McKinsey Advised Johnson & Johnson on Increasing Opioid Sales. (Walt Bogdanich, New York Times)

The Unaccountables -- lawbreaking lugubrious goobers like St. Johns. County Sheriff David Shoar, organized crime, Big Oil, tobacco companies, railroads, drug companies -- all fear and loathe Walt Bogdanich, three-time Pulitzer Prize winner with The New York Times.

Here's his latest story:

McKinsey Advised Johnson & Johnson on Increasing Opioid Sales

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Bradley Beckworth, an Oklahoma state lawyer, at a trial last week involving Johnson & Johnson and a subsidiary’s involvement in the opioid epidemic. McKinsey & Company had advised the company on driving sales of painkillers.CreditCreditPool photo by Chris Landsberger

By Walt Bogdanich

• July 25, 2019

At the global consulting firm McKinsey & Company, the rule is sacrosanct: Never publicly disclose client advice. And for the most part, adherence to that rule has served the company well.

But in recent months, as government officials seek to assign blame for the opioid crisis that has strangled large parts of the nation, McKinsey’s advice is surfacing in ways that are deeply embarrassing for the influential firm, whose clients include many of the world’s most admired companies. One lawsuit revealed McKinsey recommending that a pharmaceutical company “get more patients on higher doses of opioids” and study techniques “for keeping patients on opioids longer.”

And in a civil trial that wrapped up last week, Oklahoma joined two other states — Massachusetts and New Jersey — in showing that McKinsey offered advice to a drug company on how to increase opioid sales at a time when abuse of its pain medicine was widespread.

Although McKinsey is not a defendant, Oklahoma used McKinsey consulting records to help build its case against Johnson & Johnsonand a subsidiary, Janssen Pharmaceuticals, for what the state said was irresponsible marketing of a fentanyl patch called Duragesic.

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The Oklahoma case differed from those in the other states because it focused on Johnson & Johnson, a company that had largely avoided the spotlight during the opioid epidemic. Before the trial, two other defendants, Purdue Pharma and the Israel-based Teva Pharmaceutical Industries, settled with Oklahoma for $270 million and $85 million.

Johnson & Johnson chose not to settle, making it the first of hundreds of civil opioid cases across the nation to go to trial. Judge Thad Balkman of Oklahoma state district court heard the case without a jury and said he planned to report his findings before the end of August. Oklahoma is seeking up to $17.5 billion to address the opioid crisis in the state.

The cases in Massachusetts and New Jersey also highlighted McKinsey’s hand in marketing opioids. Those cases are still being litigated.

Earlier this month, the State of Massachusetts released new documents from 2013 that detailed McKinsey’s recommendations on how Purdue Pharma could “turbocharge” sales of its widely abused opioid OxyContin. The state said McKinsey advised Purdue to sharply increase sales visits to targeted doctors and to consider mail orders as a way to bypass pharmacies that had been tightening oversight of opioid prescriptions.

In a statement released to The New York Times on Wednesday, McKinsey said it had gotten out of the business of giving advice related to opioids. The company declined to say how much it was paid working for opioid manufacturers.

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“Our historical work for clients in this industry was designed to support the legal prescription and use of our clients’ products,” it said. “Opioids have had a devastating impact on our communities, however, and we are no longer advising clients on any opioid-specific business on a global basis.”

Purdue Pharma denies the allegations in the lawsuits and says it has done more than any company to address the opioid epidemic.

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Larry Ottaway, Johnson & Johnson’s lead lawyer, listened during closing arguments at the civil trial.CreditSue Ogrocki/Associated Press

Johnson & Johnson declined to comment.

In Oklahoma, a lawyer for the state, Bradley Beckworth, accused Johnson & Johnson’s subsidiary Janssen of being “the kingpin” of opioids because it owned two companies that produced and refined Tasmanian poppies into a narcotic for other drug manufacturers, including Purdue.

Janssen rejected that characterization, saying that it operated its poppy business — which it has since sold — legally and that it was overseen at all stages by the government regulators.

Johnson & Johnson also developed its own opioid pill, which it no longer produces, but said it constituted only a sliver of the national opioid market.

During the trial, Mr. Beckworth introduced a PowerPoint presentation, prepared by McKinsey for Johnson & Johnson in 2002, that raised the issue of whether the company had been sufficiently aggressive in courting patients for its fentanyl patch. In one slide, McKinsey asked, “Are we properly targeting and influencing prescription behavior in pain clinics?”

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McKinsey recommended “targeting and influencing” doctors who specifically treat back pain in the elderly and those in long-term care. The consultants also advised the company to move physicians who were “stuck” in prescribing less potent opioids into prescribing stronger formulations.

McKinsey, in its statement, said its work for Johnson & Johnson “was designed to support the legal use of a patch that was then widely understood to be less susceptible to abuse.”

In court testimony, Johnson & Johnson’s corporate representative, Kimberly Deem-Eshleman, tried to distance her company from McKinsey’s advice. Twice she told the judge that these were “McKinsey’s words,” not Johnson & Johnson’s.

Mr. Beckworth, the state lawyer, asked Ms. Deem-Eshleman if her company fired McKinsey because of its recommendations. She replied no.

“Still use them today?” he asked.

“Yes, for different projects,” she replied.

Ms. Deem-Eshleman said that Johnson & Johnson’s sales representatives had called on doctors to educate them on the Duragesic patch, and that there was nothing nefarious about those visits. The company said it no longer promoted the patch.

Oklahoma’s legal case rests on the claim that the company violated a public nuisance law by harming patient health. In doing so, the state tried to contrast Johnson & Johnson’s opioid sales practices with its credo: “We believe our first responsibility is to the doctors, nurses and patients, the mothers and fathers and all others who use our products and services.”

In his closing statement, Mike Hunter, the Oklahoma attorney general, described the efforts as egregious.

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“What is truly unprecedented here,” he said, “is the conduct of these defendants on embarking on a cunning, cynical and deceitful scheme to create and feed the need for opioids, engineer a mutant poppy to amplify the need they created, overstate the effectiveness and minimize the risk of these drugs.”

Johnson & Johnson’s lead lawyer, Larry Ottaway, dismissed the state’s contention that the drug company had created the opioid crisis in Oklahoma. “We have never denied the effects of opioid addiction on the citizens of this state,” Mr. Ottaway told the judge. But the company acted legally in trying to help patients seeking relief from debilitating pain, he said. He added that the company did that by introducing a fentanyl patch that, statistics show, was less prone to abuse.