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In the last decade, a spate of lawsuits—some settled, many ongoing—have shed light on the role that pharmaceutical companies have played in the US opioid epidemic, a public health emergency which claims the lives of 130 Americans every day. The most notable, Purdue Pharma, the Sackler-family owned maker of OxyContin, has been found guilty of downplaying the risks and overplaying the effectiveness of opioids, contributing to an epidemic of overprescription and diversion. 

Purdue pled guilty (pdf) to “misbranding” OxyContin “with the intent to defraud or mislead.” But the company also used legal marketing practices to boost opioid sales, despite its knowledge of the risks associated with the drug. Some of these practices are at the center of a colossal multidistrict litigation against opioid makers and distributors that is currently underway in an Ohio court.

Now, a Quartz investigation for the documentary, How to Sell Drugs (Legally), has found that Mundipharma, an international network of companies also owned by the Sacklers, deployed similar marketing techniques to sell opioids overseas. 

There are concerning signs that this drive to profit from opioids is having serious unintended consequences: Over the past decade, an opioid crisis has begun to spread in parts of Europe, Africa, Asia, and the Middle East. The United Nations’ 2019 World Drug Report found that opioids “continue to cause the most harm, accounting for two-thirds of the deaths attributed to drug use disorders.” In June, the OECD reported finding “growing, problematic opioid use” in Canada, Sweden, Norway, Ireland, England, and Wales. In France, prescriptions of oxycodone—the key ingredient in OxyContin—to treat chronic non-cancer pain increased by 1,180% between 2004 and 2017 (link in French). 

Corporations and pharmaceutical marketing alone can’t be blamed for an entire drug epidemic and its socio-economic underpinnings. But our investigation found that, as in the US, Mundipharma and other companies are spreading the idea that the world is suffering from an epidemic of untreated chronic pain, and that their products are an important and straightforward solution. That’s despite the fact that there is little high-quality evidence to support the idea that opioids are effective at treating long-term chronic pain, and stronger evidence that they increase patient’s risk of addiction over time. 

Quartz journalists traveled to Minnesota, California, and New Jersey to piece together Purdue Pharma’s pharmaceutical marketing playbook, and visited France, Pakistan, and The Netherlands to uncover how that marketing is continuing overseas. We spoke to doctors, regulators, industry consultants, patient support groups, and pharmaceutical reps. And, as we will show, we found Mundipharma and other pharmaceutical companies using doctors, medical journals, conferences, and patient groups to spread specific messages aimed at boosting the sales of opioids.  

In a statement to Quartz, Mundipharma said: “We collaborate with experts to facilitate scientific exchange on important topics. We compensate them for their time in accordance with industry guidelines, but we respect the independence of speakers, we are completely transparent with disclosure of such collaborations and we require speakers to clearly disclose any conflicts of interest when communicating with other doctors.” 

Could the same marketing practices that fueled an unprecedented public health crisis in the US be linked to an emerging opioid crisis overseas? As Nicolas Authier, a French psychiatrist specializing in addiction, told Quartz, “drug promotion has an effect on prescriptions; otherwise, [pharmaceutical companies] simply would not do it.”