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West Virginia Coal Miners Rally For Black Lung Legislation

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Photo: Perry Bennett, WV Legislative Photography

Miners and advocates rallied Wednesday at the West Virginia Capitol in support of a series of bills aimed at preventing and treating severe black lung disease.

Five bills introduced by lawmakers would make it easier to make qualify for state benefits and provide benefits to miners who have early-stage black lung.

The bills come at a time when the Ohio Valley is facing a surge in cases of severe black lung disease, also called Progressive Massive Fibrosis.

“We’re here because so many of the people that’s worked years and years years, 30, 35 years in the mines, and been exposed to coal dust their whole life and they fall through the cracks,” said Terry Abbott, president of United Mine Workers of America Local 8843, which represents miners in West Virginia’s Fayette and Kanawha counties.

A miner is tested for lung function and signs of black lung disease. Photo: Coal Miners Respiratory Clinic

We’re here to support all the miners that should be receiving compensation for the the years they put in the mines.”

Black lung is caused by exposure to coal dust and the debilitating and progressive disease has no cure. The state and federal government both have benefits systems that allow miners to make a claim against their employer for medical expenses and a small stipend.

Advocates and miners argue access to health and financial benefits increases the likelihood sufferers can seek medical treatment.

Getting those benefits through federal or state programs can be challenging, and recent changes on the state level has  made it tougher for miners to qualify.

Obstacles To Benefits

Kentucky lawmakers last year eliminated radiologists from the process miners use to qualify for benefits. In West Virginia, a decision by the state Supreme Court made it harder for miners to file a claim.

Now, advocates for black lung victims are rallying behind new legislation in West Virginia which they say can help sick miners. Kentucky representatives have also proposed a bipartisan bill that would repeal the state’s 2018 law that limits which doctors can evaluate black lung workers compensation claims.

One bill in West Virginia with bipartisan support is Senate Bill 260. Co-sponsored by two doctors, it would change the law to allow miners to receive partial disability awards if they are diagnosed with the disease. Miners diagnosed with early-stage black lung would qualify for 20 weeks of benefits.

Members of the Southeastern Kentucky Black Lung Association light candles in memory of those lost to the disease. Photo: Benny Becker, Ohio Valley ReSource

Miners would only have to have X-rays that show the presence of severe black lung disease, not a diagnosis that the disease has yet impacted their health.

Supporters of the bill argue that because black lung is progressive, there is no doubt symptoms will worsen. Providing some benefits to miners early on may boost their ability to seek treatment or assist in re-training to allow early career miners to find other employment and limit coal dust exposure.

Benefits Boost

Another bill, Senate Bill 144, would create a state black lung program that would provide $300 in monthly benefits for West Virginia miners with at least 10 years of coal dust exposure.

“We want to simplify the black lung program here in West Virginia, so the state can take care of its own, give them what they’re due, what they’re entitled to and what they’ve worked for,” said Charles Dixon, with UMWA Local 1440 in Matewan, West Virginia.

He was one of dozens of miners who rallied at the Capitol Wednesday in support of the black lung bills.

A third bill, House Bill 2588, would challenge the recent West Virginia Supreme Court decision that made it harder for miners to file a state workers’ compensation case. It stipulates a person seeking an evaluation from the state Occupational Pneumoconiosis Board can do so at any time regardless of the time limits set to file a claim and that insurance carriers must pay for the exam.

The bills have not yet advanced to a floor vote.

Dave Mistich of ReSource partner station WVPB contributed to this story. This article was originally published by Ohio Valley ReSource.

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Air Pollution Continues to Decline, Smog Remains a Problem

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Mt. Storm Power Plant in West Virginia. Photo: Cecilia Mason/WVPB

A new report released this week by the American Lung Association finds fine particle, or soot, pollution continues to improve across West Virginia, but smog pollution remains a challenge.

The American Lung Association’s 20th annual “State of the Air” report analyzed air quality data collected by federal, state and local air monitoring devices between 2015 and 2017, the most recent data available. Data is collected in just 10 of West Virginia’s 55 counties.

The Lung Association’s 2019 report found fine particle pollution continued to improve across the state. All counties with data earned an “A” grade.

Soot pollution is expelled from sources like exhaust pipes or industrial plants. It’s the fine, microscopic dust sometimes small enough to pass directly into the blood streams through the lungs. Not only can it exacerbate respiratory health problems, but fine particle pollution is also linked to heart problems.

Cabell and Kanawha counties had zero unhealthy days of short-term spikes in particle pollution for at least the fifth consecutive year, listing them among the nation’s cleanest counties for soot pollution, the report stated. The area ranked 89 worst in the country.

It was a different story, however, for ozone pollution. Ozone is a powerful lung irritant that exacerbate asthma attacks and negatively impact those with other lung diseases. The new report showed West Virignia counties had similar levels of unhealthy days of high ozone as last year’s report.

Cabell, Kanawha, Ohio and Wood counties all earned “C” grades and had four or more days with unhealthy ozone levels.

The American Lung Association said a warming climate may help explain the boost in unhealthy ozone pollution levels. Ozone levels increased in most cities around the country during the three-year period, which were also some of the warmest on record.

The report also highlighted a series of federal environmental laws that have been rolled back — from methane standards for oil and gas wells to car pollution standards — that may be negatively affecting air quality.

Nationally, the report found ozone and short-term particle pollution worsened in many cities. More than four in 10 Americans, or about 43 percent of the population, live in counties that have monitored unhealthy ozone and/or particle pollution.

This article was originally published by West Virginia Public Broadcasting.

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Serving Survivors: In Rural States, Telemedicine Brings Treatment For Sexual Abuse

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“Open plains and lots of antelope,” Matt Gray describes the Wyoming landscape. Photo: Mary Meehan, Ohio Valley ReSource

Gillette, Wyoming, isn’t the kind of place you just happen to come across.

“It’s about a four hour drive through vast, unimpacted, wide, sweeping plains,” said Matt Gray, a professor at University of Wyoming in Laramie, explaining the trek from his office to his clients.

Plains, he said, “and lots and lots of antelope.”

For the last decade, Gray and graduate students have bridged the space across the high plains with a digital connection in order to serve survivors of domestic violence and sexual abuse.

The university town of Laramie connects with the boom and bust energy town of Gillette near the South Dakota border providing specialized trauma counseling. Without that link no such service would be available.

Graphic: Alexandra Kanik, Ohio Valley ReSource

AMargie McWilliams is director of what is officially called the Gillette Abuse Refuge Foundation and unofficially called GARF. In her estimation the therapy program has been invaluable.

“Honestly, it has saved a lot of lives.”

Since the #MeToo movement started a national conversation about sexual violence, the scope of the discussion continues to grow from exposing the issue to exploring how to best help survivors. Those include rural women who are often underserved and overlooked. Each place is different but many rural communities, including those in the Ohio Valley, share the challenge of providing services when there are lots of miles between people and providers.

Underserved, Overlooked

Historically, much of the research on domestic violence and sexual assault has centered on urban areas. But a study published in the Journal of Women’s Health shows that women in rural areas suffered a higher rate of intimate partner violence than their urban counterparts.

Not only is there more violence, it is less frequently reported. A 2016 report from the Justice Department noted that in rural areas only 41 percent of violent crime and 47 percent of serious violent crimes (defined as rape or sexual assault, robbery, and aggravated assault) are reported to the police.

An earlier study explored reasons that people did not report these crimes: it was considered a personal matter; such an assault was not considered important enough to report; victims felt the police would not or could not help; and victims fear of reprisal or getting the offender into trouble.

These findings are not news to McWilliams or Gray, who between them have nearly 50 years of experience in dealing with domestic violence and sexual assault in rural communities.

Rural Similarities

Eileen Recktenwald is executive director of the Kentucky Association of Sexual Assault Programs. She said access to quality care has been an issue for the 35 years she has been an advocate. She said she could see a telehealth program working in the Ohio Valley.

Already, she said, younger people, especially ages 18 to 24, are seeking services in a different way. “They are much more electronically inclined and access services via chat or the internet,” she said.

Eileen Recktenwald of the Kentucky Association of Sexual Assault Programs. Photo: Mary Meehan, Ohio Valley ReSource

Rural communities don’t all look the same. Wyoming’s wide open spaces, as people there like to say with some pride, make it one of only two states determined to be not only rural but uber-rural, or “frontier.”  (The other frontier state being Alaska.)

But there are similarities between the plains in the west and rural parts of Kentucky, West Virginia, and Ohio.

Recktenwald said most rural parts of America share some common traits. They also have similar barriers to mental health care because they lack services and providers, face transportation barriers, and have cultural factors that can cause social stigma to be amplified.

Graphic: Alexandra Kanik, Ohio Valley ReSource

Telemedicine, as a whole, is becoming a routine part of healthcare. According to a recent report from the American Hospital Association, 76 percent of hospitals offer some kind of telehealth service. Last year, the Veterans Association launched a telehealth initiative for service members with PTSD.

But as Gray points out, the best ways to approach rural women and combat veterans are not the same. And, he said, there are other things to consider.

Why Wyoming

Gray went to college to be a dentist but soon found a passion for psychology and has specialized in sexual abuse and domestic violence for more than 20 years. With a dark beard and an easy smile, he’s the kind of guy who frequently says, “that’s a great question,” yet manages to always sound sincere.

Matt Gray, a professor at the University of Wyoming in Laramie. Photo: Mary Meehan, Ohio Valley ReSource

The university’s information technology department first brought the idea for a telehealth clinic to him. They had received grant money for telehealth but couldn’t find the right focus.

Gray said he was a little worried at first that he wasn’t tech savvy enough to oversee a digital operation. Now he rolls with the lingo.

“It was a matter of having them help set up a polycom unit that is secured and encrypted video conferencing at the distal site,” he said.

Translated, that means there is a secure computer in one place that connects to the same in the other. Those computers can only talk to each other and no one else can listen. Securing privacy is a key element given the subject of the conversations that will take place on these links.

The first clinic was in Rawlins, a town of just under 9,000 people. Rawlins already offered domestic abuse services but not therapy. Gray said only one or two clients in Rawlins access telehealth each year. Some clients come from the state’s biggest city, Cheyenne, but most come from Gillette.

Gray said he had some reservations in the beginning as to whether the person-to-person experience of counseling could be replicated in a remote and mediated setting. His research shows the clients are often more satisfied with their experience than are the therapists.

“The baseline is different because the client isn’t comparing the telehealth experience to previous counseling,” he said. For them, he said, “it’s how does this compare to getting nothing at all, which would be the only alternative.”

Student Help

Another important piece is the graduate students who make up the therapy team.

Two current team members are Kendal Binion from Georgia and Stephanie Amaya from Los Angeles.

Kendal Binion, part of the graduate student therapy team. Photo: Mary Meehan, Ohio Valley ReSource

After working together closely for two years, they frequently laugh in unison and finish each other’s sentences. It is a bound forged, they said, in doing the difficult work of providing therapy to rural survivors of sexual assault and domestic violence.

Binion said she applied to the program while working as a hospital advocate where she helped connect clients to services but didn’t provide therapy.

“What I saw was a lot of victim-blaming from not only medical providers and police officers, but from family and friends,” she said. “And I really wanted to reach out and go beyond advocacy.”

Binion gets tears in her eyes as she talks about one Wyoming client who made a lasting impression. The woman had kept the secret of her assault to herself for decades, telling no one.

“All of these cases are hard, but to have someone who had the added pain of no support,” Binion said, “it was also exceptionally hard to hear that it was for 40 years.”

Amaya said she’s been inspired by her clients. “They are the ones making those steps first,” she said.

Those first steps involve escaping the extensive control exerted by the partner. That can include, she said, the lack of access to money, the lack of the ability to leave the house, threats to take away children, and the very real possibility of additional physical or sexual violence.

The geographic isolation of a rural setting can compound those effects, she said.

“Part of that cycle of violence is isolation that the perpetrator tries to inflict on the victim, whether that be from family or from resources,” Amaya said. “And geographic isolation just really fits perfectly into that model.”

But she said therapy can work even if it is happening across a computer network instead of across the room.

“I found that human connection is transcendent,” she said. “It doesn’t depend on proximity. It depends on empathy, and a willingness to share and to open up and to support someone who needs that support.”

Finding Funding

Telehealth is not the perfect solution in rural areas, Gray said. First, there’s the question of funding.

“It goes without saying that in terms of getting dollars in resources for sexual assault and domestic violence, no matter what kind of service you’re trying to provide, that’s a really hard thing to do,” he said.

Matt Gray,
left, and trauma treatment students on a hiking field trip. Photo: Courtesy Univ. of Wyoming

Plus, he said, most available grant money is tied to innovative uses of technology for a limited number of years. There is less funding available to sustain the work of treating trauma.

There are plenty of other rural communities that would benefit from such a program, he said. But there is also a limited number of appropriate therapists-in-training. His program can serve about 20 to 25 clients at a time. Those clients receive, on average, 12 to 15 sessions.

What you don’t want to create, he said, is a service with a far reach but a long wait time.

He said that to tell a domestic violence or sexual assault victim “’we can get you but it is going to be two or three months’ is highly problematic.”

The goal of the current team is to contact a client within the first 48 hours after the first report and to have the first session with the client within 96 hours.

The need for more services, he said, is always there. “Unfortunately up until very recently mental health services has been deemed kind of a luxury,” he said.

Even the rate of sexual assault and domestic violence is not well understood in the broad community, Gray said.

He conducted a study of 2,000 University of Wyoming students on incidents of sexual misconduct, partner violence, domestic violence, sexual harassment, and stalking. The study found 27 percent of students had experienced sexual abuse. People outside of the field of study might find the results “eye popping,” he said, but “while they are tragic, they are not atypical.

“So, I do think we still have this disconnect between people who recognize how common this is — and that’s been replicated again, and again, and again — versus people who are just finding out about the magnitude of this problem for the first time,” he said.

Margie McWilliams,
left, and Shawna McDonald seen
on a telemedicine link. Photo: Mary Meeha, Ohio Valley ReSource

A #MeToo Effect

McWilliams has been at the Gillette Abuse Rescue Foundation for most of its three decades. Shawna McDonald has worked there for 15 years.

The two women are self-described left-leaning advocates in a deeply red community. They are carrying on work that began when “host families” took in victims of domestic violence in private homes back in the 1970s.

They said getting survivors into the building so they can use the telehealth service involves pushing back against cultural norms that encourage silence.

Gillette is a boom town dependent on the cyclical nature of the energy business. Because of that, the locals welcome outsiders out of economic necessity. But that has its limits, McWilliams said.

McDonald said the families that came to the region generations ago, called the “homesteaders,” still hold political sway.

“We always we call it the Good Ol’ Boy system here because, you know, men run our government.”

She said when a female GARF board member recently talked about running for a county office, one male elected official told her “we won’t be letting any little ladies” win elections.

But, they said, #MeToo is having an effect, even out on the high plains. McWilliams said they are seeing more young people seeking help.

There is something else, a cultural shift that is both quiet and broad. In January about 60 people turned out for a Women’s March in Gillette. McWilliams and McDonald said that kind of support matters.

“So to me that was a big thing that’s changed. We’ve never had that many people involved before. And of course, we got the trucks that drove by and you know flipping people off,” they recalled in unison. “But it was cool because nobody cared. We were just there for a reason and we have seen an increase in our services and sexual assault victims are coming in.”

People from more rural parts of the state came to the march. That included two moms who brought their daughters from the next town over, Sheridan. It’s 104 miles, one way.

Support for this story came from the Solutions Journalism Network. This article was originally published by Ohio Valley ReSource.

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OxyContin Maker Explored Expansion Into “Attractive” Anti-Addiction Market

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Protestors leave pill bottles outside the headquarters of Purdue Pharma in Stamford, Connecticut. Photo: AP Photo, Jessica Hill

Secret portions of a lawsuit allege that Purdue Pharma, controlled by the Sackler family, considered capitalizing on the addiction treatment boom — while going to extreme lengths to boost sales of its controversial opioid.

Not content with billions of dollars in profits from the potent painkiller OxyContin, its maker explored expanding into an “attractive market” fueled by the drug’s popularity — treatment of opioid addiction, according to previously secret passages in a court document filed by the state of Massachusetts.

In internal correspondence beginning in 2014, Purdue Pharma executives discussed how the sale of opioids and the treatment of opioid addiction are “naturally linked” and that the company should expand across “the pain and addiction spectrum,” according to redacted sections of the lawsuit by the Massachusetts attorney general. A member of the billionaire Sackler family, which founded and controls the privately held company, joined in those discussions and urged staff in an email to give “immediate attention” to this business opportunity, the complaint alleges.

ProPublica reviewed the scores of redacted paragraphs in Massachusetts’ 274-page civil complaint against Purdue, eight Sackler family members, company directors and current and former executives, which alleges that they created the opioid epidemic through illegal deceit. These passages remain blacked out at the company’s request after the rest of the complaint was made public on Jan. 15. A Massachusetts Superior Court judge on Monday ordered that the entire document be released, but the judge gave Purdue until Friday to seek a further stay of the ruling.

The sections of the complaint already made public contend that the Sacklers pushed for higher doses of OxyContin, guided efforts to mislead doctors and the public about the drug’s addictive capacity, and blamed misuse on patients.

Citing extensive emails and internal company documents, the redacted sections allege that Purdue and the Sackler family went to extreme lengths to boost OxyContin sales and burnish the drug’s reputation in the face of increased regulation and growing public awareness of its addictive nature. Concerns about doctors improperly prescribing the drug, and patients becoming addicted, were swept aside in an aggressive effort to drive OxyContin sales ever higher, the complaint alleges.

Among the allegations: Purdue paid two executives convicted of fraudulently marketing OxyContin millions of dollars to assure their loyalty, concealed information about doctors suspected of inappropriately prescribing the opioid, and was advised by global consulting firm McKinsey & Co. on strategies to boost the drug’s sales and burnish its image, including how to “counter the emotional messages” of mothers whose children overdosed. Since 2007, the Sackler family has received more than $4 billion in payouts from Purdue, according to a redacted paragraph in the complaint.

“The payments were the motivation for the Sacklers’ misconduct,” the complaint says. “And the payments were deliberate decisions to benefit from deception in Massachusetts, at great cost to patients and families.”

In 1998, two years after OxyContin was launched, Dr. Richard Sackler, a son of Purdue co-founder Raymond Sackler, instructed executives in an email that its tablets were not merely “therapeutic” but also “enhance personal performance,” like Viagra. Fifteen years later, he complained in another email that a Google alert he set up for OxyContin news was giving him too much information about the drug’s dangers.

“Why are all the alerts about negatives and not one about the positives of OxyContin tablets?” he asked a company vice president. Staff immediately offered to replace Sackler’s alert with a service that supplied more flattering stories, according to the complaint.

The redacted paragraphs leave little doubt about the dominant role of the Sackler family in Purdue’s management. The five Purdue directors who are not Sacklers always voted with the family, according to the complaint. The family-controlled board approves everything from the number of sales staff to be hired to details of their bonus incentives, which have been tied to sales volume, the complaint says. In May 2017, when longtime employee Craig Landau was seeking to become Purdue’s chief executive, he wrote that the board acted as “de-facto CEO.” He was named CEO a few weeks later.

n a statement today in response to questions about the redacted material, the company said that Massachusetts “seeks to publicly vilify Purdue, its executives, employees and directors by taking out of context snippets from tens of millions of documents and grossly distorting their meaning. The complaint is riddled with demonstrably inaccurate allegations.”

Purdue acknowledged in the statement that it was considering acquiring the rights to sell drugs that combat addiction or reverse the effects of an overdose. It criticized the state for “casting in a negative light” the company’s exploration of a potential acquisition of an addiction treatment that was already on the market, “even though the company never actually made the acquisition.”

Purdue also pointed out that OxyContin is approved by the Food and Drug Administration. It said that most opioid overdoses “now result from heroin and illicit fentanyl.”

The Sackler family was once best known for its philanthropy. Its name is engraved on museums and university buildings across the world. A group of activists has called on organizations to stop accepting Sackler donations and for the family name to be stripped from some institutions. Aggressive marketing of OxyContin is blamed by some analysts for propelling the crisis that has resulted in 200,000 overdose deaths related to prescription opioids since 1999.

After its 1996 launch, OxyContin rapidly became a top seller. But reports of patients abusing the drug soon followed. OxyContin contained more pain relief medication than older drugs, and crushing and snorting it was a simple way to get high fast. In 2007, Purdue pleaded guilty to federal charges of understating the risk of addiction and agreed to pay $600 million in fines and penalties. Still, the company argued publicly that OxyContin has “done far more good than harm,” and it sought to place responsibility for the bad acts on “certain of its supervisors and employees.”

Privately, the complaint suggests, the Sacklers were concerned about alienating two executives, then-CEO Michael Friedman and then-legal counsel Howard Udell. Friedman and Udell each pleaded guilty in 2007 in U.S. District Court in Abingdon, Virginia, to a misdemeanor charge of misbranding OxyContin, as did a former executive. The board signed off on the three executives’ decisions to plead guilty. No member of the Sackler family pleaded guilty.

Purdue paid $5 million to Udell in November 2008, and up to $1 million in November 2009, the complaint states. In February 2008, the company paid $3 million to Friedman. The complaint doesn’t mention any payments to the former executive.

“The Sacklers spent millions to keep the loyalty of people who knew the truth,” the complaint alleges.

Udell died in 2013. A person answering a phone number listed to Friedman declined comment.

The plea deals did little to hinder OxyContin sales or the Sacklers’ hands-on management. At the direction of the board, Purdue repeatedly increased its sales force, which pushed doctors to prescribe higher opioid doses.

Protesters outside the headquarters of Purdue Pharma on Aug. 17, 2018. Photo: AP Photo, Jessica Hill

In 2008, the same year that Purdue paid Udell and Friedman, Richard Sackler advised other family members that it was important to select a new chief executive who was loyal to the family. “People who will shift their loyalties rapidly under stress and temptation can become a liability from the owners’ viewpoint,” he allegedly wrote. A defendant in the Massachusetts lawsuit, Richard Sackler served in a number of different positions at the company before being named president in 1999 and then co-chairman of the board in 2003.

The company did install five new, non-family board members in the wake of the federal investigation. But in hundreds of board votes, the new directors never opposed the family, according to the complaint. Although Purdue does not operate outside the U.S., board meetings took place at a castle in Ireland as well as in Bermuda, London, Portugal and Switzerland.

When sales results disappointed, Sackler family members didn’t hesitate to intervene. In late 2010, Purdue told the family that sales of the highest dose and most profitable opioids were lower than expected, according to the complaint. That meant an expected quarter-end payout to the family of $320 million was at risk of being reduced to $260 million and would have to be made in two installments in December instead of one in November.

That news prompted a sharp email question from Mortimer D.A. Sackler, whose late father, also named Mortimer, was a Purdue co-founder. “Why are you BOTH reducing the amount of the distribution and delaying it and splitting it in two?” he asked. “Just a few weeks ago you agreed to distribute the full 320 [million dollars] in November.” The complaint doesn’t say how much was ultimately paid.

From 2009 until at least 2014, McKinsey helped Purdue shape its message for selling OxyContin and overcoming concerns about addiction and overdoses, according to redacted passages. The consultant told Purdue in a slide presentation that it could increase prescriptions by convincing doctors that opioids provide “freedom” and “peace of mind” and give patients “the best possible chance to live a full and active life.”

Purdue staff, according to the complaint, told the Sacklers that McKinsey would study “patient pushback” to encourage hesitant doctors to prescribe opioids. In a meeting with Purdue executives, McKinsey planned how to “counter the emotional messages from mothers with teenagers that overdosed in [sic] OxyContin” by recruiting pain patients to talk about the need for the drugs.

In a 2013 report, McKinsey recommended directing sales representatives to focus on the most prolific opioid prescribers because that group writes “25 times as many OxyContin scripts” as less prolific prescribers. Because prescription rates rose in tandem with visits from sales reps to doctors, McKinsey recommended increasing each salesperson’s quota from 1,400 visits a year to closer to 1,700. McKinsey estimated that targeting the most frequent prescribers could boost OxyContin sales by hundreds of millions of dollars. The quotas rose, as did total visits, the complaint states. Purdue said it planned to decrease visits relating to opioid products, and any increase was due to promoting a laxative.

Purdue Pharma headquarters in Stamford, Connecticut. Photo: AP Photo, Jessica Hill

McKinsey also recommended Purdue fight back against efforts by a major pharmacy chain, the U.S. Drug Enforcement Agency and the U.S. Department of Justice to stop illegal opioid prescribing, the complaint states. These new rules were cutting into sales of the highest doses, which were also the most profitable, it says. The complaint doesn’t say if Purdue followed McKinsey’s recommendation. Purdue said the recommendations “actually relate to ensuring continued access to pain medicines for appropriate patients.”

A McKinsey spokesman declined comment.

In September 2014, Purdue embarked on a secret project to join an industry that was booming thanks in part to OxyContin abuse: addiction treatment medication. Code-named Project Tango, it involved Purdue executives and staff as well as Dr. Kathe Sackler, a daughter of the company co-founder Mortimer Sackler and a defendant in the Massachusetts lawsuit. She participated in phone calls and told staff that the project required their “immediate attention,” according to the complaint.

Internally, Purdue touted the growth of an industry that its aggressive marketing had done so much to foster.

“It is an attractive market,” the team working on the project wrote in a presentation. “Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”

While OxyContin sales were declining, the internal team at Purdue touted the fact that the addiction treatment marketplace was expanding.

“Opioid addiction (other than heroin) has grown by ~20%” annually from 2000 to 2010, the company noted. Although Richard Sackler had blamed OxyContin abuse in an email on “reckless criminals,” the Purdue staff exploring the new business opportunity described in far more sympathetic terms the patients whom it now planned to treat.

“This can happen to any-one – from a 50 year old woman with chronic lower back pain to a 18 year old boy with a sports injury, from the very wealthy to the very poor,” it said.

Company documents recommended becoming an “end-to-end pain provider.” Initially, Purdue intended to sell one such medication, Suboxone, which is commonly retailed as a film that melts in the mouth. When Kathe Sackler asked staff members to look into reports that children might be swallowing the film, they reassured her. They responded, according to the complaint, that youngsters were overdosing on pills, but not the films, “which is a positive for Tango.”

In 2015, Purdue turned its attention to another potential product, the overdose reversing agent known as Narcan, calling it a “strategic fit.” Purdue executives discussed how its sales force could promote Narcan to the same doctors who prescribed the most opioids. Purdue said in the statement Wednesday that it decided against acquiring the rights to sell Suboxone and Narcan.

While those initiatives appear to have stalled or ended, Richard Sackler received a patent last year for a drug to treat addiction, according to the complaint. The patent application states that opioids are addictive and refers to people who suffer from substance use disorders as “junkies.”

Besides being a defendant in the Massachusetts case, Richard Sackler was deposed in a lawsuit against Purdue in Kentucky, which the company settled. It’s believed to be the only time a member of the family has been questioned under oath about OxyContin and its addictive properties. The Kentucky Court of Appeals has ordered the release of his deposition, in response to a motion by STAT, but Purdue is asking the state Supreme Court to review the ruling. Hundreds of other lawsuits filed by states, cities, counties and tribes against Purdue have been consolidated in a pending case in federal court in Ohio.

The Massachusetts complaint cites multiple incidents of Purdue allegedly sitting on information, sometimes for years, about doctors it had reason to believe were inappropriately prescribing OxyContin. In 2012, a Purdue employee appealed to the company’s head of sales to alert health insurers to data the company collected about doctors suspected of abusing or illegally prescribing OxyContin. The list of doctors was code-named Project Zero.

“At a basic level, it just seems like the right and ethical thing to do,” the employee wrote. “Doing so could help those companies identify those physicians that may be of a concern, not just with respect to our products, but also other” pain medications. “As a result, if it reduces abuse and diversion of opioids then it seems like something we should be doing.”

The idea was rejected and the employee left the company a month later, according to the complaint.

This story was co-published with STAT. It was originally published by ProPublica.

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