Fueling an Epidemic

Exposing the Financial Ties Between Opioid Manufacturers and

Third Party Advocacy Groups

EXECUTIVE SUMMARY

This report provides the first comprehensive snapshot of the financial connections between opioid 

manufacturers and advocacy groups and professional societies operating in the area of opioids policy.

Drawing on disclosures from Purdue Pharma L.P., Janssen Pharmaceuticals, Inc., Mylan N.V., Depomed, 

Inc., and Insys Therapeutics, Inc., in response to requests from Ranking Member McCaskill, the sections

below describe nearly $9 million in payments from these manufacturers to 14 outside groups working on 

chronic pain and other opioid-related issues between 2012 and 2017. In addition, physicians affiliated 

with these groups accepted more than $1.6 million in payments from the five manufacturers between 

2013 and the present. In total, the five manufacturers have made more than $10 million in payments to

these groups and affiliated individuals since January 2012.

Payments from Purdue totaling $4,153,554.33 account for roughly half of the nearly $9 million in funding 

to groups, and the company provided donations to the most diverse array of groups—a significant 

majority of the organizations profiled below. Primarily due to large payments to the National Pain 

Foundation and the U.S. Pain Foundation, Insys had the second-highest contribution total from 2012 to 

2017, with $3,146,265 in payments. Depomed contributed the third-highest total—$1,071,116.95—during 

this period, and Janssen contributed $465,152.85. At the other end of the spectrum, Mylan reported 

only $20,250 in payments during the same period.

Initiatives from the groups in this report often echoed and amplified messages favorable to increased 

opioid use—and ultimately, the financial interests of opioid manufacturers. These groups have issued 

guidelines and policies minimizing the risk of opioid addiction and promoting opioids for chronic pain, 

lobbied to change laws directed at curbing opioid use, and argued against accountability for 

physicians and industry executives responsible for overprescription and misbranding. Notably, a majority 

of these groups also strongly criticized 2016 guidelines from the Centers for Disease Control and 

Prevention (CDC) that recommended limits on opioid prescriptions for chronic pain—the first national 

standards for prescription opioids and a key federal response to the ongoing epidemic.

The fact that these same manufacturers provided millions of dollars to the groups described below 

suggests, at the very least, a direct link between corporate donations and the advancement of opioidsfriendly messaging. By aligning medical culture with industry goals in this way, many of the groups 

described in this report may have played a significant role in creating the necessary conditions for the 

U.S. opioids epidemic. 
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INTRODUCTION AND METHODOLOGY

More than 42,000 Americans died from opioid overdoses in 2016, with deaths from natural and 

semisynthetic opioid painkillers like hydrocodone and oxycodone rising roughly 14% compared to 2015.1

In Missouri, around 60% of the more than 1,300 drug overdose deaths in 2016 involved opioids,

2 and the 

epidemic cost the state $12.6 billion the same year, according to the Missouri Hospital Association.3

Alarmingly, fatal overdoses from fentanyl and other synthetic opioids more than doubled in the United 

States between 2015 and 2016—“more than an exponential increase,” according to the chief of the 

mortality statistics branch at the National Center for Health Statistics.4 This surge in overdose deaths 

resulted in the first two-year drop in average U.S. life expectancy since the early 1960s.5

The necessary conditions for this crisis may have arisen, in part, due to the financial relationships between 

opioid manufacturers and patient advocacy groups and medical professional societies—the precise 

terms of which parties to these transactions rarely disclose. Patient advocacy organizations and 

professional societies play a significant role in shaping health policy debates, setting national guidelines 

for patient treatment, raising disease awareness, and educating the public. Even small organizations—

with “their large numbers and credibility with policymakers and the public”—have “extensive influence 

in specific disease areas.”6 Larger organizations with extensive funding and outreach capabilities “likely 

have a substantial effect on policies relevant to their industry sponsors.”7

Nearly all health advocacy groups accept funding from the pharmaceutical industry. According to a 

recent study from PharmedOut—a Georgetown University Medical Center project focused on 

pharmaceutical marketing practices—only “a handful of 7,865 health advocacy groups in the U.S. are 

completely independent of pharmaceutical industry money.”8 As a result, “[t]he voices of independent 

groups that truly represent patients and consumers are drowned out by the thousands of groups that 

take money from industry and push industry viewpoints.”9

Moreover, neither pharmaceutical manufacturers nor advocacy groups fully or routinely disclose the 

extent of their financial relationships. In a special report published in the New England Journal of 

Medicine in March 2017, for example, researchers found that out of 104 organizations, “at least 83% 

received financial support from drug, device, and biotechnologies companies, and at least 39% have 

a current or former industry executive on the governing board.”10 Full disclosure of these payments was 

limited, with only 57% of organizations disclosing amounts of donations; even then, this disclosure “was 

typically done with the use of broad ranges rather than exact figures.”11 Moreover, only 12% of the 

organizations researchers examined “have published policies in place for managing institutional 

conflicts of interest.”12

A January 2017 article in JAMA Internal Medicine similarly examined relationships between patient 

advocacy organizations and the pharmaceutical industry. According to the study, more than 67% of 

245 examined organizations received industry funding within the last fiscal year, with almost 12% 

receiving more than half of their funding from industry sources.13 Only 65% of organizations that provided 

information on their funding from for-profit sources “provided a detailed breakdown” of this funding, 

and a similar percentage (63.9%) of 274 responsive organizations “reported having a written 

organizational conflict of interest policy.”14

These financial relationships—and the lack of transparency surrounding them—have raised concerns 

regarding the information and initiatives patient advocacy organizations promote. In the JAMA study 

discussed above, 8% of respondents in the study “reported [that] pressure to conform their organizations’ 

positions to the interests of industry funders is of concern.”15 Without additional disclosure, according to 

David Mitchell of Patients for Affordable Drugs, “policy makers or patients are unable to make informed 

judgments about the motives of the information being given, and the credibility of the information.”16 

On March 28, 2017, Ranking Member McCaskill issued wide-ranging requests for documents related to 

opioid sales and marketing efforts to five major opioid manufacturers: Purdue Pharma L.P., Janssen 
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Pharmaceuticals, Inc., Mylan N.V., Depomed, Inc., and Insys Therapeutics, Inc.

17 As the requests explain, 

these companies manufactured the top five opioid products as measured by worldwide 2015 sales.18

Among other items, the requests required manufacturers to produce records of payments to certain 

advocacy groups and professional societies since 2012, including the date, amount, and purpose of 

each payment.19 (Many of the groups at issue appeared in a previous congressional request from 2012 

and feature prominently in nationwide litigation against the opioids manufacturing industry.20) In 

response, manufacturers produced information on payments flowing to many—but not all—of the 

groups listed in the March 2017 requests. To verify this information, Ranking Member McCaskill issued 

additional requests directly to 15 of the organizations at issue on October 5, 2017.21 

The information produced to the Committee demonstrates that many patient advocacy organizations 

and professional societies focusing on opioids policy have promoted messages and policies favorable 

to opioid use while receiving millions of dollars in payments from opioid manufacturers. Through criticism 

of government prescribing guidelines, minimization of opioid addiction risk, and other efforts, ostensibly 

neutral advocacy organizations have often supported industry interests at the expense of their own 

constituencies.

PAYMENTS BY OPIOID MANUFACTURERS TO PATIENT ADVOCACY 

ORGANIZATIONS AND PROFESSIONAL SOCIETIES

Between January 2012 and March 2017, the five opioid manufacturers featured in this report contributed 

nearly $9 million to leading patient advocacy organizations and professional societies operating in the 

opioids policy area. For some groups, contributions from these manufacturers—alone—constituted

significant portions of their total annual contributions and grants.

In addition, the five manufacturers specifically at issue in this report also made substantial payments to 

individual group executives, staff members, board members, and advisory board members. Physicians

affiliated with these groups accepted more than $1.6 million in payments from the five manufacturers 

between 2013 and the present. These same individuals received payments totaling over $10 million from 

all opioid manufacturers during this time period. 

Opioid Manufacturers Contributed Millions to Patient Advocacy Organizations and 

Professional Societies

Purdue, Janssen, Mylan, Depomed, and Insys provided at least $8,856,339.13 in funding to 14 

outside groups working on chronic pain and other opioid-related issues between January 2012 

and March 2017. Detailed information on these payments, including payment totals for each 

manufacturer and group and the contributions applicable to each relationship, appears below 

in Figure 1.
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FIGURE 1: Manufacturer Payments to Selected Groups, 2012-2017

Purdue22 Janssen23 Depomed Insys Mylan Total

Academy of 

Integrative Pain 

Management

$1,091,024.86 $128,000.00 $43,491.95 $3,050.0024 $0.00 $1,265,566.81

American 

Academy of 

Pain Medicine 

$725,584.95 $83,975.00 $332,100.00 $57,750.00 $0.00 $1,199,409.95

AAPM 

Foundation

$0.00 $0.00 $304,605.00 $0.00 $0.00 $304,605.00

ACS Cancer 

Action Network

$168,500.0025 $0.00 $0.00 $0.00 $0.00 $168,500.00

American 

Chronic Pain 

Association 

$312,470.00 $50,000.00 $54,670.00 $0.00 $0.00 $417,140.00

American 

Geriatrics 

Society

$11,785.0026 $0.00 $0.00 $0.00 $0.00 $11,785.00

American Pain 

Foundation 

$25,000.00 $0.00 $0.00 $0.00 $0.00 $25,000.00

American Pain 

Society 

$542,259.52 $88,500.00 $288,750.00 $22,965.00 $20,250.00 $962,724.52

American 

Society of Pain 

Educators 

$30,000.00 $0.00 $0.00 $0.00 $0.00 $30,000.00

American 

Society of Pain 

Management 

Nursing

$242,535.00 $55,177.8527 $25,500.0028 $0.00 $0.00 $323,212.85

The Center for 

Practical 

Bioethics

$145,095.00 $18,000.00 $0.00 $0.00 $0.00 $163,095.00

The National 

Pain 

Foundation29

$0.00 $0.00 $0.00 $562,500.00 $0.00 $562,500.00

U.S. Pain 

Foundation

$359,300.00 $41,500.00 $22,000.00 $2,500,000.0030 $0.00 $2,922,800.00

Washington 

Legal 

Foundation

$500,000.00 $0.00 $0.00 $0.00 $0.00 $500,000.00

$4,153,554.33 $465,152.85 $1,071,116.95 $3,146,265.00 $20,250.00 $8,856,339.13
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As shown in Figure 2, payments from Purdue account for roughly half of this funding, and the 

company provided donations to the most diverse array of groups—a significant majority of the 

organizations profiled below. Primarily due to large payments to the National Pain Foundation 

and the U.S. Pain Foundation, Insys had the second-highest contribution total from 2012 to 2017.

At the other end of the spectrum, Mylan reported only $20,250 in payments during the same 

period; in correspondence with the Committee, the company has claimed a “very limited role 

in the opioid-containing products marketplace.”31

FIGURE 2: Percentages of Total Payments by Manufacturer, 2012-2017

As shown in Figure 3 below, trends based on yearly payment totals varied between 

manufacturers from 2012 to 2017. Payments from Purdue, for example, fell dramatically in 2016 

after remaining in the $800,000–$1,000,000 range between 2012 and 2015. Conversely, payments 

from Insys to advocacy groups rose significantly between 2012—when the company received 

U.S. Food and Drug Administration approval for its fentanyl drug Subsys—and 2017. As Ranking 

Member McCaskill noted in a recent report entitled, “Fueling an Epidemic: Insys Therapeutics 

and the Systemic Manipulation of Prior Authorization,” Insys revenues tripled and profits rose 45% 

between 2013 and 2015, and the value of company stock increased 296% between 2013 and 

2016.32

Payments from Janssen to the groups listed above dropped sharply to $0 in 2015 from $126,000 

in 2014 (and $99,250 and $239,902.85 in 2013 and 2012, respectively) and remained at $0 for 2016 

and 2017. In April 2015, Janssen sold U.S. licensing rights for its major Nucynta opioid product line 

to Depomed for $1.05 billion.33 For its part, Depomed more than tripled payments to the 

advocacy groups featured in this report in 2015 relative to 2014, and the payments total for 

2016—$318,257.47—remained steady compared to the 2015 total.

Mylan made a single $15,000 payment to the American Pain Society in March 2015—its first 

payment to the groups in this report—before making significantly smaller payments to the same 

group in 2016 and 2017. Also in March 2015, Mylan announced the launch of intermediate 

dosage strengths for its fentanyl transdermal system.34 In connection with this launch, according 

Purdue

Janssen

Depomed

Insys

Mylan
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to the company, Mylan “engaged in marketing efforts to educate doctors about the availability 

of the intermediate strengths.”35

 

FIGURE 3: Manufacturer Yearly Payment Totals, 2012-2017

2012 2013 2014 2015 2016 2017 Total

Purdue $824,227.86 $973,328.00 $812,451.95 $935,344.00 $558,067.52 $50,135.00 $4,153,554.33

Janssen $239,902.8536 $99,250.00 $126,000.00 $465,152.85

Depomed $73,080.00 $135,300.00 $113,600.00 $350,000.00 $318,257.47 $80,879.48 $1,071,116.95

Insys $14,040.00 $68,000.00 $34,200.00 $530,025.00 $2,500,000.00 $3,146,265.00

Mylan $15,000.00 $2,500.00 $2,750.00 $20,250.00

Total $1,151,250.71 $1,275,878.00 $1,086,251.95 $1,830,369.00 $878,824.99 $2,633,764.48 $8,856,339.13

Purpose of Manufacturer Contributions

Based on the descriptions manufacturers submitted in connection with each specific reported 

payment, the minority staff designated broad payment categories. Payments directed to 

special projects and restricted grants comprise the largest category of contributions, totaling 

$2,617,899 and constituting roughly 30% of total contributions between 2012 and 2017. For these 

types of restricted grants, donors specify a use for their contribution beyond the broad 

parameters resulting from the nature of the non-profit entity at issue, the environment in which it 

operates, or the purposes specified in its organizing documents.

37

Following closely behind the total for special projects and restricted grants is the amount 

manufacturers contributed in the form of non-education grants, which totaled $2,269,765 and 

constituted roughly 26% of all contributions. According to a publicly available overview from 

Purdue, non-education grants provide support for healthcare-related organizations or initiatives 

focused on patient and public education, scientific research, and other programs.

38

Payments for advertising and sponsorship related to group events and dues occupy the next tier 

of categories, with $1,564,215.86 and $1,253,988 in payments and roughly 18% and 14% of the 

total contributions, respectively. Finally, national grants and education grants occupy the third 

tier of categories, with similar payments totals of $413,154 and $413,128, respectively, and 

percentages of roughly 5%. According to Purdue, an education grant “[p]rovides for healthcare 

professional continuing education (CE) activities designed to foster improved understanding of 

scientific, clinical, and other healthcare issues that help to improve patient care.”39 See Figure 4.
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FIGURE 4: Payment Categories as Percentages of Total Payments, 2012-2017

Payments by Organization

The U.S. Pain Foundation received the largest amount of payments during the 2012–2017 

period—almost $3 million—which includes $2,500,000 in payments from Insys. The Academy of 

Integrative Pain Management, formerly the American Academy of Pain Management, received 

$1,265,566.81 in donations—the second-highest total—followed closely by the American 

Academy of Pain Medicine with $1,199,409.95 in payments. (The American Academy of Pain 

Medicine Foundation also received $304,605 in payments from Depomed during the same 

period.)

FIGURE 5: Group Rankings by Manufacturer Payments, 2012-2017

U.S. Pain Foundation $2,922,800.00

Academy of Integrative Pain Management $1,265,566.81

American Academy of Pain Medicine $1,199,409.95

American Pain Society $962,724.52

The National Pain Foundation $562,500.00

Washington Legal Foundation $500,000.00

American Chronic Pain Association $417,140.00

American Society of Pain Management Nursing $323,212.85

AAPM Foundation $304,605.00

ACS Cancer Action Network $168,500.00

The Center for Practical Bioethics $163,095.00

American Society of Pain Educators $30,000.00

American Pain Foundation $25,000.00

American Geriatrics Society $11,785.00

Special Projects / Restricted

Grants

Other Non-Education Grants

Events (Advertising &

Sponsorship)

Dues

National Grants

Education Grants

Sponsorship (Publication &

Awards)

Miscellaneous / Unspecified

Community Affairs

Charitable Contributions
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Contributions by Selected Manufacturers as a Percentage of Overall Contributions

Based on comparisons between manufacturer contributions to groups and group reporting on 

contributions and grants in IRS filings between 2013 and 2015, the percentage of total 

contributions attributable to the five manufacturers discussed in this report vary significantly. Insys 

contributions to the National Pain Foundation in 2015, for example, actually exceeded total 

contributions the group reported on its Form 990 by $154,800. In a less extreme example, the 

American Society of Pain Management Nursing received approximately 76% of its funding from 

Depomed, Janssen, and Purdue in 2013, although this percentage declined for 2014 and 2015.

For other groups, the percentages of contributions attributable to the five manufacturers 

remained consistent during 2013–2015. The Academy of Integrative Pain Management and the 

American Academy of Pain Medicine, for example, received between 13% and 20% of their 

contributions from at least one of the five manufacturers during this three-year period. At the 

other end of the spectrum, the American Cancer Society Cancer Action Network received less 

than 1% of its contributions from Purdue between 2013 and 2015.

FIGURE 6: Comparison of Contributions from Selected Manufacturers and Total Contributions 

and Grants, 2013-201540

2013 INFORMATION

Contributions 

from Selected 

Manufacturers

Contributions 

and Grants

% of Selected 

Contributions

Academy of Integrative Pain 

Management $319,929 $1,624,115 19.70%

American Academy of Pain 

Medicine $201,944 $1,071,992 18.84%

AAPM Foundation $50,000 $381,738 13.10%

ACS Cancer Action Network $28,500 $35,409,632 0.08%

American Chronic Pain 

Association $100,970 $564,004 17.90%

American Geriatrics Society $0 $2,709,179 0.00%

American Pain Foundation Unavailable Unavailable Unavailable

American Pain Society $161,585 $1,271,537 12.71%

American Society of Pain 

Educators $5,000 Unavailable Unavailable

American Society of Pain 

Management Nursing $97,950 $129,167 75.83%

The Center for Practical Bioethics $101,000 $1,276,473 7.91%

The National Pain Foundation $50,000 $50,100 99.80%

U.S. Pain Foundation $84,000 $467,040 17.99%

Washington Legal Foundation $75,000 $4,113,151 1.82%
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2014 INFORMATION

Contributions 

from Selected 

Manufacturers

Contributions 

and Grants

% of Selected 

Contributions

Academy of Integrative Pain 

Management $269,980 $1,929,818 13.99%

American Academy of Pain 

Medicine $255,087 $1,346,712 18.94%

AAPM Foundation $0 $533,776 0.00%

ACS Cancer Action Network $40,000 $35,288,961 0.11%

American Chronic Pain 

Association $85,000 $558,510 15.22%

American Geriatrics Society $0 $3,197,135 0.00%

American Pain Foundation Unavailable Unavailable Unavailable

American Pain Society $161,190 $949,867 16.97%

American Society of Pain 

Educators $5,000 Unavailable Unavailable

American Society of Pain 

Management Nursing $68,100 $229,732 29.64%

The Center for Practical Bioethics $30,095 $1,232,768 2.44%

The National Pain Foundation $0 $3,100 0.00%

U.S. Pain Foundation $121,800 $791,657 15.39%

Washington Legal Foundation $50,000 $4,213,431 1.19%

2015 INFORMATION

Contributions 

from Selected 

Manufacturers

Contributions 

and Grants

% of Selected 

Contributions

Academy of Integrative Pain 

Management $275,098 $1,465,067 18.78%

American Academy of Pain 

Medicine $239,941 $1,482,707 16.18%

AAPM Foundation $100,000 $451,835 22.13%

ACS Cancer Action Network $100,000 $37,925,236 0.26%

American Chronic Pain 

Association $30,000 $382,671 7.84%

American Geriatrics Society $0 $4,041,760 0.00%

American Pain Foundation Unavailable Unavailable Unavailable

American Pain Society $266,020 $660,894 40.25%

American Society of Pain 

Educators $10,000 Unavailable Unavailable

American Society of Pain 

Management Nursing $63,810 $171,256 37.26%

The Center for Practical Bioethics $3,500 $857,788 0.41%

The National Pain Foundation $512,500 $357,700 143.28%

U.S. Pain Foundation $129,500 Unavailable Unavailable

Washington Legal Foundation $100,000 $4,583,620 2.18%
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Manufacturers Also Provided Payments to Group-Affiliated Individuals 

The five manufacturers specifically at issue in this report also made substantial payments to 

individual group executives, staff members, board members, and advisory board members.

Figure 7 below lists totals for these payments between August 2013 and the present, as well as 

the sum of these payments and the amounts manufacturers contributed to the groups directly.

In terms of total contributions, the U.S. Pain Foundation ranks first among the groups despite 

minimal payments to affiliated individuals, and the National Pain Foundation assumes the 

second-place ranking due to payments to individual physicians of over $800,000. Notably, the 

nearly $300,000 in payments to individuals affiliated with the American Society of Pain Educators

significantly outweighs the relatively minor amount the group received from Purdue directly. In 

contrast, manufacturer payments to groups like the Academy of Integrative Pain Management, 

the American Academy of Pain Medicine, the American Pain Society, and the American 

Chronic Pain Association far exceeded payments to physicians affiliated with these 

organizations. 

FIGURE 7: Purdue, Janssen, Insys, Depomed, and Mylan Payments to Groups and GroupAffiliated Individuals, 2012-Present41

Payments to 

Group

Payments to GroupAffiliated Individuals

Total

U.S. Pain Foundation $2,922,800.00 $126.20 $2,922,926.20

The National Pain Foundation $562,500.00 $839,848.84 $1,402,348.84

Academy of Integrative Pain 

Management $1,265,566.81 $30,223.42 $1,295,790.23

American Academy of Pain Medicine $1,199,409.95 $16,462.42 $1,215,872.37

American Pain Society $962,724.52 $95,474.56 $1,058,199.08

AAPM Foundation $304,605.00 $314,175.58 $618,780.58

Washington Legal Foundation $500,000.00 N/A $500,000.00

American Chronic Pain Association $417,140.00 $31,265.87 $448,405.87

American Society of Pain Management 

Nursing $323,212.85 N/A $323,212.85

American Society of Pain Educators $30,000.00 $280,765.92 $310,765.92

The Center for Practical Bioethics $163,095.00 $7,116.86 $170,211.86

ACS Cancer Action Network $168,500.00 N/A $168,500.00

American Pain Foundation $25,000.00 N/A $25,000.00

American Geriatrics Society $11,785.00 $194.13 $11,979.13

Total $8,856,339.13 $1,615,653.80 $10,471,992.93

As shown in Figure 8 below, individuals affiliated with these groups have significant financial ties 

not only with the five companies at issue in this report, but also with all other opioid 

manufacturers. According to CMS Open Payments data, for example, the current President of 

the American Academy of Pain Medicine, Dr. Steven Stanos, received over $90,000 in payments 

from opioid manufacturers between 2013 and 2016.42 Additional searches of Open Payments 

data also show that multiple American Academy of Pain Medicine Corporate Relations Council 

members made payments directly to at least one American Academy of Pain Medicine board 

member between 2013 and 2016.43 In total, between 2013 and 2016, American Academy of 

Pain Medicine board members received more than $200,000 in payments from opioid 

manufacturers.44 In addition, Dr. Charles Argoff, current president of the American Academy of 

Pain Medicine Foundation, received over $600,000 in payments from opioid manufacturers 

between 2013 and 2016.45
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Similarly, Open Payments data indicates that between 2013 and 2016, ten members of the 

American Chronic Pain Association Advisory Board received more than $140,000 from opioid 

manufacturers, including Endo, Purdue, Mallinckrodt, Pfizer, Teva, and Depomed.46 In another 

prominent example, National Pain Foundation chairman and founder Dr. Daniel Bennett47

received over $170,000 from Insys Therapeutics, manufacturer of the powerful fentanyl drug 

Subsys, between 2013 and 2016.48 Members of the National Pain Foundation Board of Directors, 

which include Dr. Bennett, received more than $950,000 from opioid manufacturers, including 

more than $250,000 from Insys Therapeutics, during the same period.49 In addition, at least half 

of the members of the National Pain Foundation Clinical and Scientific Advisory Council50 have 

received general payments—totaling more than $7,900,000—from opioid manufacturers 

between 2013 and 2016.51 Manufacturer payments to all individuals affiliated with the National 

Pain Foundation total more than $8,000,000 since 2013—by far the largest total for the groups 

profiled in this report. 

FIGURE 8: Payments from All Opioid Manufacturers to Group-Affiliated Individuals, 2013-

Present52

Manufacturer Payments to 

Affiliated Individuals

The National Pain Foundation $8,307,243.47

AAPM Foundation $798,051.22

American Society of Pain Educators $749,564.78

American Academy of Pain Medicine $204,631.53

American Pain Society $187,699.34

ACS Cancer Action Network $154,578.09

American Chronic Pain Association $145,861.30

Academy of Integrative Pain Management $82,596.98

The Center for Practical Bioethics $16,945.88

American Geriatrics Society $7,548.35

U.S. Pain Foundation $138.91

American Pain Foundation N/A

American Society of Pain Management Nursing N/A

Washington Legal Foundation N/A

Total $10,654,859.85

GROUPS FAIL TO ADEQUATELY DISCLOSE MANUFACTURER CONTRIBUTIONS

Due to their classification under the U.S. tax code, the groups profiled in this report have no obligation 

to disclose their donors publicly; as a result, each group maintains different levels of transparency 

regarding its financial connections to the pharmaceutical industry. Specifically, as either 501(c)(3), 

501(c)(4), or 501(c)(6) public charities, the groups discussed below have no obligation to publicly 

disclose the list of donors they provide to the Internal Revenue Service with their annual Form 990 filing.53

Instead, these organizations have the ability to selectively disclose donors, donations, and other 

support—or no information at all. Importantly, no organization profiled in this report provides an online 
P a g e | 12

list linking donors, their specific donations, and the projects or events benefiting from each donation for 

each of the years between 2012 and 2017. 

The minority staff reviewed disclosure policies available online for each of the groups listed in the March 

28, 2017, requests. Several groups—the American Society of Pain Educators, the National Pain 

Foundation, and the Academy of Integrative Pain Management—provided no information concerning 

their policies for disclosing donors and donations. Other groups stated explicitly that they do not disclose 

any information concerning donor relationships. The Washington Legal Foundation, for example, states 

in its 2016 Annual Report: “All contributions to WLF are strictly confidential. WLF does not disclose, publish, 

or trade the names of its donors.”54 

Other groups simply list donors, “corporate members,” or “corporate partners” without indicating 

specific donation amounts or even the range of donations for each category of contributor. The website 

for the American Geriatrics Society, for example, states that “AGS corporate arrangements will be 

disclosed regularly as part of the organization’s financial reporting to the Board of Directors,” but for the 

public, the organization simply lists three “corporate partners” without details of the amounts donated 

or any related arrangements.55 The U.S. Pain Foundation similarly lists “Platinum,” “Gold,” and “Basic” 

corporate members—including opioid manufacturers like Pfizer, Teva, Depomed, Endo, Purdue, and 

Mallinckrodt—without indicating the level of donations required for each classification.56 The American 

Chronic Pain Association lists many of the same corporations as “Partners & Contributors” at the 

“Champion,” “Ambassador,” “Educator,” and “Builder” levels without specifying the applicable ranges 

of contributions.57 Both the American Cancer Society Cancer Action Network and the Center for 

Practical Bioethics also list corporate or individual donors without including donation amounts.58 Finally, 

the American Academy of Pain Medicine website lists donors between January 1, 2017, and October 

31, 2017, and describes the list as including “matching gifts from companies,” but no companies appear 

on the list.59 

A handful of groups disclose both their donors and list the ranges of donations applicable to each 

category of contributor. The American Pain Society, for example, specifies that “Corporate Council” 

contributors donated at least $25,000, “Executive” donors provided at least $15,000, and “Associate” 

contributors donated at least $7,500.60 Opioid manufacturers, including Pfizer, Teva, Depomed, Purdue, 

and Mallinckrodt, appear at all three donor levels.61 The website of the American Society of Pain 

Management Nursing similarly specifies that all listed corporations contributed more than $5,000.62 

GROUP ACTIVITIES CONTRIBUTING TO OPIOID OVERPRESCRIPTION AND 

OVERUSE

Many of the groups discussed in this report have amplified or issued messages that reinforce industry 

efforts to promote opioid prescription and use, including guidelines and policies minimizing the risk of 

addiction and promoting opioids for chronic pain. Several groups have also lobbied to change laws 

directed at curbing opioid use, strongly criticized landmark CDC guidelines on opioid prescribing, and 

challenged legal efforts to hold physicians and industry executives responsible for overprescription and 

misbranding. 

Minimizing the Risk of Addiction

Many of the groups have issued guidelines to physicians and other health practitioners that minimize 

the risk of opioid addiction or emphasize the long-term use of opioids to treat chronic pain.

According to a complaint from the City of Chicago, for example, the American Academy of Pain 

Medicine and the American Pain Society issued a consensus statement in 1997 “which endorsed 

opioids to treat chronic pain and claimed that the risk that patients would become addicted to 

opioids was low.”63 Dr. J. David Haddox, then a paid speaker for Purdue and now the Vice President 
P a g e | 13

of Health Policy at the company, co-authored the statement.64 The American Academy of Pain 

Medicine and the American Pain Society also allegedly issued guidelines in 2009 that “promote[d] 

opioids as ‘safe and effective’ for treating chronic pain, despite acknowledging limited evidence, 

and conclude[d] that the risk of addiction is manageable for patients regardless of past abuse 

histories.”65

Similarly, the American Geriatrics Society released guidelines in 2009 for the management of 

persistent pain in older patients.66 While acetaminophen remained the preferred option for the 

treatment of chronic pain patients, the American Geriatrics Society recommended opioids—as 

opposed to aspirin or ibuprofen—for those unable to gain relief from Tylenol and similar products.67

According to the City of Chicago complaint, the guidelines included these recommendations: “All 

patients with moderate to severe pain . . . should be considered for opioid therapy (low quality of 

evidence, strong recommendation),” and “the risks [of addiction] are exceedingly low in older 

patients with no current or past history of substance abuse.”68 The American Geriatrics Society also 

partnered with the American Academy of Pain Medicine and Janssen to create the 2009 patient 

education guide entitled, “Finding Relief: Pain Management for Older Adults,” which stated that 

“[m]any studies show that opioids are rarely addictive when used properly for the management of 

chronic pain.”69

Lobbying to Defeat Measures to Restrict Overprescription

Advocacy groups have engaged in extensive lobbying efforts to either defeat legislation restricting 

opioid prescribing or promote laws encouraging opioid treatment for pain. In 2014, for example, the 

Academy of Integrative Pain Management and the American Cancer Society Cancer Action 

Network led an effort to protect a 2001 Tennessee law that made it difficult to discipline doctors for 

overprescribing opioids and prohibited them from refusing to prescribe opioids unless they referred 

the patient to another “opioid-friendly” doctor.70

According to a joint investigation by the Associated Press and the Center for Public Integrity, the 

Academy of Integrative Pain Management and the American Cancer Society Cancer Action 

Network have contacted legislators and other officials about opioid measures in at least 18 states.71

More broadly, the American Cancer Society Cancer Action Network reportedly maintains “about 

200 lobbyists around the country opposed to opioid restrictions even in some cases where they 

specifically exempted cancer patients.”72 In an example of the general legislative reach of these 

groups, the U.S. Pain Foundation has “participated in more than 30 state and national advocacy 

coalitions, alliances, and task forces ... [and is] actively engaged in 70 legislative bills in 20 states with 

the support of 250 advocates engaged in outreach to policymakers.”73

Efforts to Criticize or Undermine CDC Guidelines

On March 15, 2016, the CDC issued guidelines providing prescribing recommendations for “primary 

care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, 

palliative care, and end-of-life care.”74 In introducing these guidelines—“the first national standards 

for prescription painkillers,”75 as the New York Times reported—the CDC noted that opioid 

prescriptions per capita had increased 7.3% from 2007 to 2012, “more than 165,000 persons died 

from overdose related to opioid pain medication in the United States” from 1999 to 2014, and “the 

death rate associated with opioid pain medication” had increased “markedly” in the previous 

decade.

76 The guidelines explained that non-opioid therapies are preferred for chronic pain and 

recommended that physicians prescribe immediate-release opioids at the lowest effective dosage 

and evaluate the benefits and harms of continued opioid use within one to four weeks of starting 

opioid therapy.77 The guidelines also noted that for opioid therapy for acute pain, “[t]hree days or 

less will often be sufficient; more than seven days will rarely be needed.”78

These guidelines represented an important step—and perhaps the first major step from the federal 

government—toward limiting opioid prescriptions for chronic pain in the face of an unprecedented 
P a g e | 14

public health crisis. A majority of the groups described in this report, however, strongly criticized the 

content of the guidelines, the process by which the CDC drafted them, or the experts who assisted 

during their development. In fact, the New York Times reported that the release of the CDC 

guidelines ended “months of arguments with pain doctors and drug industry groups, which had 

bitterly opposed the recommendations on the grounds that they would create unfair hurdles for 

patients.”79 As Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid 

Prescribing, has explained, “[t]he opioid lobby has very actively blocked interventions that might 

result in more cautious prescribing or reduced prescribing. They’ve very clearly defended their 

financial stake in the status quo.”80

In 2016, for example, the immediate past president of the American Academy of Pain Medicine, 

Daniel Carr, criticized the prescribing guidelines, stating “that the CDC guideline makes 

disproportionately strong recommendations based upon a narrowly selected portion of the 

available clinical evidence.”81 Similarly, several advocacy groups criticized draft guidelines in 2015, 

arguing that the “CDC slides presented on Wednesday were not transparent relative to process and 

failed to disclose the names, affiliations, and conflicts of interest of the individuals who participated 

in the construction of these guidelines.”82 Dr. Richard Payne, a physician affiliated with the Center 

for Practical Bioethics, made a similar argument, criticizing the CDC guidelines as the product of 

“conflicts of interests in terms of biases [and] intellectual conflicts”—while himself maintaining 

“financial links to numerous drug companies.”83 The Washington Legal Foundation also strongly 

criticized the guidelines on procedural grounds, claiming CDC had developed its guidelines in an 

“overly secretive manner” and in violation of the Federal Advisory Committee Act, which called 

“into question the viability of the entire enterprise.”84 The Washington Legal Foundation claimed, 

moreover, that “[s]tate governments and the medical community are unlikely to accept any 

guidelines tainted by charges that they were prepared in secret without meaningful stakeholder 

input.”85 When the CDC published its final opioid prescribing guidelines, Richard A. Samp, 

Washington Legal Foundation general counsel, reportedly believed the guidelines “were inherently 

biased, crafted by people who already had strong views about what opioid policy should look 

like.”86

The fact that these groups registered their opposition while receiving funding from the opioids 

industry raises the appearance—at the very least—of a direct link between corporate donations 

and the advancement of opioids-friendly messaging. Relatedly, in a March 2017 article published in 

JAMA Internal Medicine, researchers from Johns Hopkins University and Brandeis University examined 

industry payments to over 150 organizations that had submitted comments on the draft CDC

guidelines.87 After coding guideline comments by supportiveness and reviewing financial 

disclosures, including annual reports, tax returns, and self-reported information, researchers found 

“opposition to the guidelines was significantly more common among organizations with funding from 

opioid manufacturers than those without funding from the life sciences industry.”

88 Accordingly, a 

“major concern is that opposition to regulatory, payment, or clinical policies to reduce opioid use 

may originate from groups that stand to lose financially if opioids sales decline.”89 In an extended 

version of their findings, the researchers are more explicit: “[O]pposition to more conservative opioid 

use may, at least in part, be financially motivated.”90

Efforts to Limit Accountability

Certain advocacy groups and professional societies have also organized legal efforts to challenge 

government actions to punish physicians engaging in opioid overprescription and executives 

responsible for fraudulent marketing of opioid products. In 2005, for example, the National Pain 

Foundation submitted to the U.S. Court of Appeals for the Fourth Circuit an amicus brief in support 

of Dr. William Hurwitz,91 a doctor convicted “of 16 counts of drug trafficking, [for] prescrib[ing] 

massive quantities of medicine to patients in chronic pain.”92 Prosecutors asserted that Dr. Hurwitz 

“prescribed excessive amounts of Oxycodone and other dangerous narcotics—in one instance 

more than 1,600 pills a day—to addicts and others, some of whom then sold the medication on a 

lucrative black market.”93 In defense of Dr. Hurwitz, the National Pain Foundation suggested that 
P a g e | 15

“[t]he conviction [in the trial court] broke ground by holding that a doctor acting in the good faith 

belief that he was serving the best medical interest of his patient could be found to be a drug 

dealer.”94 Similarly, the Washington Legal Foundation filed an amicus brief challenging the exclusion 

of three former Purdue executives from participation in federal healthcare programs for 12 years for 

their admitted failure to prevent the fraudulent marketing of OxyContin.95 In a brief filed with the U.S. 

Court of Appeals for the District of Columbia Circuit, the Washington Legal Foundation argued—

unsuccessfully—that the exclusion raised serious constitutional due process concerns.96

FULL EXTENT OF INDUSTRY INFLUENCE ON GROUPS IS UNKNOWN

This report does not capture the full extent of the financial ties between opioid manufacturers and 

patient advocacy groups and professional societies. According to the Associated Press and the Center 

for Public Integrity, for example, opioid manufacturers “spent more than $880 million nationwide on 

lobbying and campaign contributions from 2006 through 2015—more than 200 times what those 

advocating for stricter [opioid] policies spent.”97

Moreover, payments between 2012 and 2017 may not fully reflect historical funding activities by 

manufacturers, given that several of the most prominent advocates in this space historically—the 

American Pain Foundation, for example—no longer operate. The fact that opioid prescribing, as 

measured in morphine milligram equivalents (MME) per capita, peaked between 2010 and 2012 before 

declining from 2012 to 2015 may also suggest more robust financing of advocacy groups in the pre-2012 

period.98

In addition, the data contained in this report may not even capture the full extent of payments between 

the covered manufacturers and patient advocacy groups and professional societies. This report is 

based on information provided voluntarily to the Committee at the request of the Ranking Member—

information which certain manufacturers changed following further inquiries from the minority staff. A 

timeline of interactions between the Committee, manufacturers, and advocacy groups appears below

as Figure 9. 

As mentioned above, Ranking Member McCaskill sent requests for payments information to Purdue, 

Janssen, Insys, Depomed, and Mylan on March 28, 2017.99 On April 25, 2017, Depomed provided an 

initial response, closely followed a response from Purdue on May 11, 2017, and a response from Janssen 

on June 12, 2017.100 Following extensive discussions with minority staff, Mylan provided payments 

information on October 5, 2017.101

On October 5, 2017, Ranking Member McCaskill sent requests for payment information directly to 15 

advocacy groups and professional societies.102 Following these letters, several manufacturers 

volunteered additional or revised data. After further due diligence, for example, Janssen reported an 

additional $7,500 payment to the American Academy of Pain Medicine and an additional $128,000 in 

cumulative payments to the Academy of Integrative Pain Management.

103 Purdue also provided 

updated information showing an additional $70,552 in payments to the American Academy of Pain 

Medicine, $415,574 in payments to the American Pain Society, and $17,755 in payments to the American 

Society of Pain Management Nursing.

104 For the first time, Purdue also reported $1,091,025 in payments 

to the Academy of Integrative Pain Management—the company had not searched for payments to 

the American Academy of Pain Management, the previous name of the organization—and $168,500 in 

payments to the American Cancer Society Cancer Action Network .

105 Purdue additionally reported 

over $91,000 in payments associated with incomplete entity names in company records.106

A comparison of payments information from the five manufacturers and the information advocacy 

groups provided directly to the Committee revealed several discrepancies. Most significantly, Insys 

Therapeutics initially failed to report $2,500,000 in responsive payments to the U.S. Pain Foundation for 

the “Gain Against Pain” patient assistance program.107 The company also did not report $12,500 in 
P a g e | 16
P a g e | 17

payments the Academy of Integrative Pain Management reported receiving in 2014 and 2015 and 

could not confirm or deny these payments after further due diligence.108 (Insys did, however, report an 

additional $3,050 in payments to the Academy of Integrative Pain Management during 2012.109) Purdue 

also failed to report $40,000 in corporate roundtable dues to the American Geriatrics Society Health in 

Aging Foundation; according to the American Geriatrics Society, this foundation received all payments 

Purdue directed to the organization between 2012 and 2017.110

In addition, Depomed later reported five additional responsive payments—totaling $17,600 to the 

American Chronic Pain Association and $28,174.95 to the Academy of Integrative Pain Management—

after receiving further correspondence from minority staff.111 According to Depomed, these payments 

“were for advertising or promotional purposes,” and the company initially considered them outside the 

scope of the March 28, 2017, requests.112 Finally, in response to information from minority staff, Janssen 

representatives also reported the company had made an additional $68,500 in payments to the 

American Pain Society and an additional $76,475 in payments to the American Academy of Pain 

Medicine via a third party during the 2012-2017 time period.

113

CONCLUSION

The privacy the advocacy groups discussed above have guarded for their donors has come at a high 

price for the public debate on chronic pain and opioid use in the United States. As a 2011 study in the 

American Journal of Public Health noted, a tension exists between the status of advocacy organizations 

as “among the most influential and trusted stakeholders in U.S. health policy,” and the reality that their 

“positions closely correspond to the marketing aims of pharmaceutical and device companies.”114 The 

findings in this report indicate that this tension exists in the area of opioids policy—that organizations 

receiving substantial funding from manufacturers have, in fact, amplified and reinforced messages 

favoring increased opioid use. By aligning medical culture with industry goals in this way, many of the 

groups described above may have played a significant role in creating the necessary conditions for the 

U.S. opioids epidemic. 

1 Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health 

Statistics, NCHS Data Brief No. 294, Drug Overdose Deaths in the United States, 1999-2016 (Dec. 21, 2017) 

(www.cdc.gov/nchs/products/databriefs/db294.htm); CDC Releases Grim New Opioid Overdose Figures: “We’re 

Talking About More Than an Exponential Increase,” Washington Post (Dec. 21, 2017) 

(www.washingtonpost.com/news/ wonk/wp/2017/12/21/cdc-releases-grim-new-opioid-overdose-figures-weretalking-about-more-than-an-exponential-increase/?utm_term=.79af03095271).

2 Opioid Crisis Drives Declines in U.S., Missouri Life Expectancy, Columbia Missourian (Jan. 10, 2018) 

(www.columbiamissourian.com/news/local/opioid-crisis-drives-declines-in-u-s-missouri-lifeexpectancy/article_cd71e66e-f488-11e7-ac3f-d77b751b7c73.html); see also Department of Health and Human 

Services, Centers for Disease Control and Prevention, Drug Overdose Mortality by State (Jan. 10, 2018) 

(www.cdc.gov/nchs/pressroom/sosmap/ drug_poisoning_mortality/drug_poisoning.htm).

3 Opioid Crisis Cost Missouri $12.6 Billion in 2016, Report Says, St. Louis Business Journal (Jan. 17, 2018).

4 CDC Releases Grim New Opioid Overdose Figures: “We’re Talking About More Than an Exponential Increase,” 

Washington Post (Dec. 21, 2017).

5 Opioid Crisis Trims U.S. Life Expectancy, Boosts Hepatitis C: CDC, Reuters (Dec. 21, 2017) (www.reuters.com/article/ususa-healthcare-cdc/opioid-crisis-trims-u-s-life-expectancy-boosts-hepatitis-c-cdc-idUSKBN1EF1TF).

6 Susannah L. Rose et al., Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest, JAMA Internal 

Medicine (Mar. 2017). 

7 Id.

8 Very Few Patient Groups Don’t Take Pharma Money, Bloomberg BNA (Oct. 20, 2017) (www.bna.com/few-patientgroups-b73014471175/).

9 PharmedOut, Pharma-Free Advocacy Groups (www.pharmedout.org/pharma-free-groups.html) (accessed Dec. 7, 

2017).

 
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10 Matthew S. McCoy et al., Conflicts of Interest for Patient-Advocacy Organizations, New England Journal of Medicine 

(Mar. 2, 2017). 

11 Id. 

12 Id. 

13 Susannah L. Rose et al., Patient Advocacy Organizations, Industry Funding, and Conflicts of Interest, JAMA Internal 

Medicine (Mar. 2017). 

14 Id. 

15 Id. 

16 More Than 80 Percent of Patient Groups Accept Drug Industry Funds, Study Shows, New York Times (Mar. 1, 2017) 

(www.nytimes.com/2017/03/01/health/patient-groups-drug-industry-money.html). 

17 See, e.g., Letter from Sen. Claire McCaskill to Santosh Vetticaden, Interim Chief Executive Officer of Insys 

Therapeutics, Inc. (Mar. 28, 2017). 

18 Id. 

19 Id. 

20 See, e.g., Letter from Sen. Baucus and Sen. Grassley to Catherine Underwood, Executive Director, American Pain 

Society (May 8, 2012); Third Amended Complaint (Oct. 25, 2016), City of Chicago v. Purdue Pharma L.P., et al., N.D. 

Ill. (No. 1:14 CV 04361). 

21 See, e.g., Letter from Sen. Claire McCaskill to Steven P. Stanos, President, American Academy of Pain Medicine (Oct. 

5, 2017).

22 Purdue also reported $91,449 in payments to entities with incomplete names like “American Academy of Pain” and 

“American Society of.” Production from Purdue Pharma to the Senate Homeland Security and Governmental Affairs 

Committee (Nov. 13, 2017)

23 Payments from Janssen include payments from Johnson & Johnson Health Care Systems, Inc. Letter from Daniel F. 

Donovan, Counsel for Janssen, to Sen. Claire McCaskill (Nov. 10, 2017).

24 Insys was unable to account for $12,500 in payments to the Academy of Integrative Pain Management for expenses 

related to the organization’s 2014 and 2015 annual meetings. Brian D. Smith, Counsel for Insys Therapeutics, Briefing 

with Senate Committee on Homeland Security and Governmental Affairs Minority Staff (Nov. 28, 2017)

25 Payments from Purdue to the American Cancer Society Cancer Action Network include payments to the American 

Cancer Society that could potentially have applied to the Cancer Action Network. Production from Purdue Pharma 

to the Senate Homeland Security and Governmental Affairs Committee (Nov. 13, 2017)

26 The American Geriatrics Society reported that Purdue also provided $40,000 in “corporate roundtable dues” to its 

AGS Health in Aging Foundation, a 501(c)(3) organization affiliated with the group, between 2012 and 2015. Letter 

from Nancy E. Lundebjerg, Chief Executive Office, American Geriatrics Society, to Sen. Claire McCaskill (Oct. 11, 

2017).

27 Payments from Janssen to the American Society of Pain Management Nursing include two payments to Rockpointe 

Corporation for an educational grant with signatories including the American Society of Pain Management Nursing. 

Production from Johnson & Johnson to the Senate Homeland Security and Governmental Affairs Committee (Nov. 

10, 2017)

28 This total includes $4,500 in reported payments from Depomed to the “American Society of Pain Management 

Nurses.” Production from Depomed to the Senate Homeland Security and Governmental Affairs Committee (Apr. 25, 

2017)

29 The National Pain Foundation changed its name to the Global Pain Initiative in mid-2017. Email from Dr. Daniel 

Bennett, Chairman, Board of Directors, Global Pain Initiative, to Committee on Homeland Security and 

Governmental Affairs Minority Staff (Jan. 10, 2018). According to Dr. Bennett, the Global Pain Initiative board 

decided in the fourth quarter of 2016 not to accept contributions from pharmaceutical or device manufacturers. 

This decision “permits an academic ‘hands off’ approach, which is crucial to [the Global Pain Initiative’s] public 

credibility and mission.” Id. 

30 An additional payment from Insys to the U.S. Pain Foundation of $250,000—on April 7, 2017—fell outside the scope of 

the March 28, 2017, requests and is not included in this total. 

31 Letter from Jonathan C. Su, Counsel for Mylan, to Sen. Claire McCaskill (Sept. 15, 2017).

32 Fentanyl Billionaire Comes Under Fire as Death Toll Mounts From Prescription Opioids, Wall Street Journal (Nov. 22, 

2016) (www.wsj.com/articles/fentanyl-billionaire-comes-under-fire-as-death-toll-mounts-from-prescription-opioids1479830968); An Opioid Spray Showered Billionaire John Kapoor in Riches. Now He’s Feeling the Pain, Forbes (Oct. 4, 

2016) (www.forbes.com/sites/matthewherper/2016/10/04/death-kickbacks-and-a-billionaire-the-story-of-adangerous-opioid/).

33 Janssen Pharmaceuticals, Inc.: Janssen Pharmaceuticals, Inc. Completes Divestiture of U.S. License Rights to 

NUCYNTA® (tapentadol), NUCYNTA® ER (tapentadol) extended-release tablets and NUCYNTA® (tapentadol) Oral 

Solution to Depomed, Inc. (Apr. 2, 2015); DepoMed to Buy U.S. Rights to Nucynta From J&J Unit, Wall Street Journal 

(Jan. 16, 2015) (www.wsj.com/articles/depomed-to-buy-u-s-rights-to-nucynta-from-j-j-unit-1421357503).

34 Mylan N.V.: Mylan Launches First and Only Available Intermediate Dosage Strengths of Fentanyl Transdermal System 

37.5, 62.5 and 87.5 mcg/hr (March 11, 2015).

35 Letter from Jonathan C. Su, Counsel for Mylan, to Sen. Claire McCaskill (Sept. 15, 2017).
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36 Although Janssen representatives confirmed the company made a $60,000 payment to the American Pain Society 

and $75,975 in payments to the American Academy of Pain Medicine via a third party during the 2012-2017 time 

period, it could not provide the exact day and month associated with these payments. See Daniel F. Donovan, 

Counsel for Janssen, Briefing with Senate Committee on Homeland Security and Governmental Affairs Minority Staff 

(Jan. 17, 2018). According to information the minority staff received from Janssen, the American Pain Society, and 

the American Academy of Pain Medicine, all these payments occurred in 2012. See E-mail from Daniel F. Donovan, 

Counsel for Janssen, to Committee on Homeland Security and Governmental Affairs Minority Staff (Jan. 31, 2018); 

Production from the American Pain Society to the Senate Homeland Security and Governmental Affairs Committee 

(Oct. 9, 2017); Production from the American Academy of Pain Medicine (Oct. 16, 2017). Janssen representatives 

later reported an additional $8,500 payment to the American Pain Society and an additional $500 payment to the 

American Academy of Pain Medicine—both via a third party in 2012. Email from Daniel F. Donovan, Counsel for 

Janssen, to Committee on Homeland Security and Governmental Affairs Minority Staff (Jan. 31, 2018).

37 Financial Accounting Standards Board, Not-for-Profit Entities (Topic 958) (Aug. 2016) 

(asc.fasb.org/imageRoot/56/92564756.pdf).

38 Purdue Pharma L.P., Grants and Giving Frequently Asked Questions (July 11, 2014).

39 Id.

40 Data on contributions and grants are taken from line 8 of Form 990 for each group. The American Pain Foundation 

ended its operations in 2012.

41 These totals consist of payments in the Open Payments database from the five opioid manufacturers at issue to 

physician board members, advisory board members, advisory council members, staff members, and officers and 

executives of the advocacy groups listed. The totals only include payments from manufacturers to physicians since 

August 2013, when the first reporting period for the CMS Open Payments database began. See Centers for 

Medicare and Medicaid Services, How Open Payments Works (Sept. 2, 2015) (www.cms.gov/OpenPayments/ 

About/How-Open-Payments-Works.html). The listed payments from manufacturers to the groups occurred between 

January 2012 and March 2017. 

42 Centers for Medicare and Medicaid Services, Steven Stanos, Open Payments Data, 

(openpaymentsdata.cms.gov/physician/138667/summary) (accessed Dec. 22, 2017). See also American Academy 

of Pain Medicine, AAPM Fact Sheet (www.painmed.org/files/aapm-fact-sheet.pdf) (accessed Dec. 22, 2017).

43 Centers for Medicare and Medicaid Services, Steven Stanos, Open Payments Data 

(openpaymentsdata.cms.gov/physician/138667/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Jianguo Cheng, Open Payments Data 

(openpaymentsdata.cms.gov/physician/163794/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Ajay Wasan, Open Payments Data (openpaymentsdata.cms.gov/physician/1272772/summary) 

(accessed Dec. 22, 2017); Centers for Medicare and Medicaid Services, Daniel B. Carr, Open Payments Data 

(openpaymentsdata.cms.gov/physician/202832/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Robert Hurley, Open Payments Data (openpaymentsdata.cms.gov/physician/299398/summary) 

(accessed Dec. 22, 2017); Centers for Medicare and Medicaid Services, Robert Wailes, Open Payments Data 

(openpaymentsdata.cms.gov/physician/233305/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Chester Church Buckenmaier III, Open Payments Data 

(openpaymentsdata.cms.gov/physician/1035447/summary) (accessed Dec. 22, 2017). See also American Academy 

of Pain Medicine, AAPM Fact Sheet (www.painmed.org/files/aapm-fact-sheet.pdf) (accessed Dec. 22, 2017). 

44 Id.

45 Centers for Medicare and Medicaid Services, Charles Argoff, Open Payments Data 

(openpaymentsdata.cms.gov/physician/93628/summary) (accessed Dec. 22, 2017). See also American Academy 

of Pain Medicine Foundation, AAPM Foundation Leadership (aapmfoundation.org/leadership) (accessed Dec. 22, 

2017).

46 Centers for Medicare and Medicaid Services, Daniel B. Carr, Open Payments Data, 

(openpaymentsdata.cms.gov/physician/202832/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Edward C. Covington, Open Payments Data, 

(openpaymentsdata.cms.gov/physician/1008604/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Steven Feinberg, Open Payments Data, 

(openpaymentsdata.cms.gov/physician/308924/payment-information) (accessed Dec. 22, 2017); Centers for 

Medicare and Medicaid Services, Gary W. Jay, Open Payments Data 

(openpaymentsdata.cms.gov/physician/1134064/payment-information) (accessed Dec. 22, 2017); Centers for 

Medicare and Medicaid Services, John D. Loeser, Open Payments Data 

(openpaymentsdata.cms.gov/physician/555855/payment-information) (accessed Dec. 22, 2017); Centers for 

Medicare and Medicaid Services, Sean Mackey, Open Payments Data 

(openpaymentsdata.cms.gov/physician/406055/summary) (accessed Dec. 22, 2017); Centers for Medicare and 

Medicaid Services, Srinivasa Raja, Open Payments Data (openpaymentsdata.cms.gov/physician/72208/paymentinformation) (accessed Dec. 22, 2017); Centers for Medicare and Medicaid Services, Steven Stanos, Open Payments 

Data (openpaymentsdata.cms.gov/physician/138667/summary) (accessed Dec. 22, 2017); Centers for Medicare 

and Medicaid Services, Knox Todd, Open Payments Data 

(openpaymentsdata.cms.gov/physician/1052955/payment-information) (accessed Dec. 22, 2017); Centers for 

Medicare and Medicaid Services, Debra Weiner, Open Payments Data
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(openpaymentsdata.cms.gov/physician/591428/payment-information) (accessed Dec. 22, 2017). See also 

American Chronic Pain Association, Advisory Board (theacpa.org/Advisory-Board) (accessed Dec. 22, 2017).

47 Global Pain Initiative, Board of Directors (www.globalpaininitiative.org/board-of-directors/) (accessed Jan. 2, 2018).

48 Centers for Medicare and Medicaid Services, Daniel S. Bennett, Open Payments Data 

(openpaymentsdata.cms.gov/physician/329225/summary) (accessed Jan. 2, 2018). See also Global Pain Initiative, 

Board of Directors (globalpaininitiative.org/board-of-directors/) (accessed Jan. 2, 2018). 

49 Centers for Medicare and Medicaid Services, Daniel S. Bennett, Open Payments Data 

(openpaymentsdata.cms.gov/physician/329225/summary) (accessed Jan. 2, 2018); Centers for Medicare and 

Medicaid Services, Dmitry M. Arbuck, Open Payments Data 

(openpaymentsdata.cms.gov/physician/213597/summary) (accessed Jan. 2, 2018); Centers for Medicare and 

Medicaid Services, Joseph V. Pergolizzi, Jr., Open Payments Data 

(openpaymentsdata.cms.gov/physician/223423/summary) (accessed Jan. 2, 2018). See also Global Pain Initiative, 

Board of Directors (globalpaininitiative.org/board-of-directors/) (accessed Jan. 2, 2018). 

50 Global Pain Initiative, Clinical and Scientific Advisory Council (www.globalpaininitiative.org/clinical-scientificcouncil/) (accessed Oct. 3, 2017).

51 Centers for Medicare and Medicaid Services, Kenny Chantasi, Open Payments Data 

(openpaymentsdata.cms.gov/physician/64321/summary) (accessed Jan. 2, 2018); Centers for Medicare and 

Medicaid Services, Leonard A. Farber, Open Payments Data (openpaymentsdata 

.cms.gov/physician/300520/summary) (accessed Jan. 2, 2018); Centers for Medicare and Medicaid Services, Perry 

G. Fine, Open Payments Data (openpaymentsdata.cms.gov/ physician/672854/summary) (accessed Jan. 2, 2018); 

Centers for Medicare and Medicaid Services, Joseph Pergolizzi, Jr., Open Payments Data 

(openpaymentsdata.cms.gov/ physician/223423/summary) (accessed Jan. 2, 2018); Centers for Medicare and 

Medicaid Services, Steven M. Simon, Open Payments Data (openpaymentsdata.cms.gov/physician/ 

386520/summary) (accessed Jan. 2, 2018); Centers for Medicare and Medicaid Services, Lisa Jo Stearns, Open 

Payments Data (openpaymentsdata.cms.gov/physician/41530/summary) (accessed Jan. 2, 2018); Centers for 

Medicare and Medicaid Services, Andrea Trescot, Open Payments Data 

(openpaymentsdata.cms.gov/physician/231857/summary) (accessed Jan. 2, 2018); Centers for Medicare and 

Medicaid Services, Lynn R. Webster, Open Payments Data 

(openpaymentsdata.cms.gov/physician/1136720/summary) (accessed Jan. 2, 2018). See also Global Pain Initiative, 

Clinical and Scientific Advisory Council (globalpaininitiative.org/clinical-scientific-council/) (accessed Jan. 2, 2018). 

52 As with the previous figure, these totals only include payments to group-affiliated physicians since August 2013. 

53 See 26 U.S.C. § 6104(d)(3)(A).

54 Washington Legal Foundation, 2016 Annual Report (2016) (www.wlf.org/pdf/ WLF2016AnnualReport.pdf).

55 American Geriatrics Society Health in Aging Foundation, Guidelines for Corporate Relationships 

(www.healthinagingfoundation.org/support-us/become-a-corporate-partner/guidelines-for-corporaterelationships/) (accessed Oct. 18, 2017); American Geriatrics Society Health in Aging Foundation, Meet Our Partners 

(www.healthinagingfoundation.org/ support-us/become-a-corporate-partner/meet-our-partners/) (accessed Jan. 

2, 2018).

56 U.S. Pain Foundation, Transparency (www.uspainfoundation.org/transparency/) (accessed Oct. 18, 2017).

57 American Chronic Pain Association, Partners & Contributors (www.theacpa.org/ Partners-Contributors) (accessed 

Oct. 18, 2017).

58 American Cancer Society Cancer Action Network, Our Partners (www.cancer.org/our-partners.html) (accessed Oct. 

18, 2017); Center for Practical Bioethics, Community Supporters (www.practicalbioethics.org/support-ourmission/community-supporters.html) (accessed Oct. 18, 2017). The website for the Center for Practical Bioethics also 

provides a link to the organization’s annual audits and Form 990 filings, which list total amounts of contributions and 

grants per year. See Ways to Help, Center for Practical Bioethics (www.practicalbioethics.org/support-our

mission/ways-to-help.html) (accessed Feb. 13, 2018).

59 American Academy of Pain Medicine Foundation, AAPM Foundation Donors (www.aapmfoundation.org/donors) 

(accessed Oct. 18, 2017).

60 American Pain Society, Corporate Council Members (www.americanpainsociety.org/ get-involved/corporatecouncil/overview) (accessed Oct. 18, 2017).

61 Id.

62 American Society for Pain Management Nursing, Corporate Membership 

(www.aspmn.org/Pages/corporatemembership.aspx) (accessed Oct. 18, 2017); American Society for Pain 

Management Nursing, ASPMN Corporate Membership Categories (www.aspmn.org/ 

Documents/Membership/Corporate%20membership%20information_17.pdf) (accessed Jan. 2, 2018).

63 Third Amended Complaint (Oct. 25, 2016), City of Chicago v. Purdue Pharma L.P., et al., N.D. Ill. (No. 1:14 CV 04361).

64 Id. 

65 Id.

66 Chronic Pain Guidelines Suggest Opioids, New York Times (May 12, 2009) 

(query.nytimes.com/gst/fullpage.html?res=9806E0D71E3AF931A25756C0A96F9C8B63).

67 Id.; see also Pharmacological Management of Persistent Pain in Older Persons: American Geriatrics Society Panel on 

the Pharmacological Management of Persistent Pain in Older Persons, Journal of the American Geriatrics Society 

(Aug. 2009).
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68 Third Amended Complaint (Oct. 25, 2016), City of Chicago v. Purdue Pharma L.P., et al., N.D. Ill. (No. 1:14 CV 04361).

69 Id.

70 Politics of Pain: Drugmakers Fought State Opioid Limits Amid Crisis, The Center for Public Integrity (Dec. 15, 2016) 

(www.publicintegrity.org/2016/09/18/20200/politics-pain-drugmakers-fought-state-opioid-limits-amid-crisis). 

71 Id.

72 Industry Uses 50-State Strategy to Weaken Drug Laws, The Journal (Sept. 22, 2016) (the-journal.com/articles/1047-

industry-uses-50-state-strategy-to-weaken-drug-laws).

73 U.S. Pain Foundation, Annual Report (www.uspainfoundation.org/about-us/annual-report/) (accessed Oct. 3, 2017).

74 Department of Health and Human Services, Centers for Disease Control and Prevention, CDC Guideline for 

Prescribing Opioids for Chronic Pain – United States, 2016 (Mar. 15, 2016) 

(www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1er.pdf). See also Deborah Dowell et al., CDC Guideline for 

Prescribing Opioids for Chronic Pain—United States, 2016, JAMA Internal Medicine (Apr. 19, 2016).

75 C.D.C. Painkiller Guidelines Aim to Reduce Addiction Risk, New York Times (Mar. 15, 2016) 

(www.nytimes.com/2016/03/16/health/cdc-opioid-guidelines.html).

76 Department of Health and Human Services, Centers for Disease Control and Prevention, CDC Guideline for 

Prescribing Opioids for Chronic Pain – United States, 2016 (Mar. 15, 2016) 

(www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1er.pdf).

77 Id.

78 Id.

79 C.D.C. Painkiller Guidelines Aim to Reduce Addiction Risk, New York Times (Mar. 15, 2016) 

(www.nytimes.com/2016/03/16/health/cdc-opioid-guidelines.html).

80 Opioid Epidemic: Ex-DEA Official Says Congress is Protecting Drug Makers, Guardian (Oct. 31, 2016) 

(www.theguardian.com/us-news/2016/oct/31/opioid-epidemic-dea-official-congress-big-pharma).

81 Practical Pain Management, Responses and Criticisms Over New CDC Opioid Prescribing Guidelines 

(www.practicalpainmanagement.com/resources/news-and-research/responses-criticisms-over-new-cdc-opioidprescribing-guidelines) (accessed Sept. 28, 2017).

82 Chronic Pain Groups Blast CDC for Opioid Guidelines, Pain News Network (Sept. 22, 2015) 

(www.painnewsnetwork.org/stories/2015/9/22/chronic-pain-groups-blast-cdc-for-opioid-guidelines).

83 Pro-Painkiller Echo Chamber Shaped Policy Amid Drug Epidemic, The Center for Public Integrity (Sept. 19, 2016) 

(www.publicintegrity.org/2016/09/19/20201/pro-painkiller-echo-chamber-shaped-policy-amid-drug-epidemic).

84 Washington Legal Foundation, Re: Guideline for Prescribing Opioids for Chronic Pain (Nov. 17, 2015) 

(www.wlf.org/upload/litigation/misc/CDCComments-Opioids.pdf). In addition to its work related to the 

pharmaceutical industry, the Washington Legal Foundation has also recently challenged the validity of Consumer 

Financial Protection Bureau enforcement actions, raised objections to certain Department of Labor disclosure 

requirements, and sought to enjoin the enforcement of a local ordinance requiring health warnings in 

advertisements for sugary drinks, among other initiatives. See Washington Legal Foundation, 2016 Annual Report

(2016) (www.wlf.org/pdf/WLF2016AnnualReport.pdf). WLF previously maintained a relationship with the Philip Morris 

tobacco company during regulatory disputes with the Food and Drug Administration throughout the 1990s. See, 

e.g., Letter from Steven C. Parrish, Senior Vice President, Corporate Affairs, Philip Morris, to Daniel J. Popeo, Chairman 

& General Counsel, Washington Legal Foundation (Mar. 21, 1996) (www.industrydocumentslibrary 

.ucsf.edu/tobacco/docs/#id=zhfw0096); Philip Morris, REM Monthly Report (Apr. 1994) 

(www.industrydocumentslibrary.ucsf.edu/tobacco/docs/#id=fphm0071); Memorandum from BSMG Worldwide to 

Philip Morris, Communications Plan – Supersized (Feb. 25, 1999) 

(www.industrydocumentslibrary.ucsf.edu/tobacco/docs/#id=xmyd0068). 

85 Washington Legal Foundation, Re: Guideline for Prescribing Opioids for Chronic Pain (Nov. 17, 2015) 

(www.wlf.org/upload/litigation/misc/CDCComments-Opioids.pdf).

86 The CDC Just Told American Doctors to Rethink Pain Treatment and Opioid Addiction, Vice (Mar. 17, 2016) 

(news.vice.com/article/the-cdc-just-told-american-doctors-to-rethink-pain-treatment-and-opioid-addiction).

87 Dora H. Lin et al., Financial Conflicts of Interest and the Centers for Disease Control and Prevention’s 2016 Guideline 

for Prescribing Opioids for Chronic Pain, JAMA Internal Medicine (Mar. 2017). 

88 Id. (emphasis added).

89 Id.

90 Dora H. Lin et al., Potential Financial Conflicts of Interest and Federal Opioid Guidelines: A Cross-Sectional Study 

(2017) (manuscript provided to minority staff).

91 Brief for Amici, The American Pain Foundation, The National Pain Foundation and The National Foundation for the 

Treatment of Pain in Support of Appellant and Reversal of the Conviction (Sept. 8, 2005), United States v. William Eliot 

Hurwitz, 4th Cir. (No. 05-4474).

92 Pain Doctor is Guilty of Drug Trafficking, Washington Post (Apr. 28, 2007) (www.washingtonpost.com/wpdyn/content/article/2007/04/27/AR2007042702204.html).

93 Id.

94 Brief for Amici, The American Pain Foundation, The National Pain Foundation, and The National Foundation for the 

Treatment of Pain in Support of Appellant and Reversal of the Conviction (Sept. 8 2005), United States v. William Eliot 

Hurwitz, 4th Cir. (No. 05-4474).
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95 Brief of Washington Legal Foundation as Amicus Curiae in Support of Appellants Urging Reversal (June 29, 2011), 

Friedman v. Sebelius, D.C. Cir. (No. 11-5028); Friedman v. Sebelius, 686 F.3d 813 (D.C. Cir. July 27, 2012)

96 Brief of Washington Legal Foundation as Amicus Curiae in Support of Appellants Urging Reversal (June 29, 2011), 

Friedman v. Sebelius, D.C. Cir. (No. 11-5028).

97 Politics of Pain: Drugmakers Fought State Opioid Limits Amid Crisis, The Center for Public Integrity (Dec. 15, 2016) 

(www.publicintegrity.org/2016/09/18/20200/politics-pain-drugmakers-fought-state-opioid-limits-amid-crisis).

98 See Dr. Gery P. Guy Jr. et al., Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015, CDC 

Morbidity and Mortality Weekly Report (July 7, 2017) (www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm).

99 See, e.g., Letter from Sen. Claire McCaskill to Santosh Vetticaden, Interim Chief Executive Officer of Insys 

Therapeutics, Inc. (Mar. 28, 2017). 

100 Production from Depomed to the Senate Homeland Security and Governmental Affairs Committee (Apr. 25, 2017); 

Production from Purdue Pharma to the Senate Homeland Security and Governmental Affairs Committee (May 11, 

2017); Production from Johnson & Johnson to the Senate Homeland Security and Governmental Affairs Committee 

(June 12, 2017). 

101 Production from Mylan to the Senate Homeland Security and Governmental Affairs Committee (Oct. 5, 2017).

102 See, e.g., Letter from Sen. Claire McCaskill to Steven P. Stanos, President, American Academy of Pain Medicine 

(Oct. 5, 2017).

103 See Production from Johnson & Johnson to the Senate Homeland Security and Governmental Affairs Committee 

(June 12, 2017); Production from Johnson & Johnson to the Senate Homeland Security and Governmental Affairs 

Committee (Nov. 10, 2017). 

104 See Production from Purdue Pharma to the Senate Homeland Security and Governmental Affairs Committee (May 

11, 2017); Production from Purdue Pharma to the Senate Homeland Security and Governmental Affairs Committee 

(Nov. 13, 2017).

105 Id. As stated above, the total for the American Cancer Society Cancer Action Network also included payments 

from Purdue to the American Cancer Society that could potentially apply to the Cancer Action Network.

106 Production from Purdue Pharma to the Senate Homeland Security and Governmental Affairs Committee (Nov. 13, 

2017).

107 See Letter from Paul Gileno, U.S. Pain Foundation, to Sen. Claire McCaskill (Oct. 5, 2017); Letter from Brian D. Smith, 

Counsel for Insys Therapeutics, to Sen. Claire McCaskill (Nov. 10, 2017). As stated above, one payment between Insys 

and the U.S. Pain Foundation related to this program—a $250,000 payment on April 7, 2017—fell outside of the scope 

of the March 28, 2017, requests and is not included in this total. See E-mail from Brian D. Smith, Counsel for Insys 

Therapeutics, to Senate Committee on Homeland Security and Governmental Affairs Minority Staff (Dec. 1, 2017). 

108 See Production from the Academy of Integrative Pain Management to the Senate Homeland Security and 

Governmental Affairs Committee (Oct. 31, 2017); Brian D. Smith, Counsel for Insys Therapeutics, Briefing with Senate 

Committee on Homeland Security and Governmental Affairs Minority Staff (Nov. 28, 2017). 

109 Email from Brian D. Smith, Counsel for Insys Therapeutics, to Committee on Homeland Security and Governmental 

Affairs Minority Staff (Dec. 1, 2017).

110 Letter from Nancy E. Lundebjerg, American Geriatrics Society, to Sen. Claire McCaskill (Oct. 11, 2017). According to 

counsel for Purdue, the company could verify three out of four payments to the American Geriatrics Society Health 

in Aging Foundation. Reginald J. Brown, Counsel for Purdue Pharma, Briefing with Senate Committee on Homeland 

Security and Governmental Affairs Minority Staff (Nov. 29, 2017). 

111 Email from Catherine A. Byrd, to Committee on Homeland Security and Governmental Affairs Minority Staff (Dec. 1, 

2017); Letter from J. Evans Rice, Counsel for Depomed, to Sen. Claire McCaskill (Dec. 5, 2017).

112 Id.

113 Daniel F. Donovan, Counsel for Janssen, Briefing with Senate Committee on Homeland Security and Governmental 

Affairs Minority Staff (Dec. 11, 2017); Daniel F. Donovan, Counsel for Janssen, Briefing with Senate Committee on 

Homeland Security and Governmental Affairs Minority Staff (Jan. 17, 2018); Email from Daniel F. Donovan, Counsel for 

Janssen, to Committee on Homeland Security and Governmental Affairs Minority Staff (Jan. 31, 2018). 

114 Sheila M. Rothman et al., Health Advocacy Organizations and the Pharmaceutical Industry: An Analysis of Disclosure 

Practices, American Journal of Public Health (Apr. 2011).