Purdue is infamous for its relentless marketing of its powerful long-acting opioid OxyContin. Among its troubling tactics: co-opting legitimate medical organizations to spread messages exaggerating the drug’s effectiveness and downplaying its addiction risks. Sales exploded, making its owners fabulously wealthy and building what journalist Patrick Radden Keefe memorably calls an “empire of pain”.
Purdue’s pursuit of profit has become a model for other drugmakers, distributors and drugstore chains. The ensuing sales frenzy led to skyrocketing rates of opioid addiction and related harms in the early 2000s – perhaps the worst pharmaceutical crisis in US history.
So when Purdue Pharma’s bankruptcy settlement was revised in March 2022 to require the family to pay US$6 billion, mostly to local and state governments, the news was met with at least some satisfaction. While it looks like none of this family will go to jail, the people often seen as the saga’s main villains were at least paying the price for their misdeeds.
But as a historian of addictive pharmaceuticals, I see a danger in associating the opioid crisis too closely with the Sackler family. My research has shown that the crisis is not an aberration caused by the individual misdeeds of bad actors. Punishing people who broke the law and making business owners pay to fix the harm they caused certainly helps. Yet sweeping reforms are also needed to prevent similar disasters from happening again.
Who are the “Sacklers”?
Despite the many people and companies involved, the Sacklers have become the public face of the opioid crisis. This partly acknowledged their status as pioneers: they were the first to market strong opioids in supermarkets, and they led the pack in blaming the resulting disaster on consumers who became addicted to these prescription painkillers.
But who are they? Their story began with Arthur, Mortimer and Raymond Sackler, three brothers who were all doctors and collectively made their fortunes in medical marketing. They acquired what was then called Purdue Frederick Co. in 1952.
After Arthur’s death in 1987, Mortimer and Raymond purchased their brother’s stake in the business from his family for $22 million. For this reason, Arthur Sackler’s heirs are not involved in an opioid-related litigation that is set to be resolved by Purdue’s bankruptcy settlement.
“The Sacklers” I refer to here – and when you read about them elsewhere – are Mortimer and Raymond and their heirs who benefited from Purdue’s profit machine, many of whom worked there, sat on its board of directors – or both.
Richard Sackler ran the company for years and later became a member of the micromanagement board. Her cousin Kathe Sackler, another former Purdue executive, repeatedly claimed OxyContin was her idea, Patrick Radden Keefe reported. It’s impossible to determine exactly how much money they collectively extracted from Purdue, but in 2021 these two branches of the Sackler family held approximately $11 billion in assets.
Pop culture villain
The Sacklers used their profits to protect the family’s reputation through lavish charitable donations to museums like the Guggenheim and the Louvre, and several universities, including Tufts and Yale.
Their philanthropy produced an aura of respectability but also made them highly visible. Eventually, journalists connected the dots, leading to a cottage industry of books and media coverage of the opioid crisis casting the Sacklers as the villains responsible for historic levels of addiction and overdose.
Sacklers’ history as comic book villains is on full display in actor Michael Stuhlbarg’s Emmy-nominated performance as the remarkably creepy Richard Sackler in the Hulu series “Dopesick,” based on Beth Macy’s book. of the same name.
Viewers can likely expect similar fare from Michael Broderick, who will play Richard Sackler in “Painkiller,” an upcoming Netflix limited series about the onset of the opioid crisis.
“White Market Drugs”
As satisfying as it may be, focusing on the misdeeds of the Sacklers can obscure as much as it reveals the root causes of the opioid crisis.
Purdue did not invent the tactic it used to sell OxyContin. Pharmaceutical companies discover and sell truly miraculous products, but they also regularly exert a disturbing influence on every step of the production and circulation of drug knowledge, which can make it difficult to understand a drug’s true value. . They oversee research that demonstrates the effectiveness of drugs. They write or help write research-based publications.
Drug manufacturers write or influence professional guidelines that encourage prescribing. They subscribe to professional organizations and pay medical experts to spread the word. They fund and channel patient advocacy organizations to support the drugs they make.
And then they push for laws, regulations and anything that can increase the demand for their drugs.
Until the Food and Drug Administration approved OxyContin in 1995, these marketing techniques were banned for opioids, which authorities considered too dangerous for them. As I explain in my book, White market drugs, federal regulators, backed by cautious medical authorities, have appointed prominent pharmacologists to test the addictive potency of new opioid products. They scrutinized the advertisements to ensure that the risks were fully and accurately conveyed.
Pharmaceutical companies tried to outsmart regulators with a parade of now-forgotten “miracle opioids” long before OxyContin. Indeed, one of these potential miracle drugs was none other than oxycodone, the main ingredient of OxyContin.
Oxycodone, discovered in 1916, was sold in the United States for most of the 20th century.
In 1949, Endo Products claimed that Percodan, its new oxycodone product, should not be subject to strict federal controls because it was chemically similar to codeine, a relatively weak opioid used in cough syrups. . The company insisted that it was not addictive when used as prescribed.
Expert pharmacologists working with federal regulators have been pushed back. Noting that oxycodone was “intensely” addictive, they pointed out that people don’t always follow doctors’ orders – especially with addictive drugs.
Purdue’s real innovation with OxyContin was commercial, not scientific. The company was the first to bring a powerful opioid to market using the most aggressive strategies that other pharmaceutical companies routinely used to introduce pharmaceutical innovations into bodies with great speed and efficiency – while maximizing profits.
Once Purdue showed it could be done, competitors quickly followed suit. The industry has replaced the age-old habits of American medicine on opioid precautions with reckless speeding.
Complicity of many industries
Purdue, that is, did not act alone. Other drugmakers like Endo and Janssen emulated and even surpassed Purdue’s example once the taboo was broken.
Generic manufacturers such as Allergan and Teva then benefited from the expansion and prolongation of the boom, as did wholesale drug distributors and retail drugstore chains. Even the prestigious consulting firm McKinsey has entered the game, advising others on how to maximize sales.
The complicity of so many industries makes opioid litigation complex and difficult to track. Cities, states and other plaintiffs have not just sued Purdue. They have turned to the legal system to make sure all other companies pay to right the harm they caused in building the historic opioid boom that has contributed to more than 500,000 overdose deaths since 1996.
The largest national opioid settlement to date involves the three major opioid distributors and Johnson & Johnson, makers of Duragesic and Nucynta opioids. It totals $26 billion, far more than Purdue and the Sacklers are paying.
But financial regulations cannot solve all the problems that made this crisis possible. Purdue and its competitors have been able to put profits ahead of consumer safety for so long, in part because their marketing strategies closely parallel how other drugs are sold in the United States.
The opioid crisis, in other words, has overstated the problems prevalent in the pharmaceutical industry in general. Until these larger issues are resolved, the unfortunate history of addictive prescription drugs will continue to repeat itself.