Clients of the consulting firm were offered in-depth experience in narcotics, from opium fields to pills that are more powerful than any other drug.
Chris and Michael were involved in the project.
The reporters pored over a lot of documents to find out what McKinsey was up to.
The health authorities were sounding the alarm that Opana was becoming the drug of choice among people abusing prescription pills.
It was easy to inject and it was twice as potent as OxyContin. A rare and life-threatening blood disorder and an H.I.V. outbreak in Indiana were linked to its misuse.
The pharmaceutical company reduced the promotion of the drug. The company refocused resources on the drug after a few months.
The sales force push was conducted with the help of McKinsey and Company, who were hired by the company to provide marketing advice.
Opana is one of the company's chronic pain products.
In a repository of more than 100,000 documents obtained by a coalition of state attorneys general in a legal settlement related to McKinsey's opioid work, there is an untold story of McKinsey's work for the company.
Over the years, there has been a lot of information about McKinsey and its relationship with the drug company. According to The Times, the firm played a bigger role in advising clients than was publicly known.
Emails, slides, spreadsheets, proposals and other documents are included in the McKinsey records. A detailed depiction of a firm that became a trusted adviser to companies at the center of an epidemic that has claimed half a million American lives is provided by them.
Mallinckrodt was advised by the firm while it held sway at Purdue. Opana was marketed by it and helped it become a leading generics manufacturer. The biggest supplier of the raw materials used to make top-selling drugs was Johnson & Johnson's subsidiary. Government agencies were counseled on how to address the aftermath of the epidemic.
The clients of McKinsey were interested in growing their businesses. The documents show that the firm offered know-how and sophistication as well as in-depth experience in narcotics.
The Massachusetts attorney general said in a statement that McKinsey was trading on its reputation and connections to make the crisis worse. The new documents expose McKinsey's role in the crisis and will inform policymakers' efforts to prevent it from happening again.
McKinsey used data and proprietary tools to advise on corporate strategy. Strategies for dealing with regulators were developed.
The firm helped companies shift resources to more potent products when they adopted more aggressive sales tactics. It profiled and targeted physicians, in some instances trying to influence the way they prescribe drugs, in ways that federal officials later warned increased the risk of overdose.
McKinsey came up with new approaches to drive sales when the government began to crack down on prescription drugs.
As part of a $600 million settlement, McKinsey agreed to give the documents to the attorneys general. In a statement on Wednesday, the firm suggested that it did not counsel or recommend to the company to promote Opana more aggressively, even though it apologized for its advice.
A McKinsey spokesman said that they have acknowledged their role in serving the makers of the drugs. We stopped that work in the middle of the year and apologized for it.
The company's work with McKinsey was not commented on by a spokeswoman. She referred to a company statement that said in September 2016 that it had stopped promoting opioids to health care professionals.
Mallinckrodt didn't want to say anything. In a statement, Johnson & Johnson said that its actions were appropriate and that it was focused on reorganizing into a new company that would deliver billions of dollars of value.
There was an unusual case in the fall of 2012 that Dr. Steven Butler helped with. A woman in her 20s arrived at the Holston Valley Medical Center in Kingsport with a number of symptoms that looked like a rare blood disorder.
A patient with the same symptoms came to the hospital. A second and a third. The Tennessee Department of Health is investigating. More patients showed up over the next few months.
They dissolved and injected a pill called Opana ER as they went through treatments.
He said that it became a very well- described phenomenon. They were simply called Opana patients.
The path that led to Opana's rise is an example of McKinsey's involvement in the business.
The firm advised Penwest on the launch of the drug years ago. The McKinsey project that paved the way for the extension of Opana's reach was done two years later.
A new version of OxyContin that would be more difficult to snort or inject was one of the things that Purdue was trying to get approved by the FDA. The F.D.A. denied its application in 2008. McKinsey was a client of the consultants who interviewed a former drug dealer, oversaw scientific studies, prepared regulatory documents and coached company officials on how to deal with the F.D.A. In 2010 the agency approved the new pills and allowed them to claim they were resistant to abuse.
Opana sales rose. In an internal document, the company attributed the rise in part to patient discontent with the new version of the drug. There was a rise and a decline in abuse data.
The new version of Opana was intended to be abuse- resistant. According to the F.D.A., the new pills showed a minimal improvement in resistance to tampering by crushing, and they were sufficiently abusable by injection. The drug entered the market without being labeled resistant to abuse.
The first Opana patient was seen by Dr.Butler within months. The F.D.A. and the CDC put out health warnings about the blood syndrome. There were other clusters in Arkansas, Florida, Pennsylvania and South Carolina.
The new version of Opana made users switch from snorting to injecting, considered a riskier form of abuse. The substance that was added to the pills made them harder to crush. It could cause rapid red blood cell destruction when injected.
Rajiv De Silva, a former leader within McKinsey's pharmaceutical practice, was hired by the company to help chart a growth strategy.
A few months after Mr. De Silva took over, McKinsey helped Endo execute a complicated maneuver known as a "tax inversion" that the Obama administration would decry as an "abuse" of the system. Ireland was the location of the Pennsylvania company's base for tax purposes.
According to a McKinsey partner, the move was a tax play to set up doing a lot of deals.
One of the largest U.S. manufacturers of generic drugs was formed by the purchase of several companies.
The production of pills was dependent on a complex and tightly regulated global supply chain stretching from the fields of Australia to the American heartland.
This was also McKinsey.
Before a patient in the United States filled a prescription for the drug, a farmer on another planet harvested a crop of thebaine. The majority of the market was held by Johnson & Johnson's subsidiary.
The raw materials made their way to the US from far flung places. Mallinckrodt, the big generics manufacturer, was one of the top U.S. producers at this time.
McKinsey worked behind the scenes to advise them. It had expertise in the international trade of legal narcotics. The consultants wrote in a memo that they served the majority of the players.
The firm worked on a project for Johnson & Johnson. The consultants told the company how to strengthen its position or sell the business if the price was right.
Johnson & Johnson's subsidiaries were involved in the opioid supply chain.
McKinsey consultants walked factory floors and watched production data to recommend ways to speed up manufacturing lines for Mallinckrodt.
Mallinckrodt was prepared by McKinsey to negotiate with companies that source generic drugs for Walmart and the Drug Enforcement Administration. McKinsey advised Mallinckrodt on how it could use logistical tactics to get a higher quota while maintaining a friendly relationship with the D.E.A.
The McKinsey spokesman denied that the work was intended to undermine the laws.
The McKinsey consultants took jobs at the companies that made the drugs. Frank Scholz, a partner in the firm's pharmaceutical practice, was promoted to president of the company's generics business.
It was the arrival of Mr. De Silva that gave McKinsey a chance. Consultants were asked to give advice on how to structure the company's sales force. McKinsey excelled in the area of how to dispatch hundreds of sales representatives.
McKinsey had a way of showing pharmaceutical companies how to deal with any problem they might face. The firm had a penchant for selling things.
McKinsey had built powerful tools for getting the right messages in front of the right physicians in the years leading up to its work on Opana.
The documents give an unprecedented look at McKinsey's tool kit. Detailed records relating to the firm's work for Purdue give insight into the strategies consultants used for other companies.
The firm recommended a technique called segmenting. The best marketing campaigns split consumers into segments based on how they act and think, then develop tailored messages to win them over, according to the consultants.
The customer was a doctor with a license to prescribe controlled substances, and the product was a narcotic.
In order to get the views of hundreds of physicians, the consultants conducted a survey. There were four groups of doctors. Consultants came up with messages to appeal to each group.
McKinsey made personality profiles of doctors to make them more likely to sell narcotics.
Doctors who were hesitant to prescribe OxyContin because of concerns about abuse, addiction and possible scrutiny from the D.E.A., were identified by McKinsey as a particular opportunity.
It could be worth hundreds of millions of dollars to convince them to switch. McKinsey proposed ways to increase physician comfort levels. According to McKinsey, sales representatives should make sure that doctors know that the drug is not for extreme pain.
In order to limit their use to cases of severe chronic pain, the F.D.A. introduced new labeling requirements for certain drugs. McKinsey had a strategy that had been put in place.
McKinsey tried to identify doctors who would give the greatest return on sales reps time.
McKinsey was brought in to help with the dip in OxyContin sales. The consultants said that the revenue was down because of the government's actions. Doctors were writing prescriptions for less tablets, and wholesalers and pharmacies were imposing new controls.
Understand how the drug affects you. Fentanyl is a drug that is very addictive. It is easy to overdose on a small amount. There is only a short time to save a person's life during an overdose with Fentanyl.
Don't go to unlicensed pharmacy. Fentanyl is found in many prescription drugs sold online or by unlicensed dealers. Only pills that were prescribed by your doctor are allowed to be taken.
You should talk to your friends and family. Fentanyl use can be prevented by educating your loved ones about it. Fentanyl can be found in pills purchased online or from friends. The aim is to establish an ongoing dialogue in short spurts.
You can learn how to spot overdoses. When someone overdoses on Fentanyl, their skin becomes bluish. Call the emergency number if you think someone is abusing drugs. If you are concerned that a loved one could be exposed to Fentanyl, you may want to buy Narcan, a medicine that can reverse an overdose in a matter of minutes.
Russell Gasdia had been pursuing a more aggressive response than McKinsey recommended. One McKinsey consultant wrote that Mr. Gasdia was focused on promoting a less potent opiate as part of the reason for the drop in revenue.
There was a call for a shift to offense. The consultants used more than just a list of high prescribers to identify specific doctors to target.
The reformulated OxyContin was thought to be a safer version of the product.
Patients may be more likely to start on the drug if the doctor has a higher ratio.
Mr. Gasdia resigned as head of sales and marketing after the board endorsed the plan. McKinsey partner Dr. Ghatak was happy with the firm's success in an internal self assessment.
We are now deeply involved in almost every facet of the company.
It didn't take the C.D.C. long to identify the cause of the cluster of H.I.V. cases. The majority of the patients had injected Opana.
A public health emergency was declared by the governor, and the list of those who had been diagnosed with an infectious disease grew.
The C.D.C. later determined that Opana posed a higher risk for disease after injecting drugs. It was ten times more powerful when injected. The high was intense but short lived. Users injected more often.
Users split pills, shared equipment and shot up multiple times in a single sitting because Opana was a high street price. A C.D.C.-led research team called it a recipe for bomb making.
McKinsey's presentations did not reflect alarm if any of this caused it.
McKinsey helped launch the "Sales Force Blitz" in the summer of 2015. The spokesman said that part of the work was done at the client's request.
McKinsey advised the company to reallocate sale representatives from a migraines drug to Opana, instead of pulling back its marketing of the painkillers.
Sherin Ijaz, a consultant, was excited in an email to the head of the pain business unit. She wrote that the next step was to identify the sweet spot of doctors so they could target them.
The fun is just beginning according to Mr. Harlow.
McKinsey was opposed to the proposal to shift some sales calls to promote the arthritis gel. At a time when we want to drive Opana, doing so would be a distraction.
More than 3000 additional physicians were directed to focus on by the consultants.
Pain re-targeting added 3,400 targets for Opana ER, increasing LAO coverage by nearly 2x.
The F.D.A. demanded that Opana be pulled from the market due to its abuse. The company agreed.
The drug brought in more than 800 million dollars in revenue after it was pulled from the market.
The drug-trafficking ring was broken up in Indiana. The man admitted that he sold Opana in bulk to a dealer. He was sentenced for 6 years.
The judge in the case scolded him, saying the whole thing is crumbling because of drugs.
You did your part, but you aren't responsible for everything.
Tom Latkovic spoke at a health care conference in June of last year.
I want to know why we continue to pay for prescriptions for people that we know are likely to abuse them.
McKinsey did not have a partner in the pharmaceutical practice. His team focused on using data analysis tools to address complex health care problems and it was homed in on the opiate epidemic.
In order to broaden this work, Mr. Latkovic told the audience that a new center would be launched.
State governments, insurers and health systems were included on the client list. Philadelphia has one of the highest death rates in the country from opiate overdoses.
Consultants worked with the city government for almost two months in 2019. McKinsey's work came at no cost to the city but was later scrapped.
The firm continued to serve the company that was often blamed for sparking the epidemic. The documents show that drafts of publications were given to consultants to review. A manager in the pharmaceutical practice wrote that the purpose was to assess whether this could create any waves on social media or from journalists that could be harmful to the pharma clients
Some consultants worried that scrutiny might extend to McKinsey as negative news coverage and lawsuits againstPurdue mounted.
Around the time of the Philadelphia project, McKinsey decided to stop advising companies on opioids, after the firm's 15-year relationship with Purdue became public as part of a court filing. McKinsey has collected millions of dollars in fees from Purdue since Mr. Latkovic gave a speech there two years ago.
There was a debate within the firm after it was disclosed that McKinsey had worked with Purdue. One consultant wrote, "We may not have done anything wrong, but did we ask ourselves what the negative consequences of the work we were doing was and how it could be mitigated?"
Dr. Ghatak was the driving force behind McKinsey's work for the two pharma companies. He created talking points for himself, much like he did for pharmaceutical executives.
The opiate crisis is terrible. It's time to acknowledge that up front. We were working on a solution to a public health crisis, not a silver bullet but definitely a solution, because we advised clients to develop products that were more difficult to abuse.
According to documents released in 2020, Dr. Ghatak and another consultant discussed destroying records. McKinsey decided to fire them.
The firm reached a settlement with the attorneys general.
Some of McKinsey's former clients were facing huge damages in court. Both Mallinckrodt and Purdue filed for Chapter 11 protection in the same year. The company said in a statement that it was appropriate and responsible to settle a number of lawsuits related to its marketing of opioids.
There is a wave of litigation over its marketing of Opana and other drugs. In a regulatory filing, the company said it had received a subpoena in 2020 from the U.S. attorney's office for the Western District of Virginia, which had previously won guilty pleas from executives of the company. The office wanted to know about McKinsey.
Mark Weaver is the top illustrator.
All Rights Reserved © 2024
