OxyContin goes global — “We’re
`only just getting started”
`
`By Harriet Ryan, Lisa Girion and Scott Glover
`Dec. 18, 2016
`
`
`
`20152016Up next
`2014
`2011
`
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`201120142014
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`201220132013
`2012
`2013
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`Lebanon, PortugalArgentinaChile, Ecuador,
`Singapore
`China
`
`
`Russia, Turkey, Egypt, MexicoBrazil
`
`
`Vienna, AustriaBrazil, ColombiaSpain
`Indonesia,
`“Dubai hub”
`
`Peru, Uruguay,
`Hong Kong,
`Vietnam, Taiwan,
`Opens factory with
`
`Launches operationsLaunches operations
`Opens new office
`
`Launches operationsLaunches chronic pain
`
`Launches operationsLaunches chronic pain
`Launches operations
`Gives office oversight
`Venezuela
`South Africa
`Thailand
`capacity to produce
`to oversee operations
`in the Middle East
`awareness campaign,
`awareness campaign,
`of Eastern Europe
`Plans to launch
`Launches operations
`Launches operations
`in the developing world
`100 million tablets
`featuring celebrities
`featuring celebrities
`operations
`
`OxyContin is a dying business in America.
`
`With the nation in the grip of an opioid epidemic that has claimed more than
`200,000 lives, the U.S. medical establishment is turning away from
`painkillers. Top health officials are discouraging primary care doctors from
`prescribing them for chronic pain, saying there is no proof they work long-
`term and substantial evidence they put patients at risk.
`
`Prescriptions for OxyContin have fallen nearly 40% since 2010, meaning
`billions in lost revenue for its Connecticut manufacturer, Purdue Pharma.
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`only just getting started”
`
`By Harriet Ryan, Lisa Girion and Scott Glover
`Dec. 18, 2016
`
`
`
`20152016Up next
`2014
`2011
`
`
`201120142014
`
`
`201220132013
`2012
`2013
`
`
`
`Lebanon, PortugalArgentinaChile, Ecuador,
`Singapore
`China
`
`
`Russia, Turkey, Egypt, MexicoBrazil
`
`
`Vienna, AustriaBrazil, ColombiaSpain
`Indonesia,
`“Dubai hub”
`
`Peru, Uruguay,
`Hong Kong,
`Vietnam, Taiwan,
`Opens factory with
`
`Launches operationsLaunches operations
`Opens new office
`
`Launches operationsLaunches chronic pain
`
`Launches operationsLaunches chronic pain
`Launches operations
`Gives office oversight
`Venezuela
`South Africa
`Thailand
`capacity to produce
`to oversee operations
`in the Middle East
`awareness campaign,
`awareness campaign,
`of Eastern Europe
`Plans to launch
`Launches operations
`Launches operations
`in the developing world
`100 million tablets
`featuring celebrities
`featuring celebrities
`operations
`
`OxyContin is a dying business in America.
`
`With the nation in the grip of an opioid epidemic that has claimed more than
`200,000 lives, the U.S. medical establishment is turning away from
`painkillers. Top health officials are discouraging primary care doctors from
`prescribing them for chronic pain, saying there is no proof they work long-
`term and substantial evidence they put patients at risk.
`
`Prescriptions for OxyContin have fallen nearly 40% since 2010, meaning
`billions in lost revenue for its Connecticut manufacturer, Purdue Pharma.
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`So the company’s owners, the Sackler family, are pursuing a new strategy: Put
`the painkiller that set off the U.S. opioid crisis into medicine cabinets around
`the world.
`
`A network of international companies owned by the family is moving rapidly
`into Latin America, Asia, the Middle East, Africa and other regions, and
`pushing for broad use of painkillers in places ill-prepared to deal with the
`ravages of opioid abuse and addiction.
`
`Visit the site
`
`Mundipharma China
`
`Mundipharma is courting Chinese patients with a campaign encouraging
`people to take medications as their physicians prescribe.
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`In this global drive, the companies, known as Mundipharma, are using some
`of the same controversial marketing practices that made OxyContin a
`pharmaceutical blockbuster in the U.S.
`
`In Brazil, China and elsewhere, the companies are running training seminars
`where doctors are urged to overcome “opiophobia” and prescribe painkillers.
`They are sponsoring public awareness campaigns that encourage people to
`seek medical treatment for chronic pain. They are even offering patient
`discounts to make prescription opioids more affordable.
`
`U.S. Surgeon General Vivek H. Murthy said he would advise his peers abroad
`“to be very careful” with opioid medications and to learn from American
`“missteps.”
`
`“I would urge them to be very cautious about the marketing of these
`medications.” — Vivek H. Murthy, U.S. Surgeon General
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`Surgeon General Vivek H. Murthy has called on U.S. doctors to help end the opioid epidemic. (Charles
`Dharapak / AP)
`
`“I would urge them to be very cautious about the marketing of these
`medications,” he said in an interview. “Now, in retrospect, we realize that for
`many the benefits did not outweigh the risks.”
`
`Former U.S. Food and Drug Administration commissioner David A. Kessler
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`has called the failure to recognize the dangers of painkillers one of the
`biggest mistakes in modern medicine. Speaking of Mundipharma’s push into
`foreign markets, he said, “It’s right out of the playbook of Big Tobacco. As the
`United States takes steps to limit sales here, the company goes abroad.”
`
`“It’s right out of the playbook of Big Tobacco.” — David A. Kessler, former
`commissioner of the U.S. Food and Drug Administration
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`David A. Kessler, a physician, was head of the U.S. Food and Drug Administration from 1990 to 1997. (Randi
`Lynn Beach / Los Angeles Times)
`
`Some Mundipharma representatives and promotional material have
`downplayed the risk that patients will become addicted to their opioid
`medications. Those claims recall the initial marketing of OxyContin in the
`U.S. in the late 1990s when Purdue deceived doctors about the drug’s
`addictiveness.
`
`Purdue and three executives pleaded guilty in 2007 to federal charges of
`misbranding drugs and were ordered to pay $635 million. The Drug
`Enforcement Administration said in 2003 that the company’s “aggressive,
`excessive and inappropriate” marketing “very much exacerbated” abuse and
`criminal trafficking of OxyContin.
`
`Purdue was a small New York City pharmaceutical firm when brothers
`Mortimer and Raymond Sackler, both psychiatrists, bought it in 1952. The
`spectacular success of OxyContin has generated nearly $35 billion in revenue
`over the last two decades and made the Sacklers one of the nation’s wealthiest
`families. Three generations of the family now help oversee Purdue and the
`Mundipharma associated foreign corporations.
`
`Family members declined to be interviewed for this article, as did executives
`who run their international companies.
`
`In a statement, Mundipharma International, which is based in Cambridge,
`England and responsible for European operations, said it was “mindful of the
`risk of abuse and misuse of opioids” and was “drawing on the experiences
`and insights of the US in tackling this issue.”
`
`Mundipharma said those efforts include seeking regulatory approval in
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`Europe for a formulation of OxyContin already sold in the U.S. that deters
`certain forms of abuse and introducing another opioid painkiller, Targin,
`with similar abuse-deterrent properties.
`
`“Mundipharma is committed to developing prescription medicines for
`healthcare professionals to treat patients in pain safely and responsibly,” the
`statement said.
`
`Promotional videos for Mundipharma, which feature smiling people of many
`ethnicities, suggest the companies regard OxyContin’s U.S. success as merely
`a beginning.
`
`“We’re only just getting started,” the videos declare.
`“Opiophobia” around the globe
`Joseph Pergolizzi Jr. is a Florida doctor with an array of business ventures. He
`runs a pain management clinic and co-founded a drug research company. He
`invented a non-prescription pain-relieving cream he sells on cable television
`and he serves as an expert for a mail-order nutritional supplements company.
`He also talks up opioids to foreign doctors for Mundipharma.
`
`In April, Pergolizzi was in Rio de Janeiro at a cancer pain seminar sponsored
`by the company. For an hour, Pergolizzi lectured the gathered physicians in
`English about the use of opioids in cancer patients and those with what he
`called “the death sentence of chronic pain.”
`
`Brazil had stepped up its use of painkillers in recent years, he said, but “you
`are still low” compared with the U.S., Canada and Europe.
`
`“I think unfortunately you may not have all the tools you need to properly
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`address pain,” he said, according to a video of the seminar posted online by
`Mundipharma.
`
`Consultants like Pergolizzi are key to helping
`Mundipharma overcome one of its greatest
`obstacles to selling painkillers abroad: Doctors’
`aversion to prescribing narcotics.
`
`Consultants like Pergolizzi are key to helping Mundipharma overcome one of
`its greatest obstacles to selling painkillers abroad: Doctors’ aversion to
`prescribing narcotics. For generations, physicians have been taught that
`opioid painkillers are highly addictive and should be used sparingly and
`primarily in patients near death.
`
`Mundipharma executives and consultants call this “opiophobia” and top
`company officials have said publicly that success in new markets depends on
`defeating this mind-set. Speeches like Pergolizzi’s portray painkillers as a
`modern approach endorsed by leading experts in the U.S.
`
`Mundipharma presented Pergolizzi to the Brazilian group as a professor at
`the Johns Hopkins and Temple University medical schools. Medical journal
`articles published in 2015 and 2016 with funding from Mundipharma or in
`collaboration with its scientists have identified him variously as a faculty
`member at Johns Hopkins, Temple and Georgetown University medical
`schools.
`
`In fact, he is an adjunct professor at Johns Hopkins and he has not been
`affiliated with Georgetown since 2010 or Temple since 2014, according to
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`school officials.
`
`Asked to explain, Pergolizzi said by email that he was having “paperwork
`issues” at Temple “which I am rectifying with their full cooperation” and was
`“in discussions” with Georgetown about an adjunct position.
`
`“I have never intentionally misrepresented … my university affiliations,” he
`wrote in another email.
`
`Joseph Pergolizzi addresses an April cancer pain seminar in Brazil sponsored by Mundipharma.
`(Mundipharma)
`
`A Temple spokesman said the university had “no reason to believe he will
`have any future relationship” with the school, and a Georgetown
`spokeswoman said, “We are not in discussions with that gentleman.”
`
`Government records indicate that Purdue and other U.S. pharmaceutical
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`firms have paid Pergolizzi more than $1 million since 2013 for consulting
`work, speaking engagements and other services as well as travel
`reimbursements. The records do not include any payments he may have
`received from foreign pharmaceutical firms such as Mundipharma. In his Rio
`presentation, he clicked quickly past a slide listing 16 drug companies for
`which he had done work.
`
`After Purdue launched OxyContin in the U.S. in 1996, the company ran
`similar training seminars for specialists — known in pharmaceutical
`marketing as “key opinion leaders” — in the pain field. Doctors were invited
`to all-expenses paid weekends in resort locations like Boca Raton, Fla., and
`Scottsdale, Ariz. The company found that doctors who attended seminars in
`1996 wrote more than twice as many prescriptions as those who didn’t,
`according to a company analysis.
`
`Several thousand of these specialists signed on to the Purdue “speakers
`bureau,” which paid them to make speeches about opioids at medical
`conferences and at hospitals.
`
`Dr. Barry Cole, a Reno psychiatrist and pain management specialist, started
`giving speeches about OxyContin for Purdue the year the drug hit the
`market. In recent years, he moved to the company’s international operation in
`a consulting role he described in an online resume as a “pain ambassador,”
`teaching the use of opioids to doctors in Colombia, Brazil, South Korea, the
`Philippines, China and Singapore.
`
`“Any side effect is reversible when treatment is discontinued, and there is no
`permanent damage to the body,” Cole told a 2014 conference of pain
`specialists in Veracruz, Mexico, according to an account of the presentation
`published on Mexican health websites.
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`In an interview with The Times, Cole said he made the foreign presentations
`despite having developed deep misgivings about the use of OxyContin and
`similar drugs in the U.S. Witnessing the opioid epidemic unfold, seeing the
`effect of opioids on his patients and reading scientific literature about the
`drugs, he said, led him to conclude by about 2010 that painkillers were too
`dangerous for most chronic pain patients.
`
`“We thought we could just get away with putting everybody on opioids, and it
`would be hunky-dory,” Cole said. “And it didn’t work and it had darker
`consequences than any of us were predicting.”
`
`He defended his work promoting opioids to foreign doctors, saying
`terminally ill patients were dying in pain in many places he visited. He said
`he never shied away from questions about abuse and had no way of knowing
`whether his talks led doctors to prescribe more opioids.
`
`“You show up, do a presentation and then you get back on the plane and are
`gone,” he said. He said he stopped making appearances for Mundipharma
`last year.
`
`One “key opinion leader” who attended Cole’s seminars was Ricardo
`Plancarte Sanchez, a Mexico City pain doctor who holds a position at
`Mexico’s national cancer institute.
`
`Plancarte now speaks at Mundipharma seminars in Mexico. In an interview,
`he said his aim was to help “demystify the use of opioids in chronic pain” and
`that he was not paid for his appearances.
`
`“We need to work more to educate so that people use analgesics more,”
`Plancarte said.
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`He said he was not concerned Mexico would see large-scale abuse and
`addiction.
`
`“If we educate our doctors as well as our patients, there will be better use of
`the drugs than in the United States,” he said.
`‘Talking about big money’
`Untreated pain is a global scourge. Each year millions with terminal cancer
`and end-stage AIDS die in needless agony, according to the United Nations.
`The problem is most acute in the poorest countries.
`
`Stefano Berterame, an officer of the U.N.-affiliated International Narcotics
`Control Board in Vienna, works to increase access to opioids in countries
`with shortages. He said most of the global problem could be solved with
`“very cheap morphine” but that selling it held little allure for multinational
`drug companies
`
`“It’s not very profitable,” he said. “Companies prefer to market expensive
`preparations.”
`
`Purdue charges hundreds of dollars a bottle for a month’s supply of
`OxyContin in the U.S. Generic morphine, which provides similar pain relief,
`can cost as little as 15 cents a day.
`
`Mundipharma is not alone in seeking new markets for opioids outside
`American borders. In the last year, two other manufacturers, Teva and
`Grunenthal, each bought drug companies in Mexico.
`
`Mundipharma sells drugs for a range of conditions, including asthma, cancer,
`and arthritis, but the core of its product line is opioid painkillers. In its global
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`expansion, Mundipharma is looking to countries with wealth, health benefits
`or large emerging middle classes. And it is pursuing patients healthy enough
`to be customers for a long time.
`
`“If your market is only cases of terminal cancer, then your market is relatively
`limited…,” Berterame said. “If you enlarge the market to also chronic pain,
`then you are talking about big money.”
`‘Rebel against the pain’
`Seeking new patients in Spain, Mundipharma chose ambassadors
`guaranteed to attract attention: Naked celebrities.
`
`A string of topless actors, musicians and models looked into the camera and
`told fellow Spaniards to stop dismissing aches and pains as a normal part of
`life.
`
`“Don’t resign yourself,” Maria Reyes, a model and former Miss Spain, said in
`the 2014 television spot.
`
`“Chronic pain is an illness in and of itself,” the pop singer Conchita added.
`
`The one-minute ad was part of a nationwide campaign developed and
`financed by Mundipharma to raise awareness of chronic pain — Rebélate
`contra el dolor (Rebel against the pain).
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`The ads do not recommend a specific treatment or medication, but do urge
`sufferers to see a healthcare professional — thousands of whom have been
`trained by the company in the use of opioids.
`
`The campaign is part of a strategy to redefine back pain, joint aches and other
`common conditions as a distinct malady — chronic pain — that doctors and
`patients should take seriously.
`
`Chronic pain patients, who fill prescriptions month after month and often
`year upon year, have been the driver of billion-dollar sales for Purdue in the
`U.S. University of North Carolina researchers analyzed the medical records of
`patients taking OxyContin at strengths of 30 milligrams or more— common
`doses for the drug — and found that more than 85% were diagnosed with
`chronic pain of one type or another.
`
`In Spain, painkiller use is on the rise. Company sales were up seven-fold
`since 2007, a Mundipharma executive said in a 2014 interview with an
`industry blog.
`
`Spanish pain specialist Cesar Margarit, a consultant for Mundipharma, said
`the celebrity ads performed a public service by propelling patients who were
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`“shy in recognizing they suffer from pain” to seek treatment.
`
`“You have celebrities saying, ‘I have chronic pain.’ [Patients] say, ‘OK, if they
`can say that, I can too,” Margarit said. “The impact in Spain was a very big
`one.”
`
`A Spanish-language promotional video titled “Dolor Cronico Camapana 2014” shows people discussing
`pain and where it might afflict them with graphic illustrations. (Instituto Mundipharma)
`
`The company removed the “Rebel against the pain” spots from its YouTube
`channel this fall — after The Times submitted questions to the company
`about the chronic pain campaign. A spokeswoman said the videos were taken
`down because the program was inactive.
`
`Around the world, Mundipharma companies cite statistics suggesting there is
`a great unmet need for their products. Opening an office in Mexico in 2014,
`Mundipharma officials declared that 28 million citizens were suffering from
`chronic pain. In Brazil, the company cited a figure of 80 million. In Colombia
`last year, a company news release said 47% of the population — about 22
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`million people — were afflicted by “this silent epidemic.”
`
`OxyContin sales
`
`$3.5 billion
`
`3.0
`
`2.5
`
`2.0
`
`1.5
`
`1.0
`
`0.5
`
`0
`
`ʼ08
`
`ʼ10
`
`ʼ15
`
`Source: QuintilesIMS National Sales Perspective
`
`Paul Duginski / @latimesgraphics
`
`A 2011 survey in the Philippines designed and paid for by the company
`concluded that the “government should recognize chronic pain as a specific
`health problem” and should improve access to pain medications.
`
`Health authorities in the U.S. say opioids are not the solution to chronic pain.
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`The Centers for Disease Control and Prevention said this year there is
`“insufficient evidence” that the drugs relieve pain in patients who take them
`for more than three months.
`
`Up to 24% of people on the drugs long-term become addicted, the CDC said.
`
`Up to 24% of patients who take the drugs long-
`term develop addiction problems, the CDC said.
`
`Some Mundipharma representatives abroad have suggested publicly that
`painkiller risk is overblown. As public health officials in the U.S. were issuing
`their latest warning about painkiller abuse last year, a Mundipharma
`executive was quoted in a Seoul newspaper saying that Korean doctors
`“worry too much” about addiction.
`
`“But many studies have shown that it’s almost impossible for those with
`chronic or severe pain to become addicted to narcotics, as long as the drug is
`used for pain relief,” Lee Jong-ho told the Korea Herald. Lee could not be
`reached for comment.
`
`Willem Scholten, a retired World Health Organization official Mundipharma
`has paid to speak at medical conferences, said President Obama, public
`health officials and the media have “exaggerated” the U.S. prescription opioid
`crisis. The surge in addiction and death was largely due to recreational abuse,
`he said.
`
`“The problem is a lot of crime,” Scholten, a Dutch pharmacist, said in an
`interview. “If [other countries] make good regulations, they won’t have similar
`problems.”
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`He said that “there is hardly any evidence” that pain patients abuse
`medications.
`
`Sharon Walsh, a University of Kentucky addiction expert who advises the
`FDA on risks from pain drugs, called the assertions “completely untrue.”
`
`“That is exactly the same thing they were teaching U.S. physicians when they
`launched OxyContin in this country,” said Walsh, who runs the university’s
`Center on Drug and Alcohol Research.
`‘The Google of the pharma industry’
`Mundipharma’s operations in the developing world are run out of a sleek
`Singapore office with a Silicon Valley feel. There are bean bag chairs, a “chill-
`out zone” and a tea bar, and employees are encouraged to think of the
`company as a nimble, creative start-up — “the Google of the pharma
`industry,” in the words of one executive.
`
`After introducing OxyContin in the U.S., Purdue’s Canadian affiliate and
`Mundipharma’s Australian company began promoting the painkiller in those
`countries. In the last decade and a half, both have seen U.S.-style problems,
`including criminal trafficking, addiction and death.
`
`Mundipharma turned its focus to the developing world in 2011, as U.S. sales
`began their drop. Rapidly modernizing countries are expected to spend more
`than $20 billion on pain medicines by 2020, according to QuintilesIMS
`Institute for Healthcare Informatics.
`
`Mundipharma expanded first in Asia, then Latin America and then the
`Middle East and Africa, ultimately having a presence in 122 developing
`markets.
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`The high cost of brand-name medications remains a barrier in many
`developing countries, but Mundipharma has sought ways to adjust. In Brazil,
`the company started a program this year that offers patients discounts on the
`cost of pills. Purdue used coupons in the U.S. that offered patients a free
`initial prescription for OxyContin. About 34,000 coupons were redeemed
`before the company terminated the program as concerns about abuse grew,
`according to a Congressional report.
`
`Revenues for Mundipharma Emerging Markets, the Singapore-based
`company that oversees developing world operations, have risen 800% over
`the last five years to about $600 million annually. A Mundipharma
`spokeswoman said that growth included revenue from deals the companies
`have made with other manufacturers to sell non-opioid products.
`
`Raman Singh, head of Mundipharma Emerging Markets, has said publicly
`that pain treatment in Asia is 1/50th of what it should be. Half the company’s
`worldwide sales in the developing world, which include products other than
`painkillers, already come from China, according to Mundipharma, and
`China is central to the Mundipharma’s global strategy.
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`As the head of Mundipharma Emerging Markets, Raman Singh, right, has overseen 800% sales growth in
`the developing world. Tennis star Caroline Wozniacki, left, is a Mundipharma brand ambassador for the
`antiseptic Betadine. (Suhaimi Abdullah / Getty Images)
`
`The Chinese government has pledged that all 1.4 billion citizens will have
`health insurance by the close of the decade, and the company is working
`quickly to establish itself as the market leader in pain medications. Since
`2011, Mundipharma has hired more than a thousand employees, most of
`them sales representatives, and now has a presence in 300 cities.
`
`Thousands of Chinese doctors have attended training seminars about
`Mundipharma’s drugs, and it claims a 60% share of the cancer pain market.
`Mundipharma has sponsored clinical trials of OxyContin and Targin at
`hospitals across the country.
`
`There remains, however, a deep-seated fear of opioids stemming from
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`Chinese defeats in the 19th century Opium Wars that left millions addicted.
`Under strict government regulations, patients can purchase OxyContin only
`from a hospital or other medical institution, and can receive no more than a
`15-day supply. Relatively few Chinese use Mundipharma’s painkillers for
`chronic pain because of their high price.
`
`Mundipharma's operation in China, headquartered in a Beijing skyscraper, has expanded rapidly since 2011.
`(Jonathan Kaiman/Los Angeles Times)
`
`Mundipharma is courting Chinese patients with a campaign encouraging
`people to take medications as their physicians prescribe. In one animated
`video on the company’s website, an elderly cancer patient who expresses fear
`about becoming addicted to painkillers is corrected by his nurse.
`
`“You will not be addicted if you follow the doctor’s instructions,” she tells
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`him. The video was removed from the site this fall at around the time The
`Times asked company officials about it. Asked why, a company spokeswoman
`said “programs and campaigns change frequently and content is updated
`often.”
`
`In China, where there are nearly 3 million registered drug abusers, the
`government has forced addicts into boot-camp style treatment that human
`rights advocates have described as prisons. Treatment is rudimentary or
`unavailable in many parts of the developing world.
`
`UNC researcher Nabarun Dasgupta, who has advised federal health
`authorities and the WHO on prescription opioid abuse, said the wide use of
`painkillers in those countries “sounds like a recipe for disaster” because “a
`certain percent [of users] will go on to need addiction treatment.”
`
`“A certain percent [of users] will go on to need addiction treatment.” —
`Nabarun Dasgupta, University of North Carolina researcher
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`Dr. Nabarun Dasgupta of the University of North Carolina has advised U.S. and world health authorities on
`opioid abuse. (Los Angeles Times)
`
`Mundipharma Emerging Markets said in a statement, “We attach great
`importance on promoting our pain medicines in a balanced and responsible
`manner so that the correct physicians are prescribing the correct medicines
`to the correct patients.”
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`‘A big deal’
`Public health officials in Europe worry far less about painkiller addiction
`than their American counterparts. Government health systems in many
`countries track prescriptions, making it more difficult than in the U.S. to
`obtain large amounts of opioid medication for abuse or criminal trafficking.
`
`But when a team of international researchers recently conducted the first
`large-scale survey of drug abuse in Europe, they found what the lead
`investigator described as a significant problem with prescription opioid
`abuse.
`
`Painkiller abuse rates are similar to the U.S. in the early 2000s “before the
`epidemic really got going,” Scott Novak, a scientist at the nonprofit RTI
`International in North Carolina, said in an interview.
`
`In Spain, 18% of those surveyed acknowledged abusing painkillers in the
`course of their life, according to the study published in August. Across
`Europe, people with prescriptions were eight times as likely to abuse the
`drugs.
`
`“They are potentially at the precipice of a major public health problem if
`prescribing increases,” Novak said.
`
`Mundipharma International took issue with that conclusion. The company
`said in a statement that painkiller abuse is less of a problem in Europe than
`in the U.S., in part because of stricter pharmacy regulation and government
`health systems. Mundipharma said that it was conducting a study of abuse in
`Britain and Germany and that initial results “suggest that in these countries
`abuse of prescription opioids is less than 1%.”
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`In one European country — Cyprus — OxyContin abuse is an acknowledged
`problem. Mundipharma began marketing the painkiller in 2008 on the
`Mediterranean island of 1 million. Government health coverage made the
`medication cheaper than heroin and addicts began crushing and snorting the
`pills.
`
`Officers responding to overdoses knew little of the U.S. experience with
`painkillers. Stelios Sergides, a superintendent with the Cyprus National
`Police, said that the first time he heard the word OxyContin, he had to look it
`up online.
`
`Since 2013, authorities have linked six deaths to the drug.
`
`“It’s a big deal, a big deal,” Sergides said.
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`Police superintendent Stelios Sergides has investigated OxyContin dealing on the small Mediterranean
`island of Cyprus. (Lisa Girion / Los Angeles Times)
`
`Mundipharma said it was “deeply disturbed” by the deaths in Cyprus and
`suggested the blame rested with a rehab center which used OxyContin to
`treat heroin addiction, a practice the company does not recommend.
`
`Police in Cyprus are investigating doctors suspected of overprescribing and
`working with public health officials to get addicts into rehab. Last year, 59
`people requested treatment.
`
`“We are worried, of course, because of the numbers, especially the treatment
`demand,” Sergides said.
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`In the Mundipharma’s Cyprus office, managing director, Menicos M. Petrou,
`called OxyContin “an excellent product” and said he had been honored to
`meet members of the Sackler family during visits to a factory on the island.
`
`“If people misuse drugs, most of the time there is little a pharmaceutical
`company can do,” he said.
`
`Times staff writers Hector Becerra, Marisa Gerber and Brittny Mejia in Los Angeles
`and special correspondent Jessica Meyers and news assistants Nicole Liu and
`Yingzhi Yang in The Times’ Beijing bureau contributed to this report.
`
`Additional credits: Lily Mihalik and Evan Wagstaff.
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