1 Unknown From: Dr Richard Sackler Sent; Tuesday. January 14. 1997 1012? PM To: Mlcnael Friedman; James .J Long; Dr Paul Goldenheim: Dr Robert Kaiko; Dr Robert Reder Subject: Re: Merck?Medan unponance: Law Why don't you guys plan a presentation about addiction that could be given first by RR or BK and eventually by our senior managed health care people. I think that Paul has a good point, but we ahbuld consider that "addiction" may be a comrenient way to "just say and when this objection is obliterated. they will fall back on the question of cost. Unlesa we can give a convincing presentation that c.r. products are 13238 prone to addiction potential. abuse or diversion than products. I think that this can be done, but I defer to BK and RR and other experts. Forward Header subject: Re: Merck?Medea Author: Paul Goldenheim/PHARMA at Notesro Date: 1/14/97 2:42 PM I am in agreement I believe that we all are) that this area is very important, and we have a number of plans underway -- new trials, completed trials, and retrospectiva examinations of older data. However, the EMail that started this. I think, hao little to do with pharmacoeconmies. we need to talk to Medea and othern about adai'ction. In this regard, we have a strong PI and can bring a lot of experience and.in?ormation to the table. (Embedded image moved Dr Richard Sackler at NORHALK CCMAIL to tile: 01/11/97 08:27 PM PIC001.PCX) To: Paul Goldenheim/PHARMA, Michael Friedman at NORWALK CCMBIL cc: Robert Susan Ron Fitzmartin/PBARMA. William Dr Robert Kaiko at NORWALK 6 CCMAIL, Ellen Ingber at NORWALKZ CCMAIL Subject: Re: Merck?Medea I think that there are two issues here. One is pharmacoeconomics. and there is no doubt that we have to do semething about this issue. In 1 CONFIDENTIAL INFORMATION PDD9520801620 CONFIDENTIAL SUBJECT TO PROTECTIVE ORDER COMMONWEALTH OF KENTUCKY, EX REL. JACK CONWAY, ATTORNEY GENERAL v. PURDUE PHARMA L.P., ET AL, CIVIL ACTION (PIKE COUNTY CIRCUIT COURT). fact. I beli6ve that we are already running some studies that address this. Paul? . The second issue is the chronic non?malignant pain Patient- and his/her right to effective Opioid treatment. Paul, where are we on this issue in terms of clinical studies. We may.need to start a campaign to focus attention on the untreated patient in severe pain who is mobiliied and given his life back by our products. Paul, Michael, I think that this is something that we should start this year. All three threads really are entwined into a sihgle skein. We reallY should work with all three at the same time. Reply Separator Subject: Merck-Medea AuthorI ,Michael Friedman at NORWALK Date: 1/11/97 6:45 PM 1 This is becoming a more common comment. I would not overreact, however, we will need pharmacoweconomic arguments. MP Forward Header Subject: Merck?Medea Author: James Lang at NORWALK Date: 1/11/97 1:46 AM 0 Michael our-success with OxyContin in starting to create concerns amongst the large as you already know because they recognize we are targeting non cancer pain. This goes beyond their inital perception that it was primarily a cancer pain medication. Below is another example of the problem we are encounteringe From a saleg perspective Iwe are attempting to deal with this issue. We will however reguire pharmacoeconomic and quality of life studies to support our efforts and to justify the.bene?its or OxyContin versea currently used less coatly medications. I think a meeting with Ernie and Tim would be appropriate so they can provide a more first hand view of the number ct managed care lives that are at risk if our sales efforts are in effective. Jim Jim Forward Header Subject: Merck-Medea Author: Russell Gasdia at Norwalk Date: 1/8/97 10:30 PM Gentlemen: This was forwarded by windell. It goes directly to the issue we discussed earlier this week. As we continue to promote OxyContin in non-cancer pain. the PBMB and MCOs will be forced to look more closely at us and the coat of using OxyContin. 2 COWENM PDD9520801621 - CONFIDENTIAL A SUBJECT TO PROTECTIVE ORDER COMMONWEALTH OF KENTUCKY, EX REL. JACK CONWAY, ATTORNEY GENERAL v. PURDUE PHARMA L.P., ET AL, CIVIL ACTION NO. (PIKE COUNTY CIRCUIT COURT). -7 Russ Forward Header Subject: Merck?Medea Author: Hindell Fisher at norwalk Date: 1/3/97 7:20 pm Ruse, Just to keep you in the lbop. MHC is actively pursuing this at this point. 8? Forward Header Subject: Merck?Medea Author: WILLIAM Gergely a: NORWALK Date: 1/5/97 10:17 PM Below is a situation at a MOD that is of great concern to the anestheologist writing our products for nonEmalignant pain. Can your give us acme help here? A Bill Forward Header SubjeCE; Merck-Medea Author: Ed Gargasz at Sa1e5_Force Date: 1/3/97 10:32 AM Bill: I just spoke to two of my pain clinic doctors in Meadvilic and'a question came up about Merck?Medea. Dr. Mc Ginnia showed me 2 letters from the FEM of Merck?Madco in which they were concerned about abuse potential in these patients on our products. 1 patient was on Oxycontin and the other on He Contin, both these patients have had extensive work ups and doing very well on our products. Dr. McGinnis was mad about this and he believes in uning our groducts in the chronic non-malignant pain patient. He asked me,'Is Purdue Frederick doing anything to enlighten these folks at Merck?Medea?. He is concerneg that in the future he will get more pressure from them to not use our products. Eddie 0 - a PD D9520801 622 CONFIDENTIAL SUBJECT TO PROTECTIVE ORDER COMMONWEALTH OF KENTUCKY, EX REL. JACK CONWAY, ATTORNEY GENERAL v. PURDUE PHARMA L.P., ET AL, CIVIL ACTION NO. (PIKE COUNTY CIRCUIT COURT).