From dealer to doctor: A case study examining how Purdue Pharma sought to leverage racial health disparities to attenuate flagging OxyContin sales.

The objective of this study is to demonstrate ways in which Purdue Pharma and their primary consultant, McKinsey & Company, sought to leverage existing health disparities to maintain profits as the opioid epidemic worsened and regulatory pressure and negative media attention led to decreases in prescriptions of OxyContin and similar drugs. We use documents from the UCSF-Johns Hopkins Opioid Industry Documents Library, and correspondent media and policy documents, to evaluate "Project Tango," a strategy the two companies devised between 2014 and 2015 to enter the substance use disorder treatment market and expand sales to new customers. We find that Project Tango was one part of a broader strategy by Purdue Pharma to adapt and profit from the existing landscape of structural racism in medical care by investing more in drug sales and targeting medically underserved patients, particularly Black and Latino populations, and those enrolled in Medicaid. We contextualize the results to underline the importance of processes of structural racism to segmenting the pain management and substance use treatment markets in a manner that sought to capitalize on the very racism that prevented Asian, Black, Indigenous and Latino patients from obtaining pharmaceutical relief in the earlier days of the epidemic. We conclude that, (1) in absence of stronger federal regulation, especially in light of the recent reversal of the Chevron doctrine, local and state regulatory policies have found considerable success in limiting pharmaceutical excess, and policy at subnational levels will continue to be essential as the opioid epidemic still rages; and (2) greater use of resources such as the opioid industry documents can provide novel insight into processes of structural racism and offer targets for counter-intervention strategies.