Marketing Opioids to Veterans and Older Adults: A Content Analysis of Internal Industry Documents 

Abstract

Background: From 1999 to 2020, the opioid epidemic claimed over 400,000 lives in the United States. Military veteran and geriatric adults, two populations with considerable overlap, were uniquely devastated by opioid addiction. Veterans’ death attributed to opioid use increased by 65% from 2010 to 2016 while opioid prescriptions for older adults increased by a factor of nine between 1995 to 2010. Methods: “Documents-related” research is a growing field of qualitative study that involves the interpretation of documents in order to elicit meaning. In January 2020, documents used in State of Oklahoma v Purdue Pharma, L.P. et al were released to the Drug Industry Document Archive (DIDA) at the University of California, San Francisco for storage in perpetuity. Two authors (HY and BG) completed an initial screen of all 503 internal documents, totaling 62,703 pages, in the Oklahoma collection based on document numbering as labeled by DIDA. Documents were organized into a master file that identified key concepts related to the opioid industry’s targeting of high-risk populations for increased opioid sales. The master file and supporting documents were then reviewed by the entire team until a final consensus was reached regarding interpretation. This study includes 225 relevant documents from the Oklahoma Collection, all of which specifically referred to efforts to sell opioids to military veterans and older adults. These documents detailed the opinions of executives, corporate goals, and plans to increase opioid consumption in these specific populations, and were comprised of internal emails, sales pitches, and PowerPoint presentations.Results: We identified opioid manufacturer targeted marketing to military veterans and older adults. Efforts to market opioids to veterans used the trauma of war as a selling strategy. Strategies to target older adults focused on funding patient outreach programs that exploited the worries of the elderly community, specifically loss of functionality and quality of life. Conclusion: Pharmaceutical companies preyed on the fears of military veterans and older adults to market opioids, claiming that opioid use would improve quality of life and lead to self-fulfillment. These campaigns masqueraded as public health initiatives and disease awareness campaigns.