But Portenoy's study, along with a host of others, said that patients in real pain wouldn't get addicted, because their bodies wouldn't produce the same feeling of euphoria that people who shoot heroin for recreational purposes feel.
"We were all, in the pain field, excited by the possibility that we could treat patients with opioids," said Dr. Jane Ballantyne, a professor of anesthesiology and pain medicine at the University of Washington. She began studying pain treatment in Boston in the early 1990s, just as the field was growing.
"A lot of people were beginning to say it was inhumane to not treat people with opioids," Ballantyne said. "The feeling was that we ought to throw off the shackles of concern about addiction and use drugs to help patients manage chronic pain, because it's awful to live with chronic pain."
At the same time, the pharmaceutical manufacturer Purdue was working on a new pain medication: OxyContin. Oxy was actually a reformulation of a much older drug, the opioid oxycodone; because oxycodone was already approved by the FDA, it was easier for Purdue to bring the new version to market without passing through the rigorous FDA oversight that applies to new drugs.
Purdue secured approval for OxyContin from the FDA in 1995. With its release, Purdue launched a widespread marketing campaign, planting seeds in the ground Portenoy and others had tilled. The company published advertisements aimed at doctors in mainstream medical journals, as well as "ask your doctor" ads aimed at patients suffering from pain. Purdue's marketing message was simple: pain is costly, it can be treated, and it can be treated with long-term use of opioids without addiction.
A 2007 lawsuit filed by the US Attorney General's office against Purdue would later cite "misleading scientific charts" and graphs shown to physicians by sales reps pushing the pills. The suit would also show that Purdue Pharma trained its sales reps on how to overcome concerns by doctors that OxyContin could be easily abused. The reps were told to tell health-care providers that it was more difficult to extract the oxycodone from an OxyContin tablet for intravenous use, despite the fact that "Purdue's own study showed that a drug abuser could extract approximately 68 percent of the oxycodone from a single 10 mg OxyContin tablet by crushing the tablet, stirring it in water, and drawing the solution through a cotton into a syringe."
Sales reps were given charts that showed fewer "peak and trough" blood-level effects than immediate-release opioids, which were simply inaccurate and blatantly misleading. They also reportedly told health-care providers that patients who stop abruptly wouldn't experience withdrawal and that patients wouldn't develop a tolerance to the drug.
But Purdue didn't stop at the sales reps. As is common with most pharmaceutical companies when they're introducing a new drug to the market, they also paid leaders in the medical field to give lunchtime or dinnertime lectures to groups of doctors. One of those leaders was Portenoy.
Over a decade later, in a 2011 video filmed and published by Physicians for Responsible Opioid Prescribing, Portenoy admits that he used studies that weren't based in evidence to convince primary-care doctors that long-term use of opioids wouldn't end in addiction.