Purdue Pharma employed a variety of promotional channels to market its best-selling painkiller, OxyContin.

But one of the most aggressively used tactics in the company’s arsenal, according to a lawsuit recently unsealed by the state of Tennessee, involved directing its sales agents to call on GPs who had little training or experience in opioids, with a deceptive narrative that claimed these products were safer than they actually were.

The suit, along with a trove of internal budget and other records recently released by Kaiser Health News, demonstrate how Purdue helped usher aggressive promotional tactics into the prescription opioid marketing playbook.

The 274-page suit was produced at the behest of the Tennessee Coalition for Open Government, as well as the Knoxville News Sentinel. State AG Herbert Slatery unsealed the document last Wednesday, citing the public’s right to be made aware of the litany of damning evidence against the company and the aggressive techniques it employed when it came to pushing opioid sales.

“The state’s complaint contains specific examples of defendant’s unlawful conduct, its scale and impact on the state, the company’s knowledge of activities and financial gain,” wrote Slatery. “It is difficult to imagine litigation that is of more public concern.”

The lawsuit accuses Purdue of pursuing an explicit agenda to press as many providers as possible to prescribe Oxycontin, urging its sales reps to push for increased dosages while downplaying concerns.

“Through unprecedented marketing for a narcotic, Purdue created a false narrative to reverse these attitudes among the public, healthcare providers, and other stakeholders in order to increase sales of its opioid products and its own market share. Time and again, Purdue placed profits over people,” the suit alleges.

When selecting care providers to target, Purdue also allegedly counseled reps to focus on busy providers less likely to have pain management expertise, as well as those less likely to have time to appropriately monitor patients on opioids. It also taught them to overcome providers’ objections about writing prescriptions for the powerful, demonstrably risky pain meds.

In its trainings, the company even invoked the famous phrase from the classic film Glengarry Glen Ross, instructing its reps to “always be closing.”

Meanwhile, the trove of documents released by Kaiser Health News, obtained from a Florida attorney general’s office investigation of Purdue’s sales efforts that ended late in 2002, shows how unusually thorough Purdue was in its marketing of OxyContin.

The drugmaker “financed activities across nearly every quarter of medicine, from awarding grants to health care groups that set standards for opioid use to reminding reluctant pharmacists how they could profit from stocking OxyContin pills on their shelves,” according to the news service.

Its $400 million in marketing spend after 2000 also included ads in medical journals, a find-a-doctor website, direct mail recommending OxyContin for “pain syndromes” including osteoarthritis and back pain (the drug was first marketed for cancer pain), a video claiming  OxyContin presents little to no risk of addiction (a claim refuted by the FDA), and of course sales agents.

Reps made thousands of sales calls to GPs who had little training or experience in opioids, per a 2003 OIG audit cited by KHN. Among the documents released is a set of handwritten notes of a state investigator’s interview with a former Purdue sales manager, who claimed the company told staff at a launch meeting that the drug was “non-habit forming.”

Purdue paid $600 million in 2007 and plead guilty to “misbranding” Oxycontin “with intent to defraud or mislead.” Advising its sales reps to tell HCPs the drug was less addictive than other opioids was among the deceptions to which it confessed.

The Tennessee suit also provides deeper details about the warning signs Purdue allegedly ignored in pursuit of profits, including calling on a pair of providers 48 times even after law enforcement alerted the company that the two were responsible for substantial interstate Oxycontin diversion. Purdue courted another provider 31 times after the provider’s license was placed on probation concerning high-prescribing of controlled substances.

The unsealing of the suit came a couple of weeks after Purdue slashed what was left of its sales force in June, cutting around 350 positions, including about 250 focused specifically on promoting Symproic, which treats opioid-induced constipation.

In February, Purdue agreed to stop promoting opioid drugs to doctors. In a statement, the company vowed to continue to research cancer, and spread its offerings into new areas, like the central nervous system.

“While the development of important new medicines will be the company’s priority going forward, we will continue to support our opioid analgesic product portfolio while continuing our commitment to take meaningful steps to reduce opioid abuse and addiction,” the company stated.

Tennessee was just one of six states to sue Purdue in May for its hand in perpetuating the opioid crisis. Purdue’s sales increased by $35 billion after it introduced OxyContin to the market in the mid-90s, and now earns $3 billion annually in drug sales.

Meanwhile, about 1,500-plus lawsuits have been filed mostly on behalf of cities, counties and states, against opioid manufacturers for their role in allegedly laying the foundation for the current opioid crisis, a charge which Purdue has denied.

An investigation from ProPublica found that pharma companies made 33% fewer opioid-related payments to physicians in 2016 from 2015, down from $23.7 million to $15.8 million. Still, around 42,000 people died from opioid overdoses in 2016. Of those, around 40% were from prescription opioids.