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Wednesday, August 21, 2019

Marketing of J&J's opioids discussed at Oklahoma's big trial


By John Sammon | Jun 11, 2019

NORMAN, Okla. (Legal Newsline) – A marketing specialist told attorneys for the State of Oklahoma on Monday that the rise in the sales of opioid drugs could be tied to a similar rise over the same period from 1996 to 2017 to deaths from overdose.

“The (drug) sales go up at the same rate as opioid deaths and treatment,” C. Renzi Stone, the CEO of Saxum Strategic Communications an Oklahoma City marketing firm, told the attorneys.

The trial in the Cleveland County District Court is being streamed live courtesy of Courtroom View Network.

The State of Oklahoma, through private lawyers hired by Attorney General Mike Hunter on a contingency fee, sued Johnson & Johnson and its drug subsidiary Janssen Pharmaceuticals claiming that the company’s aggressive marketing of opioid drugs as painkillers fueled an overdose epidemic Hunter called the worst in the state’s history.

Thousands of cases are still pending around the country and the Oklahoma case is being followed nationwide. It's also the first opioid trial under the "public nuisance" legal theory, attempting to hold pharmaceutical companies, distributors and pharmacies liable for the nation's addiction crisis. Critics of the nuisance claim say the state’s case is in reality a products liability case.

Two other co-defendant pharmaceutical companies, Purdue and Teva Pharmaceutical, recently settled with Oklahoma - $270 million from Purdue and $85 million from Teva. That left J&J (and Janssen) as sole defendants in the case.

In the Purdue Pharma settlement, private attorneys took in $60 million, while about $200 million went to a research project at Oklahoma State University, which is Hunter's alma mater.

Purdue officials pleaded guilty in 2007 of misleading the public about the risk of addiction from OxyContin and agreed to pay $600 million, at the time one of the largest pharmaceutical settlements in U.S. history.

J&J's opioid products are Nucynta and Duragesic, which dispenses opioids by the use of a timed-release patch.

Stone appeared as an expert witness called to testify on Johnson & Johnson’s advertising campaign.

He indicated the word “barrier” in sales literature meant getting around objections to make sales.

Reggie Whitten, the state-appointed attorney with the law firm of Whitten Burrage in Oklahoma City, asked about use of the word “hook” that also appeared in J&J literature discussing drug sales.

“We call these key messages,” Stone said. “The idea is that the most compelling messages are to change behavior.”

“Did you see the word 'influence?'” Whitten asked.

“Yes, it’s at the core of marketing,” Stone responded. “How to move someone from A to B. How to use influence to drive purchase decisions. The other (buying) party doesn’t know they’ve been influenced.”

Stone said the company had also made use of key opinion leaders called KOLs and third parties to influence buying decisions.

Doctors to be sold the drug products were referred to as “targets” in the sales literature.

“As a marketer do you want people to know they have been targeted?” Whitten asked.

“No,” Stone responded.

Sales literature for the opioid drug Tapentadol, used in the production of Nucynta stated, “This is a huge opportunity for the corporation (Johnson & Johnson) and all of us.”

Stone said effective selling requires involving the potential customer emotionally as well as intellectually.

“You’re using emotion in a way that the heart helps to sell the product,” he noted.

Sales literature for Duragesic showing a lion with a rose in its mouth Stone said advertised both strength and softness in the product as a selling pitch.

He indicated that sales reps were trained to overcome opio-phobia, the fear of opioid drugs because of their potential for addiction.

Stone called Johnson & Johnson’s effort to sell opioid drugs like Duragesic and Nucynta wildly successful and impressive.

A chart was exhibited showing 20,953 visits to the state of Oklahoma by drug sales reps for the company in 2004 and 18,264 visits in 2017. Charts showed that deaths and sales of the drugs peaked at the same rate.

“Deaths went up and sales went up,” Stone said. “It (sales campaign) was brilliant, awesome. “They (J&J) nailed it.”

Under cross examination, Larry Ottaway the attorney for Johnson & Johnson with the law firm of Foliart, Huff, Ottaway & Bottom of Oklahoma City asked Stone if chronic pain in the state was under-treated.

“I don’t know,” Stone responded.

Ottaway asked Stone if he thought doctors in Oklahoma understood that opioids are a dangerous drug that need to be carefully proscribed.

“I do not,” Stone said.

Ottaway asked if Stone was aware of risk and (drug) mitigation programs put in place by pharmacies and state government.

“It’s hard to have an opinion about their effectiveness,” Stone said.

Stone told Ottaway a proposed drug epidemic abatement plan could take 20 years to reverse the crisis and require a staff of 20 people with a budget of $4 million per year ($200,000 yearly salary per employee).   

“You’re not an expert in opioids?” Ottaway asked.

“No,” Stone said.

“Is it your opinion there are doctors in this state who don’t know as much as you?”

“I know addiction is complicated,” Stone replied.

On redirect examination Whitten asked Stone how many times he had seen warning labels with the drugs referred to or quoted by reps.

“Never,” Stone said.

“Have you ever heard us say that opioids should be outlawed?” Whitten asked.

“I did not,” Stone said.

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