Did Free Pens Cause the Opioid Crisis?

Early in Dopesick, a book examining how Purdue Pharma helped addict an alarming number of Americans to opioids, Beth Macy writes about the army of drug reps who pushed the painkiller OxyContin. In its approach to sales, Macy shows, Purdue was scientific. Using information purchased from a data-mining firm, the company determined which physicians were prescribing the most of its competitors’ painkillers, and dispatched sales reps to their practices. The more likely a doctor was to prescribe, the more often the reps darkened his door. The reps were highly motivated: Their bonuses were pegged to the milligrams of OxyContin a doctor prescribed.

The reps, traditionally known as “”—though since the mid-1990s, when OxyContin was introduced, the field has become more associated with young women—usually arrived bearing gifts. A rep might invite a doctor out to a fine restaurant, or on a junket in a desirable vacation destination. For doctors too busy for such gifts, work-arounds were devised. “Reps began coming by before holidays to