The gleaming white booth towered over the medical conference in Italy in October, advertising a new brand of antidote for opioid overdoses. “Be prepared. Get naloxone. Save a life,” the slogan on its walls said.
Some conference attendees were stunned when they saw the company logo: Mundipharma, the international affiliate of Purdue Pharma — the maker of the blockbuster opioid, OxyContin, widely blamed for unleashing the American overdose epidemic.
Here they were cashing in on a cure.
“You’re in the business of selling medicine that causes addiction and overdoses, and now you’re in the business of selling medicine that treats addiction and overdoses?” asked Dr. Andrew Kolodny, an outspoken critic of Purdue who has testified against the company in court. “That’s pretty clever, isn’t it?”
As Purdue Pharma buckles under a mountain of litigation and public protest in the United States, its foreign affiliate, Mundipharma, has expanded abroad, using some of the same tactics to sell the addictive opioids that made its owners, the Sackler family, among the richest in the world. Mundipharma is also pushing another strategy globally: From Europe to Australia, it is working to dominate the market for opioid overdose treatment.
“The way that they’ve pushed their opioids initially and now coming up with the expensive kind of antidote — it’s something that just strikes me as deeply, deeply cynical,” said Ross Bell, executive director of the New Zealand Drug Foundation and a longtime advocate of greater naloxone availability. “You’ve got families devastated by this, and a company who sees dollar signs flashing.”
Nyxoid
Mundipharma’s antidote, a naloxone nasal spray called Nyxoid, was recently approved in New Zealand, Europe and Australia. Mundipharma defended it as a tool to help those whose lives are at risk, and even experts who criticize the company say that antidotes to opioid overdoses are badly needed. Patrice Grand, a spokesman for Mundipharma Europe, said in a statement that heroin is the leading cause of overdose death in European countries and nasal naloxone is an important treatment option.
Injectable naloxone has long been available; it is generic and cheap. But Mundipharma’s Nyxoid is the first in many countries that comes pre-packaged as a nasal spray — an easier, less threatening way for those who witness an overdose to intervene. Nyxoid, which isn’t sold in the U.S., is more expensive than injectable naloxone, running more than $50 a dose in some European countries. A similar product manufactured by another pharmaceutical company has been available for years in the U.S. under the brand name Narcan.
Critics say Nyxoid’s price is excessive, particularly when inexpensive naloxone products already exist. Grand declined to say how much Nyxoid costs Mundipharma to manufacture or how profitable it has been.
The Sackler family’s pharmaceutical empire has long considered whether it might make money treating addiction, according to lawsuits filed against Purdue and the family. In the U.S., Purdue Pharma called its secret proposal Project Tango, the attorneys general of Massachusetts and New York have alleged, and discussed it in a September 2014 conference call that included family member Kathe Sackler.
In internal documents, the lawsuits allege, Purdue illustrated the connection they had publicly denied between opioids and addiction with a graphic of a blue funnel. The top end was labeled “Pain treatment.” The bottom: “opioid addiction treatment.” The slideshow said they had an opportunity to become an “end-to-end provider” — opioids on the front end, and addiction treatment on the back end.
“It is an attractive market,” the staff wrote, according to the Massachusetts complaint. “Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”
In its response to the court, the family’s lawyers wrote that the plan was put forward by a third-party private equity fund as a potential joint venture and “at the very most, Project Tango was mentioned in passing on a few occasions and the proposal was subsequently abandoned.” A press release issued by the Sacklers said no member of the family or board had an active role in the presentations or supported the proposal, and called the lawsuits “sensationalized” and “misleading.” Purdue declined to comment.
New York’s lawsuit alleges that in 2015, Project Tango was presented to Purdue’s board as a joint venture to sell the addiction medication suboxone that could become the “market lead in the addiction medicine space.” The presentation highlighted the sales opportunity in opioid addiction: 40 to 60 percent who went through treatment would relapse and need it again.
Project Tango stalled. It was revised the next year with a new plan to sell naloxone, the lawsuits allege.
Naloxone a ‘strategic fit’
Publicly, Purdue was denying that its painkillers caused the addiction epidemic. But in internal communications, the company described naloxone as a “strategic fit” and a “complementary” product to the prescription opioids they were already selling, the Massachusetts attorney general said. Purdue calculated that the need for overdose reversal medication was increasing so rapidly, potential revenue could triple from 2016 to 2018.
The lawsuit alleges that Purdue identified its own painkiller patients as a target market for naloxone — and that it could use its sales force already visiting doctors to promote opioids to also promote overdose reversal medication. They saw potential profits in government efforts to expand access to naloxone to stem the tide of overdose deaths, a toll that has soared to 400,000 since the American epidemic began.
Project Tango fizzled in the U.S.; the family’s press release said Purdue’s board rejected it.
But half a world away, in Australia, Mundipharma embarked on an effort to promote naloxone that was sweeping and effective.
As part of an Australian coroner’s investigation last year into six fatal opioid overdoses in New South Wales state, Mundipharma submitted a 15-page document touting the benefits of naloxone. If people around the overdose victims had had access to naloxone, the company wrote, many of those deaths may have been avoided. At the same time, Mundipharma was registering Nyxoid in Australia, a fact it acknowledged within its submission.
In the document, the company suggested that officials change the country’s laws to allow for easier access to naloxone, get naloxone into needle exchange programs, detox centers and supervised injecting clinics, and establish a national, free take-home naloxone program.
