In 2015, as opioid-related overdose deaths hit an all-time high in West Virginia, the trade group of the nation’s largest drug distributors drew up a plan to “turn the tide.”
The plan was not to reverse this trend, which for years would have been driven by a flood of prescription pain relievers shipped to the state by members of the trade group.
Instead, they wanted reporters to stop writing about it.
The plan was detailed in a memo, sent to a senior executive at this business group, the Healthcare Distribution Alliance, which lamented “unbalanced” coverage by reporters from local newspapers, including the Charleston Gazette, and proposed strategies to “inoculate industry” to blame it on pharmacists, doctors and their patients.
This note was publicly filed in another state federal court in 2019 and was mentioned in opening statements for the historic Charleston trial underway. The city of Huntington and Cabell County are fighting to hold the country’s âbig threeâ drug distributors – McKesson, AmerisourceBergen and Cardinal Health – financially responsible for the opioid epidemic.
“It’s unbelievable,” Cabell County attorney Paul Farrell Jr. told U.S. District Judge David Faber, summing up the note last month.
Farrell and his co-counsel argued that drug distributors knew they were fueling an epidemic of opioid addiction, but were more concerned with their results than with restricting the flow of opioids. Meanwhile, defense attorneys argued that drug distributors are just middlemen and their actions did not trigger the opioid crisis.
It is not clear whether the HDA or the distributors acted on specific advice in the note.
But, argued Farrell, the memo illustrates the desire of drug companies to chase profits rather than patient safety.
âWhat’s at stake? Not lives. The credibility and reputation of our industry,â Farrell said sarcastically.
Offer “carrots” to keep journalists running
Drug distributors were on the defensive. West Virginia had filed a lawsuit against the companies and, thanks to that litigation, sales information that the companies had desperately tried to keep secret was leaking. Between 2007 and 2012, drug distributors shipped over 200 million doses of opioid pain relievers to the state, Eric Eyre reported in the Charleston Gazette in May 2015. (Eyre is now co-founder of Mountain State Spotlight and reports on this essay.)
But these figures were not complete. They excluded data from the country’s two largest distributors at the time, Cardinal Health and McKesson. And other distributors refused to disclose “confidential” data on the number of pills sent to individual pharmacies.
Eyre was doing all he could to obtain this data. And the drug distributors – through their business group – hatched a plan to distract him.
They turned to GMMB, the powerful political consultancy firm. The company has helped the last three Democratic presidents win the White House and has been a major recipient of spending by Democratic candidates in the last election cycle. But the company also provides public relations support to large trade associations such as the Healthcare Distribution Alliance and the American Beverage Association, which represents Coca Cola and Pepsi – a fact that GMMB rarely announces when promote its efforts to promote public health.
In a memo to John Parker, HDA’s communications manager, GMMB noted that keeping sales data private gives distributors a bad image. To counter the bad press, GMMB recommended offering a scoop to Eyre: exclusive access to two âkeyâ speakers during a closed-door summit with US Senator Joe Manchin where drug distributors could highlight their efforts to fight against opioid abuse.
This, and an âexclusiveâ first look at a subsequent report, would be a âcarrotâ for Eyre and âhelp expand HDMA’s relationship with him,â GMMB wrote, referring to HDA ââby its old acronym, which stood for Healthcare. Distribution Management Association.
The GMMB also recommended holding âofficeâ briefings with West Virginia reporters.
“We would include Eric Eyre in this group and carefully prepare any spokespersons before speaking to him,” GMMB said in the note.
Siobhan Bunaes, senior vice president of GMMB, said in A declaration at Mountain State Spotlight that his company developed marketing materials for HDA in 2015 and 2016, but “was never contracted by or performed any work for HDA related to opioid use.”
In that same statement, she acknowledged that GMMB had proposed the summit in response to a request from HDA for “a proposal to address growing concerns about the use of opioids.”
The proposed summit described in the GMMB memo appears never to have taken place, and it is not clear to what extent HDA followed the advice outlined by GMMB in the memo. Parker declined to comment for this story, citing the ongoing litigation.
The efforts of both organizations to hijack Eyre have not worked.
A little over a year later, Eyre finally got the data from the state attorney general’s office and released a pair success stories which revealed the impressive number of pill dispensers delivered to West Virginia – 433 per person over a six-year period – and the fact that distributors and the State had long been aware of the problem.
These stories, coupled with the release of national data by the United States Drug Enforcement Administration to attorneys representing local governments across the country, have led to thousands of lawsuits against distributors. Eyre ultimately won the Pulitzer Prize for his work.
An overview of a corporate influencer campaign
Jonathan Marks, professor of bioethics at Penn State University, said he was not at all surprised by the content of GMMB’s memo.
âIt’s straight out of the corporate influence playbook,â he said.
He drew parallels between drug distributors, automakers and tobacco manufacturers who have all been involved in high-profile litigation as a result of efforts to minimize the deadly consequences of using their products, which Marks called “deeply ethically problematic behavior”.
Marks noted that each year these companies were able to push back the media, regulatory and legal scrutiny was another year they could make incredible profits.
âWe have created strong structural incentives for companies to bury the problems,â he said.
Cabell County attorneys in the Charleston lawsuit hired another professor, Jakki Mohr of the University of Montana, to provide expert testimony on distributors’ efforts to minimize their contribution to the opioid crisis. Mohr concluded that companies have âeffectively influenced the media to get their message acrossâ.
In a discussion thread reviewed by Mohr, representatives from the âbig threeâ distributors offered to let âHDA take the leadâ on managing the response to critical media coverage and were pleased with the results. An AmerisourceBergen executive wrote that the trade association can “say things we can’t / don’t want.”
HDA got to work. Not only did it work with GMMB, but according to Mohr’s testimony, the trade group contracted with consultant Eric Dezenhall, who has been dubbed the “public relations pit bullFor its effectiveness, to counter the growing wave of negative press.
Dezenhall’s company has done a lot of work for the opioid industry and has managed to plant a pro-opioid story in The New York Times, according to a ProPublica survey. He did not return a request for comment for this story.
The company had also launched a successful attack on one of the first media investigations into the opioid epidemic, a five-series part in the Orlando Sentinel in 2003. The reporter who conducted this investigation resigned and the newspaper printed a front-page correction after Dezenhall’s company made holes in the reporter’s analysis.
But instead of being “exaggerated” as executives at OxyContin maker Purdue Pharma referred to the media coverage, the story turned out to be premonitory. More than a decade later, the Columbia Journalism Review called the Sentinel series “just too soon.”