote, according to a copy of the letter he provided to The Times. "This duty may or may not be a legal one, but at the very least the company has an ethical duty to let authorities know about dangerous doctors."
State Sen. Mark DeSaulnier (D-Concord) said he would join Lieu in making the request of Purdue. DeSaulnier said he has been asking the company for years to help fund California's prescription drug monitoring system, known has CURES, but hasn't had much success. He said the cynical view of some pharmaceutical firms is that they don't want to help with prescription drug abuse because they profit from the problem. Purdue has sold more than $27 billion worth of OxyContin since its introduction in 1996.
"I would like to think that these big companies have more of an ethical backbone than that," DeSaulnier said. For Purdue, he said, sharing information on California doctors is "an easy chance for them to actually help with the problem."
Sharon Levine, president of the Medical Board of California, said she was pleased by the senators' request and hoped that Purdue would comply.
"We would be thrilled to have that information," Levine said. She said that even though the database was based on suspicions — not proof — it would provide potentially valuable leads.
California, like other states, is grappling with a prescription drug death problem that the U.S. Centers for Disease Control and Prevention has deemed an epidemic.
Purdue has promoted the idea that the epidemic was fueled largely by pharmacy robberies, doctor-shopping patients and teens raiding home medicine cabinets. The company's database suggests that it has long known that physicians also play a significant role in the crisis.
Beginning in 2002, Purdue trained its sales representatives to report "red flags" in doctors' offices such as young patients, long lines, people nodding off in waiting rooms and frequent cash transactions. Purdue attorneys review their reports and if a doctor's practice is deemed too risky, the company bars sales representatives from marketing to the physicians. The suspect doctors are removed from the company's numbered sales territories and assigned to the database, known as "Region Zero."
In 2010, Purdue introduced a tamper-resistant reformulation of OxyContin that made it less prone to abuse. A recent study by Purdue of 364 Region Zero prescribers found that their prescriptions for the maximum-strength dosage of the drug — the one favored by addicts — plummeted by 80% after the new pill was introduced. Purdue concluded that a small number of physicians might account for a "substantial portion" of the nation's black-market supply of prescription painkillers, according to a summary of the unpublished study. Fifty-nine of the prescribers in the study practiced in California, the company said.
Rep. Bill Cassidy, a Louisiana Republican who has voiced suspicions that a small percentage of doctors account for a disproportionate number of bad prescriptions, said he did not see it as Purdue's responsibility to share its information with the Drug Enforcement Administration.
Rather, he said, he wants to know why the DEA can't develop such information on its own.
"I don't know why they can't do what Purdue has done." Cassidy said. "This is a problem bigger than Purdue. That's why it seems that the DEA should be pursuing this as aggressively as possible, and I don't know if that is the case."
Joseph Rannazzisi, the DEA official in charge of the office of prescription drug control, declined to be interviewed for this article.