William K. Rashbaum, Roni Caryn Rabin and Danny Hakim

The company’s flood-the-zone sales strategy was among the new disclosures contained in court papers filed Thursday by New York Attorney General Letitia James as part of the office’s lawsuit against opioid manufacturers, distributors and eight members of the Sackler family, who control Purdue.

During that time the sales force had the most visits per capita, 11,881 per 100,000 people, to rural Herkimer County (2017 population: 62,240) in the Mohawk Valley, according to the papers. State data shows that the county’s rate of emergency room visits involving opioids was nearly three times higher than New York City’s in 2017.

Sales reps made more than 250 visits that year to one “pain-management facility with three locations in central New York,” the court papers said. That comes out to about one visit every weekday.

The disclosures were contained in a new version of the attorney general’s amended complaint, which was originally filed two weeks ago with significant portions of the document redacted. Over the past two weeks, lawyers in the attorney general’s office have negotiated with the lawyers for the defendants to lift most of the redactions.

In a statement, Purdue Pharma said the new court filing “contains factual errors and gross distortions and misrepresentations based on highly selective excerpting of language from tens of millions of documents. The complaint is designed to publicly vilify Purdue and its former directors.”

The new disclosures make clear that Purdue was not the only manufacturer with a marketing strategy that in some measure seemed to suggest a military campaign.

One supervisor at Mallinckrodt Pharmaceuticals, a manufacturer of branded and generic opioids based in Ireland, urged his sales force to “ATTACK,” according to the papers, telling them they could get “big bonus dollars” by waiting in front of the doors of health care providers and by using free trial offers to win business.

Another Mallinckrodt sales supervisor told the company’s New York staff that the company’s Xartemis opioid “is the BEST opportunity to make lots of money!!!”

Mallinckrodt’s approach was so aggressive that the Drug Enforcement Administration referred to the company as the “kingpin of the drug cartel,” according to the court papers.

Mallinckrodt did not respond to requests for comment.

The complaint described a visit an internal investigator for one of Mallinckrodt’s distributors made to the Staten Island office of a physician assistant in 2010. The investigator reported: “The parking lot was packed and the street was also full of cars. Many people were sitting around in the cars and half-dozen milling around in the parking lot. Looks like a typical Florida pill mill. I am very uncomfortable with this.”

Despite these red flags, sales representatives from Mallinckrodt continued to visit the office, the complaint says. The physician assistant, Leonard Marchetta, was indicted in 2014 for conspiracy to distribute narcotics, pleaded guilty the next year and was sentenced to 11 years in prison.

The filing also removed the redaction on several emails sent by Richard Sackler, a former president of Purdue. In one, he suggested that people who took OxyContin were solely to blame for their addiction. “They get themselves addicted over and over again,” Sackler wrote. “They engage in it with full, criminal intent. Why should they be entitled to our sympathies?”

The Sacklers have filed a motion to dismiss a similar lawsuit against individual family members brought by Massachusetts Attorney General Maura Healey. It contends that many of the allegations were based on misleading representations of routine board meetings, using “snippets of emails,” many of which are “stale and distorted.”

It further argues that the Sacklers were often acting in their legal obligations to the company and disputes the lawsuit’s assertion that they directed the company’s conduct.

“These are examples of an overriding theme in the complaint against the Sacklers,” said a lawyer for the families. “If you look at everything in the most dated and cynical way, then you can make anything sound terrible.”

There were other new disclosures in the latest filings in the New York case:

— Purdue employees knew as early as 1999 that people were abusing OxyContin and knew the ways they were doing so. In an internal email to a senior executive, an employee disputed the claim that some abusers of the drug “shoot,” or inject, it, saying that they crushed the tablets and snorted the powder. “Injection is not too popular because the waxy junk in the tablets can mess up the user’s veins,” the employee wrote. “At least, that’s what I’ve read,” the email said. “I understand that OxyContin is the preferred drug,” the email said.

— Purdue Pharma spent $68 million from 2006 to 2016 on opioid education, much of it directed to front groups, and $1.5 million in New York in roughly the same period to push its message “through seemingly legitimate sources,” according to the complaint.

— Mallinckrodt paid $300,000 to a Kansas doctor, Sri Nalamachu, who was featured in a brochure in which “he criticized efforts to restrict access to pain prescription medication due to concerns” about opioid abuse, the complaint said. The payment was never disclosed, in the brochure or elsewhere.

— An executive at a regional drug distribution company asked a Mallinckrodt executive to keep supplying the opioid oxycodone. It’s “like people are addicted to these things. Oh, wait, people are,” the first executive wrote. The Mallinckrodt executive responded that it was “just like Doritos.”

“Keep eating,” he added, “we’ll make more.”

This article originally appeared in <a id="471dda8d-41da-3b7e-a520-a6509616b61a" href="https://www.nytimes.com/2019/04/11/health/opioids-sacklers-new-york-purdue.html">The New York Times</a>.

Opioid sales reps swarmed New York at height of crisis

Purdue Pharma’s sales force swept through New York state, visiting doctors and pharmacies nearly half a million times between 2006 and 2017 to promote OxyContin and other opioid painkillers. That is roughly 160 sales stops in the state each weekday during the height of the nation’s addiction crisis.

A statement issued on behalf of Sackler said he was “sorry for using insensitive language in an email to a friend nearly 20 years ago during moments of frustration about reports of illicit activity.”

This article originally appeared in <a href="https://www.nytimes.com/2019/04/11/health/opioids-sacklers-new-york-purdue.html" id="471dda8d-41da-3b7e-a520-a6509616b61a">The New York Times</a>.

Purdue Sales Force Swarmed New York at Height of Opioid Crisis

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William K. Rashbaum, Roni Caryn Rabin and Danny Hakim

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Opioid sales reps swarmed New York at height of crisis

Purdue Sales Force Swarmed New York at Height of Opioid Crisis