• The media conversation around the biggest public health crisis in the US has immensely strengthened the already popular narrative portraying Big Pharma as an industry which prioritises profit over consumer well-being.
  • Purdue Pharma, which was recently sued by nearly every US state, was presented as the main villain in the opioid epidemic, as it was accused of deceptive marketing strategies.
  • Although Johnson & Johnson, the world’s largest healthcare company, isn’t a big player in the opioid market in the US, it was in the centre of the media discussion because it was hit by a landmark court ruling which could have grave implications for its traditionally family-focused brand.

As the media conversation around the ongoing US opioid epidemic becomes more and more intense, with the companies involved under ongoing pressure of litigation and public shaming, the pharmaceutical industry is experiencing unprecedented reputational declines. According to a new Gallup poll, pharma is now the most poorly regarded industry in the US, unseating the federal government.

In fact, the net ratings for the pharma industry have never been lower since Gallup started its industry surveys in 2001. The reasons for this new low ranged from high drug prices to spending on lobbying, but Gallup emphasised the industry’s role in the opioid crisis as a particularly burning issue, suggesting that until that problem is properly addressed, it’s unlikely that pharma’s reputation will recover.

In the US, opioid overdoses are officially a public health emergency, with more than 130 people dying daily, according to a 2019 report from the National Institute on Drug Abuse. Last year, Congress allocated more than $3 billion in new funding to address the crisis, while the President signed into law the SUPPORT Patients and Communities Act, which aims to manage the epidemic through treatment, awareness and recovery services.

Another worrying aspect of the crisis is that people who become dependent on pain pills are likely to switch to heroin because it’s cheaper than prescription drugs. The National Institute on Drug Abuse found that almost half of young people who use heroin started doing so after abusing prescription painkillers. Those addicted to prescription opioids are 40 times more likely to become addicted to heroin.

Nearly every US state has sued pharma companies involved in the crisis, with many of the claims relating to the companies’ marketing practices. Researchers found a link between doctor-targeted marketing of opioid products and the increase in US deaths from overdoses: when manufacturers increased their opioid marketing budgets by only $5.29 per 1,000 population, the number of prescriptions rose by 82% and the opioid death rate was 9% higher a year later.

The media industry itself is also under scrutiny in this context. For example, communications companies such as Medscape, which was funded by some pharma players, exist between independent news and branded content, and doctors might find it difficult see where editorial content ends and industry influence begins.

Much of the recent media coverage demonises pharma companies and tells stories of wasted lives, but according to some medical professionals, the opioid media narrative was very different in the 1990s, with outlets championing a paradigm shift in the way we thought about pain relief by telling that pain was undertreated and opioids were safe.

This narrative was influenced by the marketing strategies of opioid producers which used “emotional selling” techniques to persuade doctors that pain was undertreated and patients suffered as a result. They also pushed the idea that when patients wanted higher doses, this wasn’t a sign of addiction but a need for better treatment.

Historically, journalists have framed people with addictions as criminals, instead of treating them like medical patients, according to two Northeastern researchers, who recently launched “Changing the Narrative,” a guide for healthcare professionals, journalists, policymakers and lawyers to help “nudge them toward more accurate, less stigmatized language.”

Using less-stigmatising language – for instance “person with a substance-use disorder” instead of “addict” or “drug abuser” – could help ease negative biases and change how medical professionals treat addiction. The academics argue that even the commonly-used term “opioid epidemic” is misleading because addiction isn’t infectious, and urge journalists to choose their sources carefully: for instance, not to quote prosecutors, who usually don’t have medical backgrounds, as experts on addiction.

Companies under fire

The media conversation around the opioid crisis in the top-tier English language publications from October 2018 to September 2019 was dominated by two companies – Purdue Pharma and Johnson & Johnson:

Privately held pain management company Purdue Pharma, the producer of the controversial opioid prescription painkiller OxyContin, was portrayed as a prime villain in the national opioid crisis. The company was already infamous for having paid one of the largest fines ever in the pharma industry for mislabeling its blockbuster drug.

Purdue has had a crisis-related media presence for a long time: widespread reports of OxyContin abuse, marketed as “smooth and sustained pain control all day and all night”, began to appear in the early 2000s.

A 2012 study found that 76% of people seeking help for heroin addiction often started by abusing OxyContin, and that there was a correlation between Purdue‘s marketing and the heroin epidemic that followed. The company’s marketing strategy included pressing doctors to prescribe OxyContin, offering them free trips to seminars and paid engagements.

The sample of the media discussion we analysed revolved around the company being sued by nearly every US state and almost 2,000 counties and cities in what was perceived as a historic multi-district litigation case.

Eight members of the billionaire Sackler family, the famous philanthropists who own Purdue, were also sued personally and targeted with protests in galleries, which bear their name. A widely covered part of the protests was the instalment of a giant sculpture of a heroin spoon in front of the company’s headquarters, which later appeared at the front gates of Rhodes Pharmaceuticals. The activists behind the sculpture explained that it was about “exposing this web of influence that Big Pharma has had on us.”

The Sacklers were accused of crafting a “deadly, deceptive … illegal scheme” which caused much of the crisis: they directed Purdue aggressively to push deceptive OxyContin marketing materials to health care providers, and misled prescribers and the public about the risks of addiction. They also provided funding to the Massachusetts General Hospital Purdue Pharma Pain Program and a degree program at Tufts University to deceptively “influence Massachusetts doctors to use its drugs”.

A separate lawsuit filed by 600 US cities and counties across 28 states and eight Native American tribes, claimed that the unprecedented opioid addiction crisis was “initiated and perpetuated by the Sackler defendants for their own financial gain.”

Following the Massachusetts state lawsuit, the media presented the Sacklers as the masterminds who got more patients on opioids than ever before, helping create “the worst drug crisis in American history”.

After the Associated Press reported that Purdue was expected to file for bankruptcy, the company reached a tentative agreement to settle some 2,000 opioid lawsuits. The deal will reportedly cost the company between $10 billion and $12 billion, including $3 billion from the Sackler family’s personal fortune, according to the Washington Post.

A family-friendly brand in a reputational danger

While Purdue has a long-established media presence relating to the opioid crisis, Johnson & Johnson, the world’s largest healthcare company, is just beginning to gather international attention for its role in the scandal. In August, a judge in Oklahoma found that it followed a similar marketing plan to other opioid manufacturers.

Johnson & Johnson, with its lesser-known pharmaceutical division, Janssen Pharmaceuticals, isn’t a big player in the US opioid market and it had less than 1% of the market in Oklahoma. However, it’s a leading supplier for the raw ingredients in painkillers and developed a strain of poppy for the core painkilling agent in Purdue Pharmas OxyContin.

Various media outlets suggested that the verdict and the $572 million fine it was ordered to pay could be the beginning of further investigations into the company’s sales and manufacturing practices and could attract more plaintiffs, such as state attorneys-general who have until now concentrated on Purdue.

The accusation at the trial that Johnson & Johnson behaved as a “drug kingpin” could result in significant reputational damage for the brand widely known for infant shampoo and family-friendly products. It was revealed as one of the companies which pushed unscientific theories about drug addiction in order to persuade doctors to prescribe even more opioids after patients showed signs of dependency.

The threat to the 124-year-old brand became a subject for extensive media analyses with titles such as the New York Times‘ “Johnson & Johnson’s Brand Falters Over Its Role in the Opioid Crisis“, Financial Times‘ “J&J: The next target of anger over America’s opioid crisis?” and CBS‘ “Opioid claims tarnish Johnson & Johnson’ family-friendly image“.

Some brand experts suggested that while the company has been successful in crafting an image around childhood and babies, it might fall into the public stereotype of a greedy corporation. Business analysts, on the other hand, say that investors are “terrified” that the story will be similar to what happened to Bayer with Monsanto.

German chemical and pharmaceutical company Bayer, which acquired Monsanto for $63 billion in 2018 and became the biggest player in the seeds and pesticides market, has received a heavy load of bad publicity due to the lawsuits over Monsanto’s glyphosate-based Roundup weed killer which allegedly caused cancer. A California jury awarded a couple $2 billion in punitive damages after finding that sustained exposure to Roundup led to their cancer diagnoses.

Part of Bayer’s response was to argue that studies have established that Roundup’s active ingredient glyphosate is safe. The company said it plans to invest $5.6 billion over the next decade in developing new weedkillers.

For more on that topic, read our analysis „GMOs in the Media: The Genetics of a Spicy Debate“.

Johnson & Johnson is still in the midst of its crisis communications strategy. The company is certainly no stranger to crisis management – in fact, one of the best-known examples in the crisis management literature is its successful recall of the pain relief product Tylenol in 1982 after some fatal incidents. The pharma giant implemented a decisive response strategy which included a forthright media campaign, new tamper-resistant packaging designs and a hotline for customers.

Johnson & Johnson was praised by consumers, regulators and the media for acting quickly and openly, and for communicating the measures it took. The brand’s image was even boosted by the manner in which it managed the crisis because the company showed that it prioritised consumer well-being even though the recall cost millions.

For more insights on crisis management, read our case study “Boeing’s Ethiopian Crash: A Study in Bad Crisis Management”.

But addressing its current opioid troubles could prove to be far more complex as the company is already vilified in the media following the ruling. In a statement, Johnson & Johnson portrayed the judge’s decision as flawed and asserted Oklahoma didn’t give evidence that its actions constituted a public nuisance, which was a central question of the trial.

It also said it had followed state and federal laws when supplying opiates to firms like Purdue and that it didn’t participate in the marketing of end products. But critics claimed that pharma companies should be held accountable when they act as suppliers of risky ingredients.

With the CEO Alex Gorsky saying that he recognises the severity of the situation and wants to take a “very broad holistic approach” to the epidemic, the company launched programmes that help nurses and physicians with pain management and cooperate on research into treatments for opioid use disorder. Gorsky was a spokesperson for the non-profit Business Roundtable last month when it sent the message that the purpose of a corporation was not just to make money for shareholders.

According to the Reputation Institute, the Oklahoma trial changed the company’s reputation from “strong” to “average”. The pharma giant is currently not even in the top 100 most reputable companies in the US, while in 2016, it was in the top 10.

“It’s fair to say that the opioid trial is probably the straw that broke the camel’s back for Johnson & Johnson’s reputation,” Stephen Hahn-Griffiths, an executive at Reputation Institute, said. “We’ve not in recent years seen Johnson & Johnson’s reputation dip as low as it’s currently tracking.”

The company’s stock hasn’t suffered, with investors relieved that the judgment, which initially sought a $17 billion fine, wasn’t that substantial. This comes as further proof that there is no direct correlation between stock market performance and corporate reputation at least in the short term.

A good illustration of this lack of correlation between share price and reputation is the case of Facebook: the company’s share price has not suffered dramatically in line with its reputational decline, and actually tends to recover after crises. Yet, the social media giant is at the bottom of Reputation Institute’s U.S. RepTrak and was also the worst-performing company in the 2019 Harris Poll Reputation Quotient.

For more on this topic, read our analysis “From Media Data to Reputation Analytics: A Case Study of Facebook”.

But other companies in our media research sample weren’t treated as favourably by investors – for example, the stocks of Teva Pharmaceutical Industries and Endo International dipped significantly. Oklahoma reached settlements with Teva for $85 million and Endo agreed to pay $10 million to settle a landmark case brought by Ohio counties.

Meanwhile, Insys Therapeutics became the first opioid manufacturer to declare bankruptcy after reaching a $225m settlement with the justice department over fraud charges. The company’s founder John Kapoor and four former executives were convicted of bribing doctors to prescribe an opioid product to patients who didn’t need it.

Google was mentioned for backing a state-of-the-art treatment centre in Dayton, Ohio, which had one of the highest rates of fatal opioid overdoses. In addition, one of the tech giant’s key products, Google Maps, will begin showing people where to discard unneeded medications by guiding them to places such as local pharmacies, hospitals and government buildings.

The conversation around opioids is the latest example of Google‘s name being increasingly mentioned in a healthcare context. It also gathered media attention when Alphabet bought app developer Senosis Health, which uses smartphone sensors as healthcare services, and when its healthcare unit Verily was reported as plotting an expansion into the managed care space, in addition to its numerous studies spanning telemedicine and age-related diseases.

For more on this topic, read our analysis “Big Pharma vs Big Tech: Healthcare Innovation Trends in the Media”.

“Brainwashing campaigns”

The most often quoted spokespeople in the media conversation around opioids were the officials who blamed Purdue and Johnson & Johnson for the crisis:

Oklahoma Attorney General Mike Hunter, who brought the case against Johnson & Johnson, said in interviews that the company waged “a multimillion-dollar brainwashing campaign” alongside other drug companies in order to persuade doctors that opioids were only rarely addictive. For him, the $572 million award doesn’t reflect “the alpha-to-omega harm” to Oklahoma, but it should serve as a roadmap for other states: “We did it in Oklahoma. You can do it elsewhere.”

Judge Thad Balkman was cited for his ruling that Johnson & Johnson’s “false, misleading, and dangerous marketing campaigns have caused exponentially increasing rates of addiction, overdose deaths and neonatal abstinence syndrome”.

Meanwhile, New York Attorney General Letitia James said in her complaint that Purdue was the company to tip the first domino in the crisis: “The others quickly went in on the scheme to expand the opioids market through a predatory campaign of lies, payoffs and high-pressure sales tactics.” Massachusetts Attorney General Maura Healey said she wants any settlement to include more money than the $10 billion to $12 billion offered by Purdue and the $3 billion offered from the Sacklers to make them “pay for the damage they have caused.”

The most prominent corporate spokesperson, Richard Sackler, the former head of Purdue, appeared in a newly obtained video deposition where he defended the marketing of OxyContin. The 2015 video was believed to be the first time any member of the Sackler family was questioned under oath about their role in the marketing of Purdue’s blockbuster drug.

John Kapoor, who was convicted of bribing doctors to prescribe Insys Therapeutics’ opioid products, denied all wrongdoing, with his lawyers saying they would continue the fight to clear his name. He was referred to as a “rags-to-riches Indian billionaire” by some media outlets, which also suggested his trial may set a precedent for many similar hearings. In contrast, former Insys CEO Michael Babich pleaded guilty and testified against his colleagues.

Health and Human Services Secretary Alex Azar proposed to renew stringent patient confidentiality regulations to make it easier to share a patient’s drug treatment history with doctors treating that person for other problems, which could prevent erroneously prescribing opioid painkillers to a surgical patient with an addiction history.

Nan Goldin, a photographer who leads the Prescription Addiction Intervention Now (Pain) activist group against opioid makers, is becoming a louder voice in the conversation. She said the protests are starting to extend their focus beyond Purdue and even addressed Johnson & Johnson CEO Alex Gorsky: “Pay back the money you’ve made. You’ve deceived the public enormously.”

Voices like hers are likely to get even more attention by the media, as national and specialised outlets get more and more hungry for opioid crisis stories. What many have defined as the biggest public health crisis in the US has immensely strengthened the already popular narrative portraying Big Pharma as an industry which prioritises profit over consumer well-being.

While the allegations of price-rigging have contributed to the common public perception that pharma companies manipulate the system to keep drugs expensive, the allegations for causing the opioid crisis have contributed to the perception that corporations are ready to risk patients’ lives for better financial performance.

The Reputation Institute’s 2019 US Pharma RepTrak study identified the media’s attachment to the role and responsibility of pharma companies in the opioid crisis as a top management priority. Alongside price-rigging, the opioid crisis could be the hardest hit to pharma’s fragile reputation, and, if we believe Gallup, the industry would not recover until it manages to effectively deal with the issue.

Read our analysis “PR Measurement in Pharma: The Key to Effective Communication Strategies”.