Understanding pharmaceutical industry coalitions: a case study of Mallinckrodt

The opioid industry has used coalitions to lobby for policies beneficial to its interests and to influence public discourse. In this study, we reviewed the creation of Mallinckrodt's Alliance for Balanced Pain Management (AfBPM) to better understand opioid industry coalitions. We searched the Opioid Industry Documents Archive (OIDA), an online, open-access collection of documents released in US litigation against opioid manufacturers, for materials on AfBPM. We conducted a retrospective qualitative content analysis of 132 documents, including emails, press releases, and internal presentations, by coding them by themes drawn from the Policy Dystopia model. In the mid-2010s, Mallinckrodt created AfBPM to position itself as a responsible opioid manufacturer. It recruited independent organizations and held a 2014 summit to draw press attention. It sought to convey the message that opioid misuse was the responsibility of healthcare providers and patients, and used its website, news media campaigns, op-eds, and social media to spread these messages. Mallinckrodt used AfBPM as a tool to recruit other organizations and to claim that patients and prescribers were responsible for opioid misuse. Understanding industry use of coalitions like AfBPM can help develop policies that prevent healthcare-focused coalitions from being co-opted by pharmaceutical manufacturers.