Context: The United States is deeply entangled in an opioid crisis that began with the overuse of prescription painkillers. At the height of the prescription opioid crisis (2006-2012), Mallinckrodt Pharmaceuticals was the largest opioid manufacturer. This study explores Mallinckrodt strategies to expand its market share by promoting a new opioid.

Methods: Using the Opioids Industry Document Archive, we analyzed the incentive structures, sales contests, and rhetorical strategy behind Mallinckrodt's “Operation Change Agent,” a campaign to switch patients from OxyContin to Mallinckrodt-branded painkillers. A structured search of the archive in October 2022 retrieved 464 documents dated between 2010 and 2020.

Findings: We identified a range of sales force motivational techniques, including hypertargeting high-decile prescribers, the provision of free trial kits, using emotion-based language to connect with prescribers, and strategies to oppose prescriber resistance. Throughout, managers used specific incentivization metaphors to frame strategies through sport and ultramarathons.

Conclusions: This research on internal corporate strategy adds to growing challenges to industry claims that opioid sales teams simply educated providers and helped fill existing demand for their products. Moreover, this research has important implications for regulatory policy and consumer protections that can better protect health in the face of competitive market forces.

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