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    Company officials worried that if oxycontin wasnt seen as a 12-hour drug, insurance companies and hospitals would balk at paying hundreds of dollars a bottle. In the five-minute presentation, egilman accused purdue of ignoring its own science for financial reasons and sending patients on a dangerous roller coaster of withdrawal and relief. In the fall of 2004, in a remote courthouse in appalachia, the 12-hour dosing issue came close to a public airing.

    Then i start going into withdrawal, one patient wrote on an online message board in 2004. Thats because plaque will start to clog the small arteries in the penis before the wider coronary arteries. On the eve of trial, purdue agreed to settle the case by paying the state 10 million for programs to discourage drug abuse.

    The company charged wholesalers on average about 97 for a bottle of the 10-milligram pills, the smallest dosage, while the maximum strength, 80 milligrams, ran more than 630, according to 2001 sales data the company disclosed in litigation with the state of west virginia. As a varsity athlete at the university of central florida and later a public school teacher, burgess macnamara was used to following rules. The times asked the fda for comment on the drugs failure to provide 12 hours of relief for many patients.

    After some physicians began prescribing oxycontin more frequently than every 12 hours, purdue summoned its sales force to special seminars. Eight-hour dosing, the attorneys wrote, could optimize treatment for some patients and should level out the narcotic roller coaster. Some drug companies discuss that variability on their product labels and recommend that doctors adjust the frequency with which patients take the drugs, depending on their individual response.

    Reporters also examined food and drug administration records, patent office files and medical journal articles, and interviewed experts in pain treatment, addiction medicine and pharmacology. Purdue already had developed a technique to stretch a drugs release over time. Stephens, son of a local coal miner and the first african american elected to the west virginia circuit court.

    With percocet and other short-acting drugs, patients have to remember to take a pill up to six times a day, purdue told doctors. The case centered on elements of purdues marketing campaign that suggested to doctors that oxycontin was less addictive than other painkillers. Q8 dosing with oxycontin, one sales manager told her reps, according to a memo cited in an fda filing. And some of them are more cost-effective than the brand-name pills advertised on television. Purdue held closed-door meetings to retrain its sales force on the importance of 12-hour dosing, according to training documents, some included in sealed court files and others described in fda files.

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    In the meantime, your doctor will probably prescribe a phosphodiesterase type 5 inhibitor, also called a pde-5 inhibitor, like viagra, cialis or levitra. Then i start going into withdrawal, one patient wrote on an online message board in 2004. But ask your doctor about an injection thats a cocktail of generic forms of alprostadil, papaverine and phentolamine. A tennessee pain specialist whom purdue selected to field-test the drug in 1995 as part of the fda approval process eventually moved 8 of 15 chronic pain patients to 8-hour dosing because they were not getting adequate relief taking the drug twice a day. More than half of long-term oxycontin users are on doses that public health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for the times.

    By 2000, it was clear that chiding memos to sales reps werent enough. The problem offers new insight into why so many people have become addicted to oxycontin, one of the most abused pharmaceuticals in u. In the years after the settlement, purdue funded programs to prevent pharmacy robberies and keep teenagers from stealing relatives pills. Without that, it offers little advantage over less expensive painkillers when many doctors began prescribing oxycontin at shorter intervals in the late 1990s, purdue executives mobilized hundreds of sales reps to refocus physicians on 12-hour dosing. The times investigation, based on thousands of pages of confidential purdue documents and other records, found that purdue has known about the problem for decades.

    On the strength of that promise, oxycontin became americas bestselling painkiller, and purdue reaped 31 billion in revenue. His father, an attorney, wrote letters on his law office letterhead pleading with his sons doctor to take him off the drug, and his mother hid any oxycontin bottles she found, gallegos sister, kathryn galvan, recalled. Reps were ordered to visit doctors and refocus the clinician back to q12h. After oxycontin hit the market in 1996, ads in medical journals left no ambiguity about how long it lasted. For the first two or three hours, she experienced a modicum of relief. Sales would continue to climb until 2010, when they leveled off at 3 billion. Robert reder wrote to the memphis physician, using medical shorthand for 12-hour dosing. In this 1996 letter, a purdue regional manager writes that he is concerned about doctors prescribing oxycontin at 8-hour intervals. Executives anticipated a massive loss of revenue as generic versions drove down the price of ms contin, according to internal company correspondence from the period. Jerry bodie accused purdue of overstating the duration of oxycontin, among other complaints.

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