Angela Kennecke: 0:08

Deaths from opioids started rising rapidly after the powerful prescription painkiller OxyContin hit the market. The company behind the opioid, Purdue Pharma, has been found guilty on several charges and is the subject of the Netflix docu series, Painkiller, along with the company's aggressive sales reps, as portrayed here in a clip from the show.

Painkiller: 0:30

You will be convincing doctors to take pain seriously. Oh! Oxycontin is the one to start with and the one to stay with. The more you prescribe, the more you'll help. It is now the number one opioid.

Angela Kennecke: 0:44

For some viewers, like today's guest, the show hits too close to home. Stephen May joined Purdue as an Oxycontin sales rep in 1999. At the time, he believed in the product, but that soon changed, leading him to become a whistleblower.

Steven May: 1:00

So at the same time that my territory was going down in sales, the abuse issue was growing within the same territory. And I was getting a lot of pressure from my manager. Oh, have we hired the wrong sales rep? We hired,

Painkiller: 1:17

you know,

Steven May: 1:17

other people. We need to hire somebody to get in here and fix this. and overcome these objectives that the doctors were

Angela Kennecke: 1:24

having. So I'm getting that pressure at the same time. On today's episode, Stephen gives us a behind the scenes look at what was happening at Purdue as the company got rich and opioid addiction rates skyrocketed. I'm your host, Angela Kenecke, and you're listening to Grieving Out Loud. Well, Steve, welcome to Grieving Out Loud. I'm really grateful for the chance to get to talk to you on one hand, because I spent 35 years working as a journalist and as an investigative reporter, and I'm always interested in the whistleblower. It usually takes a whistleblower for big cases to crack and for companies to be exposed for any wrongdoing. And of course, I'm interested in your perspectives from the beginnings of the opioid crisis and where we are today in this country, because really, if you look back at Purdue and OxyContin and the Sackler family, I don't think we would be where we are today with the fentanyl crisis if it were not for OxyContin.

Steven May: 2:34

Totally agree. Totally agree.

Angela Kennecke: 2:36

So let's go back to, was it 1999 when you started working for Purdue? Yeah.

Steven May: 2:42

Yeah, I was recruited. I was working for another pharmaceutical company at the time. Before that, believe it or not, I had been law enforcement, which is what I went to college to do. I desired a license in law, but took a different route when I became a drug dealer.

Angela Kennecke: 3:02

In 1999, Purdue recruited Stephen to work for the company. At the time, he thought it sounded like a great opportunity.

Steven May: 3:12

They were one of the most prestigious pharmaceutical companies to work for in terms of pay, the culture, everything. It was a pretty coveted type position.

Angela Kennecke: 3:21

And you would say that back at the turn of the century, that Purdue had a good reputation.

Steven May: 3:27

Oh, absolutely. Yeah. They had a solid reputation. It was a pretty tough process to go through just to get recruited. You had to be in the top 10 percent of your current pharmaceutical company and, you know, everything that I had heard and seen and had actually known the rep was going to be replacing when I joined Purdue. Yeah. Everything I knew about the company was top notch. And

Angela Kennecke: 3:50

I remember back in the early 2000s having friends go into pharmaceutical sales and it was very lucrative. I don't know if it's as lucrative as it used to be, but it sure was back then.

Steven May: 4:00

Yeah, I mean, I would say it was probably above average for the type of work we were doing. I mean, it wasn't on the level of, let's say, medical device representatives or surgical reps. But it was a pretty, And you

Angela Kennecke: 4:18

call yourself a drug dealer, which we should say you're dealing a drug that was basically heroin in a pill form. We know that now. I don't think that the public necessarily knew that then. And I don't know that the sales reps know that

Steven May: 4:31

then. Well, I think we had an idea. I mean, I understood the whole scheduling of drugs at the time when I joined, but in terms of what I joined the company to do and what we were trained to do and what we had hoped that we were doing was we were trying to help people, you know, that was one of the big pushes that the company had was really got people to emotionally become invested in the whole concept of helping people.

Angela Kennecke: 5:00

Stephen wasn't just recruited to work for Purdue. He also found himself at the forefront of the opioid epidemic. Right in and around Roanoke, Virginia. The very area depicted in the Emmy Award winning TV series, Dope Sick. Here's a glimpse from the show's trailer.

Dopesick: 5:19

You will be the largest sales force in pharmaceutical history. Make your doctors feel special. Take them to expensive dinners. Bribe the receptionist with a mani pedi. Whatever it takes to win their trust.

Steven May: 5:32

My territory basically covered from Roanoke, Virginia south and westward. And so I really covered most of southwestern Virginia and parts of southern western. And if you look back in the time frame of the opioid crisis, That area of the country was really the original epicenter of the entire opioid crisis. It's where Purdue was convicted criminally for over marketing of the oxytoc back in 2006.

Angela Kennecke: 6:00

And Steve, you would say that is because of the demand for people who needed relief from pain to begin with, right? I mean, I think this has been portrayed as, you know, an area where you had a lot of mining accidents, you had a lot of manual labor, that kind of thing.

Steven May: 6:15

Oh, absolutely. Yeah. So. There was the demographics, you know, manual labor type jobs throughout the entire region. And it was also a pretty depressed area as well.

Angela Kennecke: 6:27

So people that are maybe not in the best state of mind, don't have the best economics are going to be more likely when they do take a drug that is, can be mind altering to want more of that too. Not only for the pain, but for the emotional and mental things that they're going through.

Steven May: 6:44

Yeah, absolutely.

Angela Kennecke: 6:51

After joining Purdue in 1999, Stephen went through training and then became a field representative in January of 2020. It didn't take long for him to realize that OxyContin wasn't always as helpful to patients as he initially thought.

Steven May: 7:08

What really struck me with that was within my first month of working for Purdue, I had a national sales trainer came road with me. And at the time she was the reigning number one rep in the entire country, you know, so the previous year she was the rep of the year. And so she came to ride with me, training, pretty normal process and everything. And I'll never forget going to visit a doctor in Lewisburg, West Virginia. We walked into her office, uh, introduced ourselves as the Purdue OxyContin representative. She knew my predecessors very well. And, uh, she says, wait for me in my office. So we waited and she came in a few minutes later and she said, I just wanted to let you know that I'm no longer going to be prescribing the drug because my relative niece had overdosed the previous weekend as a result of OxyContin, therefore she was done with it. I can tell you, it was a pretty shocking moment. We left her office, went and sat down at a place where we could have some coffee and try to. You know, think through what we had just heard because it was the first time I had heard or had a doctor just flat out tell me this is what your drug is doing to my community and specifically her family. And it even, you know, took the rep of the year by surprise. She'd been with the company, I think at the time, you know, four or five years. So she was quite, you know, taken aback by it. We reported it up the normal chain of communication or let the company know that, hey, we had this adverse event reporting, which is. what we're supposed to do by law and such. And I'll never forget that day because from that day, I became really hypersensitive to constant complaints that I would hear from doctors as I was going out marketing the drug within my territory and over the next few months to a year to a year and a half. the noise of this abuse and diversion crisis kept growing.

Angela Kennecke: 9:16

Despite increasing complaints from doctors and rising deaths, Steven says Purdue pushed him even harder to sell the drug.

Steven May: 9:27

You know, the message is those are people who are abusing the product, not real patients. You need to get the doctor to focus on treating legitimate patients. Almost a Jedi mind trick that we were trying to do on the doctor. You know, it's emotionally tugging their hearts to get them back over and

Angela Kennecke: 9:46

prescribed it. And there was a lot of pressure, too. And there were a couple things that were going on at the time with Purdue. Well, first of all, the FDA had said it was less likely to be addictive, right? I'm not sure if I have the exact wording correct there.

Steven May: 9:59

I'll tell you what the exact wording was. The package insert. I still remember it. I memorized it. It was, The long acting delivery mechanism of OxyContin is believed to reduce the abuse liability of the drug. And that is actually a message that we eventually, I think about a year and a half later, they were forced to take that particular claim out.

Angela Kennecke: 10:20

And there's a lot of questions about how that got approved in the first place, how that line got in there and, and why it was there and who allowed it and who was rewarded for allowing it. And if you watch or read any of these books, you'll get deeper into that story. But Really, did the sales reps believe that? Did they believe that?

Steven May: 10:39

I think a lot of us did, and I think a lot of us held on for years after this really started blowing up.

Angela Kennecke: 10:47

And blow up it did. Within the four years Stephen worked for Purdue, he saw the opioid epidemic get progressively worse, along with doctors trust in the company.

Steven May: 11:00

When I joined the company, my territory was ranked number 29 or 30. Thank you. Out of 600 reps throughout the entire country. And I would say that within about six to nine months, my territory was on a rapid downward trajectory. I eventually became dead last in the company. So at the same time that my territory is going down in sales, the abuse issue was growing within the same territory. And I was getting a lot of pressure from my management. Oh, have we hired the wrong sales rep? We hired. you know, other people, we need to hire somebody to get in here and, and overcome these objectives that the DACA people are having. So I'm getting that pressure at the same time.

Angela Kennecke: 11:46

You know, one thing we've interviewed a couple of authors on this podcast, Sam Quinones and Philip Isle, and they talk a lot about the pill mills that popped up, you know, the doctors that were running the pill mills, or sometimes they were run by people who didn't even have a medical background, but they had employed a doctor. Here's a short clip from a recent Grieving Out Loud podcast featuring Philip Isle, who wrote a book about Dr. Paul Voltman. Volkman was sentenced to four consecutive life terms for illegally prescribing pain medications that led to multiple deaths.

Philip Eli: 12:21

He started prescribing opiates and other controlled substances at a tremendous clip, so much that local pharmacies pretty quickly said, Hey, we're going to stop filling these scripts. That didn't stop him. He and his clinic owner applied to the Ohio Board of Pharmacy to establish an on site pharmacy. and that's what they did. They got the green light and things just continued from there.

Angela Kennecke: 12:52

And they were just writing out these scripts left and right because it was so profitable for them. Did you see that during your time as a sales rep for Purdue?

Steven May: 13:01

Oh yeah, we actually had a few of them, not only within my territory, but the surrounding territories. Quite frankly, those were the most profitable. Doctors to call on for the company for a while before they actually realized that that was that problem. You know, we were encouraged to go and market to those doctors, the top doctors. Those pill mills were quite profitable clinics for the company. And I think the company early on, and probably through 2000 and 2002 wanted to continue to, to target those types of doctors.

Angela Kennecke: 13:36

And how did that sit with you as you were in the midst of all of this and selling this drug?

Steven May: 13:41

At some point, we were told to pull back calling on, you know, some either there was news that they were being investigated for over prescribing or something like that. But it was a challenge to a point that I remember one day, you know, I was so frustrated with the whole situation. I hate to say it, I totally bought into the whole treating legitimate pain thing. The treating pain became pretty partial. But I remember one day walking into the sheriff's department in Pulaski, Virginia. I said, Hey guys, I'm the OxyContin representative and you could have seen the jaws drop at that moment. They were shocked to see me. And basically my whole purpose was I wanted to open up a dialogue between our company and them and the doctors and try to get better communication because the doctors were afraid of prescribing. So I would say, Really trying to take a more proactive and aggressive role in trying to combat some of that. While at the same time, I'm being told I'm not a great representative because I'm dead. Last place in the company,

Angela Kennecke: 14:50

Purdue Pharma has become known for its aggressive and deceptive marketing of Oxycontin. A story brought to light in the Netflix series, painkiller.

Painkiller: 15:00

Oxycontin is the one to start with and the one to stay with. The more you prescribe, the more you'll help.

Dopesick: 15:09

This drug is permeating every part of our community. You're the cutest little oxycontin kitten we've seen in a minute.

Angela Kennecke: 15:18

So I have a question for you. Have you seen the show Painkiller? Yes, I have. So my question for you is, I met Wes DeCovney, who played the young sales rep, who was just learning, I think her name was Shannon, the character's name was Shannon, they portrayed these sales reps. And then there was the experienced sales rep that she went out with, who had all these materialistic things. And when you talked about going out with that person to learn the route and all that, was it like that? Was it like how it was portrayed in Painkiller?

Steven May: 15:48

I gotta tell you, I watched about two episodes and got a little PTSD after it. You did? Yeah, I told my wife, I said, this is too close to home, but at the same time, for me personally, even though that show is kind of about my territory and the territory throughout because it was talking about Roanoke, Virginia, and I'm going, this is way too close to home. And I kept watching it in terms of arguing, pushing back that that's not what happened. That's not how I live. That's not, you know. what I was doing. Now, were there reps living high on the hog as they say? Yes, there were in other parts of the country, but I can speak specifically for myself. Purdue was known at the time as one of the highest paying companies. When you've got the dead last territory, it's not. But you see everybody else around you.

Angela Kennecke: 16:38

So you weren't making the big bucks at the time is what you were saying.

Steven May: 16:41

I was just making the paid salary, except for the very first couple of months of my entire career. Yeah.

Angela Kennecke: 16:55

Along with exposing Purdue Pharma's aggressive marketing, Painkiller also shows how the company starts to unravel as people began dying from the opioid and authorities stepped in to investigate.

Painkiller: 17:08

I am an investigator with the U. S.

Dopesick: 17:09

Attorney's Office.

Painkiller: 17:11

You

Angela Kennecke: 17:11

lie,

Painkiller: 17:11

you

Dopesick: 17:12

hurt

Painkiller: 17:12

people, you

Angela Kennecke: 17:12

go down.

Dopesick: 17:14

You ever prosecute a company as big as Purdue Pharma?

Angela Kennecke: 17:18

This part of the show hits especially close to home for Steven. At one point, he was even interviewed by the state attorney general about his role in marketing the drug.

Steven May: 17:29

Pretty quickly, and at least felt pretty quickly, like I was being put in a position where the company would at any point would love to see it. That rep right there, it's his fault that all of this is happening. Be the

Angela Kennecke: 17:43

fall

Steven May: 17:43

guy. Be the fall guy. Yeah. I really felt that. In fact, I think my second day of being interviewed by the state attorney general's office, that's when I felt like, okay, I'm finding myself in a really bad situation. The company was, Oh, they're paying for the lawyers that are there to represent me, but they're not there to represent me. They were there to protect the company. But I would sit there and my call notes would be read back to me and I'm myself. It's a good thing that I document the way did. So yeah, I saw firsthand the legal pushback that started happening as a result as well.

Angela Kennecke: 18:20

Have you lost a loved one to overdose or fentanyl poisoning? I'd like to invite you to share their story on our new Emily's Hope Memorial website called More Than Just a Number. They were our children, siblings, cousins, husbands, wives, aunts, uncles, and friends. So much more than just a number. You can submit a memorial today on MoreThanJustANumber. org. Stephen left Purdue in January of 2005. The following year, he began volunteering at the Roanoke Rescue Mission, a program dedicated to helping those struggling with substance use disorder.

Steven May: 19:04

Some of my friends that I met during that time, developed relationships with. I mean, I worked with them for almost three years. I got to love them, really had a heart for them and then find out, oh, Oxy. It was a tough situation.

Angela Kennecke: 19:18

And so let's go back just a bit. Why did you leave the company?

Steven May: 19:23

I was recruited to work for another company.

Angela Kennecke: 19:25

Oh, okay. So it wasn't like you had a, necessarily a huge moral problem with what you were doing at the time, or you got discouraged? Well, I

Steven May: 19:33

did. I was discouraged by the end of 2004. Company had its first layoffs, I think in company history, and it was pretty low. The company at that point,

Angela Kennecke: 19:49

after leaving the company, Steven was contacted by the wife of his former manager, mark Radcliff, who had marketed Oxycontin for Purdue Pharma from 1996 to 2005. Mark was filing a lawsuit against Purdue alleging that the company had misled doctors about the drug's potency and cost savings.

Steven May: 20:09

Basically exposing the fact that the company had committed fraud, made a false claim about the efficacy of the product when they were marketing it and when they submitted the product to the FDA. And that false claim was based upon a one dose, single day clinical trial that would show that OxyContin is twice as potent as morphine. Therefore, you'll end up prescribing less oxycontin than you would of morphine. And, oh, by the way, because of this two to one conversion, it actually costs less than the morphine, which was, at the time, Purdue had MS CONT, which is a long acting morphine. That was in the process of becoming generic, so they needed to launch oxycontin in order to make up for the lost revenue that they would have when the MS CONT was generic. But the problem with that clinical study It was making a false claim because when you take morphine over and over, it builds up in the body, and as a result, it actually becomes a one to one conversion, or at best a one to 1. 5, depending upon the literature of the grade. Really, most of the literature, I think, was one to one conversion. So it wasn't twice as potent as morphine. You would only take half the amount of morphine that you would on a milligram per milligram baby. The end. When you do the math on that false two to one conversion, and you compare it to a one to one conversion, instead of Oxycontin being less expensive, it becomes 1. 6 times more expensive than morphine. Well, that extra expense leads to a much bigger bottom line, more profitability for the company. They can pay their reps better than any other company in the industry, okay? They can hire more reps. And that's what I believe led to the big push of pain management. You know, pain is the fifth vital sign.

Angela Kennecke: 22:11

Mark Radcliffe's lawsuit ended up being dismissed because when he was laid off during a reduction in force, he had signed a contract with Purdue agreeing not to sue the company in exchange for an enhanced severance package.

Steven May: 22:24

A couple years later, myself and his wife blocked the case. She asked me if I'd be willing to join her case against Purdue and thought about it a lot and knowing the friends that I had at the time within the rescue mission, knowing personal friends that had been affected by it, kind of saw it as an opportunity to get back, you know, to really say, no, this was a problem. And we were more successful in bringing that case because we got to the point where we went into discovery and it's when you go into discovery when the company gives all the materials that they have about, you know, that particular claim that they were making, I was beginning to see during that time that not only did the company know that they were making a false claim about the efficacy of the product, the FDA knew and so did many other regulatory agencies around the world. You know, I can remember reading. Emails from a director of the Japanese equivalent of their SDA saying you can't be making this two to one conversion equivalence and the company would push back on at the same time. I'm also with internal emails that I got this company that said, Hey, we have to protect our franchise. You know, and that's is going generic. Oxycontin is going to be the only thing that will float this company. So there was a big push to protect that. And I. personally believe that had they not been able to make that false claim, I'm not sure how well accepted it would have become in the market. It would have been a whole lot harder to sell the product to doctors if I had to tell them, Oh, it's 1. 6 times more expensive than generic morphine. Yeah. Right. Unfortunately, our case was thrown out pretty much on the same basis that they tried to throw it out on that technicality a couple of years earlier. And we ultimately lost on the appeal, so I never got to make these claims in court.

Angela Kennecke: 24:25

Were you ever threatened or harassed for filing the suit?

Steven May: 24:29

Only threatened in the sense that the high powered attorneys at Purdue had said that they would come after us if we don't drop the suit. You know, they'll sue us for everything we have, but quite frankly, at the time, I didn't have too much.

Angela Kennecke: 24:41

Didn't have a lot to lose?

Steven May: 24:42

Didn't have a lot. I can promise you, at that time, I didn't have a whole lot.

Angela Kennecke: 24:47

Even though the suit was thrown out on a technicality. Are you still glad that you filed it?

Steven May: 24:53

Yeah, I mean, I learned a lot. I think that our case could have been a momentous, you know, one of those, Oh wow, this product should never have been approved. My case was dismissed only a couple of days before we were scheduled to depose Richard Sackler. Not only do I feel like the company did a really good job of persuading the court to dismiss my case, I think the court didn't want to have anything to

Angela Kennecke: 25:20

do with it. Some parents who've lost children to Oxycontin and who've suffered horribly want to see the Sacklers charged criminally. And they've been demanding that from the Department of Justice. Do you think that should happen?

Steven May: 25:35

Oh, absolutely. I think not only that, I think anybody within the FDA who is part of the approval of the charge, and once again, they knew they would make false claims about the efficacy of the product. The Sacklers. they're executives. I've read their email. Unfortunately, I never was able to present that information and evidence in court, but I know what I've seen and I know they have a liability and so do the people who are involved in the regulatory process. And to some degree, I fault the DOJ for not adequately wanting to go after them.

Angela Kennecke: 26:14

And maybe some of that will come out now that they cannot have immunity in these cases. So maybe some of these things will come out in other cases.

Steven May: 26:22

Yeah, and it breaks my heart. I mean, I don't know how parents, family members live. And I've got kids at an age when it's a dangerous world out there. And, you know, my personal biggest fear is them getting something that they had no idea was laced with that.

Angela Kennecke: 26:42

Happens every day in this country, over and over again. And that's why we're talking about it here. We're talking about it here to try to prevent and try to educate people. And sadly, yeah. Well, thank you for, for sharing your story with us and our audience and, and thank you for the work that you did do to try to shed some light on what was going on and that you're talking more about it now. Really appreciate that. I

Steven May: 27:07

appreciate you giving me the voice. Thank you.

Angela Kennecke: 27:14

And thank you for taking the time to learn more about one of the most pressing issues facing our country, the opioid crisis. To listen to more podcast episodes, along with checking out the latest news headlines surrounding substance use disorder and the fentanyl epidemic, head over to our website, emilyshope. charity. I want to thank you for listening. Until next time, wishing you faith, hope, and courage. This podcast is produced by Casey Weinberg King and Michael Garron.