doctor and patient

In Italy, a peculiar rise in opioid prescriptions brought suspicion against Perdue Pharmaceuticals and a doctor named Guido Fanelli. Authorities began to suspect a conspiracy among a group of pharmaceutical executives police nicknamed “The Pain League.” Used to fighting corruption and the inner workings of criminal cases such as mob bosses, authorities sought to find culpability within Mundipharma — the international arm of Purdue Pharma. They began an investigation using wiretaps and subpoenas to follow the money.

Purdue Pharma, the manufacturer of Oxycontin, faces over 2,000 lawsuits in the United States over its role in the opioid crisis. This case is the first known case outside the U.S., where executives and employees of Perdue are criminally charged and implicated. While the opioid epidemic has cost fewer lives in Italy, the criminal intent, prosecutors say, is clear.

Making Money Promoting Opioids

According to the investigative file, 464,000 euros from Mundipharma, and 640,855 euros from Grunenthal (about $700,000) flowed into businesses Fanelli allegedly set up to hide the payments, beginning in 2009.

While the pharma companies say these are legitimate payments, the government say that it was all a ruse to have a trusted doctor take advantage of patients and sell a drug that is highly addictive.

The Evidence Against Perdue/Mundipharma

The Associated Press has received and reviewed hundreds of pages of investigative files from the probe. They say that Dr. Fanelli helped executives from Mundipharma’s Italian branch and other companies promote painkillers via illegal means. The pharmaceutical ghostwrote medical papers, helped Dr. Fanelli organize multiple conferences, and performed other marketing activities that were meant to counteract any negative publicity surrounding Oxycontin, all in the name of profit, according to investigators.

Time and time again, the AP found, the manufacturer downplayed the risks associated with the pain drugs. They also worked to spread the message that without opioids, many pain patients would be without treatment, and addiction was a small risk for such a benefit.

Italian police, via wiretaps, observed that pharmaceutical executives still pushed opioids abroad even after losing lawsuits and settling out-of-court due to their role in America’s addiction epidemic, primarily fueled by the rise in fentanyl and Oxycontin sales.

Last January, two Mundipharma managers accepted plea bargains in January for their role in bribing Dr. Fanelli sell more drugs. Also, the company’s Italian branch was fined, although the corporation did not admit.

Internal communications previously made light of their loose promotional practices. At one point, the police were listening to an alleged conspirator who joked that Mundipharma employees had given Fanelli so much money, the company logo should “be plastered on the stern.”

Pending Charges Against Dr. Fanelli

Italy, unlike the U.S., has strict laws limiting drug companies’ influence on medical training and practice. A specialized unit of the Carabinieri (police) actively works to help regulate shady medical practices.

Fanelli was an established and respected physician in Italy back in 2009. He was regularly called on to give expert testimony on television and served as chief of the anesthesiology and pain therapy department at Maggiore Hospital in Parma.

By 2010, he called himself the “father” of a law that made opioids easier to prescribe. He said it would alleviate suffering for hundreds of patients that had trouble finding pain reliefs.

Law enforcement say these were calculated moves, meant to help him sale more pain pills and accept more money and assistance from pharma companies.

“The drug companies saw him as the vehicle to commercially promote their drugs,” said Maj. Gianfranco Di Sario, who oversaw the police investigation. Prosecutors allege that Fanelli drew in a web of conspirators, from organizers of medical conferences to fellow physicians. Fanelli, through his lawyer, declined comment.

Fanelli spent four months on house arrest at his penthouse in Parma, and he is suspended without pay and barred from practicing medicine until his case is resolved. He is currently awaiting a trial date for his actions.

This is the first time any country outside the US has sought to proescute the makers of Oxycontin.