The Sacklers: Rich People Problems and a Possible Solution

Heroin Spoon sculpture left outside Purdue Pharma

 

 

The Sackler family is having rich- people problems. No, let me correct that: they are having ultra-rich -people problems. They can’t find museums to accept their financial donations.

This family made its fortune, estimated into the billions, by making and promoting sales of OxyContin, the drug that started the opioid epidemic in North American.

I know some readers will quibble about that statement and tell me there are other reasons for our opioid epidemic. I know there were other factors: an FDA that was perhaps too cozy with drug companies, a nationwide push to do a better job of treating pain, so-called pain experts who used shaky data to support their safety claims for long-term opioid prescribing, and few prescription monitoring programs that could identify patients who were developing opioid use disorders by doctor-shopping. These were factors. But the opioid firepower in OxyContin tablets, easily available by removing a coating, fueled our opioid epidemic for more than ten years.

In April 2019, the New York Times ran an article about the Sackler family, their wealth, and their legal problems. [1]

Purdue Pharma, the drug company owned by the Sacklers, has been sued by various entities claiming OxyContin caused harm. As I’ve written about in previous blog posts, Virginia won a $600 million award against the drug company and its three top executives in 2007, after the company and executives pled guilty to criminal charges of misbranding. It’s a big verdict, but perhaps not so big, given the wealth of the Sackler family, estimated by Forbes to be about $13 billion.

In the past, the Sackler family distanced itself from the problems of their pharmaceutical company. Now, individual family members are being sued for their part in pushing OxyContin inappropriately. New York, Massachusetts, Utah, Connecticut and Rhode Island have all filed suits against members of the Sackler family. The New York Times says more than 500 cities, counties, and tribes have coalesced to sue members of the Sackler family.

These agencies claim some of the Sacklers are more involved in sales decisions that they would like the courts to believe. For example, according to the NYT, two years after the Virginia guilty plea, Mortimer Sackler, who was on Purdue Pharma’s board, wrote a memo inquiring why Purdue’s sales force wasn’t selling more opioids.

Either this man either didn’t understand his company’s guilty plea two years earlier, which is unlikely, given all he’s achieved in life, or he didn’t care. He wanted to make more money, at any cost.

The family, well-known for their philanthropy, has made big donations to various cultural and educational institutions. They’ve donated large sums to the Metropolitan Museum of Art, where they financed an entire wing: The Temple of Dendur. They’ve donated to the Louvre in Paris, the Guggenheim, and to colleges and universities.

Earlier this year, activists targeted several of these locations as protest sites, and asked museums to refuse money from the Sacklers, tainted as it is by association with the opioid epidemic. In February, protesters at the Guggenheim dropped paper slips made to resemble prescriptions from upper floors of that museum to protest acceptance of the Sackler’s money. Protesters also staged a “die-in” to represent the lives lost to opioid use disorder, and the Sackler family’s role in those deaths.

Last year, sculptor Domenic Esposito placed an 800-lb sculpture of a bent spoon containing heroin outside Purdue Pharma’s headquarters in Stamford, Connecticut, to protest the Sackler’s role in the opioid epidemic. The spoon was confiscated by police and eventually returned to its creator.

Because of the political pressure from protesters, this summer, the Metropolitan Museum of Art decided not to accept further money from the Sackler family, as did the Guggenheim and the National Portrait Gallery in London.

Thus the ultra-rich problem of having no outlet to make charitable contributions.

The Sacklers defend their actions in manufacturing and promoting sales of OxyContin, saying they were mislead like everyone else into thinking that prescription opioid pain pills, when prescribed for pain, put patients at very low risk for developing opioid use disorder. They say they were taken in with the bad science of the age like other health agencies, and that it’s not fair to blame them for the opioid epidemic.

I find the Sackler’s proclamations of ignorance to be implausible, for several reasons. I can remember attending a course called “Pain and Addiction: Common Threads,” around 2004. At that course, a physician associated with Purdue Pharma chided physicians in the meeting who were trying to tell the presenters about how easy it was to inject or snort OxyContin. My memory may be inaccurate, but I know those meetings were recorded. I think I once possessed cassette tapes of a 2003 meeting, made by a company working for the American Society of Addiction Medicine. I surely wish I hadn’t discarded these old tapes; it would make for some interesting listening, given all that has happened since.

In Barry Meier’s prescient book, “Pain Killer,” he described how small-town physician Dr. Art Van Zee tried very hard to tell Purdue Pharma representatives about the devastation he was seeing and treating in opioid-addicted patients. Meier’s book was published in 2005, so Dr. Van Zee’s efforts had to be taking place around 2003.

In 2003, a Purdue Pharma representative testified before Congress that the company knew people were misusing their medication, and that they were re-formulating their medication to make it more abuse-resistant. But Purdue Pharma didn’t make that change until 2010, seven years of profit later.

Richard Sackler, once Purdue Pharma’s CEO, called people who misused OxyContin “scum of the earth,” “criminals,” and “victimizers,” in an article in the New York Daily News published in May of this year. Sackler has since said he made those uninformed statements decades ago, and that he understands more about opioid use disorder now and recognizes his lack of sensitivity to people suffering with opioid use disorder. [2]

This evidence indicates Purdue Pharma knew about the problem of misuse. The Sackler’s claim they had no knowledge of the death and destruction associated with their medication just isn’t credible. If the Sackler family didn’t know about the destruction their medication was causing, they’d have to be stupid or living under a rock. You don’t get to be billionaires by being stupid.

However, the Sacklers may be politically tone-deaf. In one of the biggest shows of chutzpah in the world, Purdue Pharma at one point considered getting into the opioid use disorder treatment market by manufacturing buprenorphine products to sell.

Yes, that’s right. In a full circle of greed, Richard Sackler got a patent in 2018 for a new form of buprenorphine in a wafer form. Since it dissolves in only a few seconds, it claims an advantage over tablet and film forms of the product now on the market.

This incredible development leads to the point of this blog: I have a solution for the unfortunate Sacklers, who have a bunch of money they want to give away but can’t. They say they want to help fix this opioid epidemic, and they now have a patented form of the product.

I say let the Sacklers, through Purdue Pharma, manufacture buprenorphine for the treatment of opioid use disorder and provide it free of charge to any patient who needs treatment. All the patient would have to do is see a physician, who prescribes Purdue’s buprenorphine product. The patient takes this prescription to any pharmacy to receive free treatment medication. Purdue could pay the small pharmacy fee for stocking and dispensing the medication. More patients could access treatment this way.

Everyone wins with my idea. The Sacklers get to give away money in a method that provides direct amends to the very patients they have harmed. Physicians no longer have to agonize over which form of buprenorphine to prescribe so that the patient can afford it. Patients get treatment that saves lives.

My idea has the advantage of removing middle-men. If Purdue Pharma and/or the Sackler family are found guilty in future lawsuits, they could pay their fine in the form of free treatment medication. This method avoids pitfalls with money gathered from civil fines that must be filtered through layers of government. Sometimes such money gets spent well, and sometimes not. With my method, it all goes to benefit the patients.

I love my idea, both for its practicality and for its poetic justice.

What do you think?

 

  1. https://www.nytimes.com/2019/04/01/health/sacklers-oxycontin-lawsuits.html
  2. http://www.nydailynews.com/news/national/ny-news-richard-sackler-opioid-addicts-scum-criminals-emails-20190507-ujfmvpphqjc77icemxafbjhlai-story.html
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18 responses to this post.

  1. Posted by Alan Wartenberg MD on June 23, 2019 at 10:39 pm

    I make no excuses for the many pharmaceutical companies who profited from these drugs while downplaying, ignoring and denying the risks associated with putting a large amount of opioid in a form devoid of acetaminophen (which limits use of large doses of those meds) and capable of being crushed, snorted and injection. However, physicians have their own share of the responsibility. I and many other addiction physicians in Boston were cautioning our colleagues about not taking adequate histories of risk factors in patients, escalating doses recklessly, and not recognizing the addiction in front of their eyes. Drug representatives have always tried to oversell their product, and it is the responsibility of physicians to keep themselves well-informed on the science. There is more than enough blames to go around.

    Reply

  2. Posted by Mary Anne Hughes on June 23, 2019 at 11:23 pm

    Just finished reading “Dopesick; Dealers, Doctors and The Drug Company That Addicted America” by Beth Macy, which talks about the perfect storm which helped to create the epidemic which remained hidden in plain site, for so many years. Agree, more than enough blame to go around and also agree with idea that Purdue pay for free treatment. Now THAT would be poetic justice and really bring the circle around! Thanks, Jana, for another great column. And as far as I am concerned, Dr. Art Van Zee and Sister Beth Davies are modern day saints.

    Reply

  3. Posted by Kayce Godar on June 23, 2019 at 11:37 pm

    Sounds great to me! I would like to see them produce methadone as well. I dont understand how or why cities and states are winning millions?! Does that give me the right as a recovering addict to sue big pharma? Can i do the same these states are doing? Maybe im not understanding because i dont feel its right unless im able to do the same thing.

    Reply

  4. I appreciate this post, as a physician I heard the sales pitch and grateful that I never bought it, I know they knew there was a big problem with this medication in 2000. In 2008, my son notes he was using OxyContin..he died in 2017.. I know they had many years to get this drug off the market but, they choose to make money and profit from our children

    Reply

  5. Posted by william taylor MD on June 24, 2019 at 1:59 am

    Dr. Burson, you must work in the private sector. The whole point of civil fines is that they are filtered through layers of government, and the attorneys thereof. The Sacklers have it coming, but I’m unnerved by going after Teva, Mallinckrodt, and other makers of low priced generics. They will just raise prices, effectively turning the process into a tax on the sick, in order to fill government coffers.

    Reply

  6. Posted by Sparky on June 24, 2019 at 6:18 am

    OxyContin is and has been a godsend for certain pain patients and it has a place in medical society,it has helped thousands of people,now If people are gonna snort it up their nose or use a needle to stick it in a vein that is the patients fault for not following the drs prescribing,you can’t hold a dr or the maker of the drug accountable for what a patient does

    Reply

  7. Posted by Lisa on June 24, 2019 at 12:59 pm

    I am an MSW working at a Methadone clinic in FL. I have seen first hand the heartbreak and fear in patients that have to leave treatment due to inability to pay. I believe making the pharmaceutical companies accountable to the population they have effectively destroyed through addiction is most appropriate. In response to the comment about the choices people make to abuse prescribed medication….for the most part patients do not start out addicted. In Florida when doctors refuse to continue prescribing opiates to patients they moved on to the pill mills. Then Florida shut those down, leaving many addicted patients with the only the option of engaging in the extremely high risk behavior of buying off the street. As professionals dealing with the aftermath it is our responsibility to make every attempt to remove the stigma attached to treatment and addiction.

    Reply

    • Posted by Charlene Jordan on October 3, 2019 at 6:03 pm

      I live in Florida to,..there we’re pain management doctors on every corner..I went on to choose buprenorphine treatment and I agree that somehow the state should work out a way to help those patients who have addiction problems..money wise it’s expensive for treatment and the medacine..I’m lucky to have disability benefits with insurance. At first in 2005 I didn’t..except the doctor visit was $40. The medacine was $575 a month..back then the prescribed dose was 8mg x4 daily…and I did that for many years. The price has dropped down a lot since then..now anyone who needs treatment should not be turned down because of Money…my problem is my husband was working and now retired..but because I’m married we were always on the lines of help, but by a few extra dollars we didn’t qualify for any type of help..just a few dollars different. We are always just right in the middle of either getting something or not..now I believe it should be..I could not imagine being the one who could not get my methadone or the buprenorphine treatment…if I added all mine up since 2005 the money we put out..it would of been cheaper doing drugs..which is not what I like just sayin

      Reply

  8. Posted by J. Dishman on June 24, 2019 at 11:54 pm

    I love your idea Dr. Burson. However, I am afraid Purdue would provide a low quality form of buprenorphine in such a scheme. I know there are testing methods to ensure drug potency and quality but I also know companies like Purdue can skirt their way around any regulation or standard they so desire. In theory, I applaud your idea and I think it would require constant oversight from a third party. Relatedly, I have witnessed the potency of some drug products for methadone maintenance seemingly decrease in potency and I don’t see this issue being addressed by the industry or FDA. Thanks for your thoughtful writing, Dr. Burson. You are one of the best advocates we have.

    Reply

    • Thanks for reading. Supposedly the FDA sets the limits for how much variation manufacturers can have in their pharmaceutical products.

      Reply

    • Posted by Charlene Jordan on October 3, 2019 at 5:47 pm

      Purdue has a buprenorphine product distribution Rhodes..8.64mg bup, equivalent to 8mg, and the..2.16mg bup equivalent to 2mg..I have been on buprenorphine treatments 8mg since 2005, we only have 6 genetics to choose from and almost everyone agrees Rhodes is #2, following is hikma brand..in the Rhodes product of the 8mg the inactive ingredients are so very close to original subtext brand when it first came out..so the company was very clever to make a great generic trying to make something like original brand probly knowing most everyone will want their products..because if they know it’s so close to original we will all want to choose it above the others…

      Reply

  9. Posted by Simon on June 25, 2019 at 9:12 pm

    I think it’s a great ide, but I doubt the Sacklers would.

    When the Sacklers donate to a museum the money comes from the Sacklers. This provides them with a double whammy:
    1. They look “good” for donating money; &
    2. They get a tax deduction / write off (not sure of the terminology in the US).

    Which of those two do you think is their primary motivation?

    Distributing free Buprenorphine would have to be done via Purdue. So whilst they’d still get to “look good”, they’d lose their deduction. I imagine they’d also be admitting liability to some degree.

    Maybe they could set up a Sackler family addiction medicine trust as a charitable cause and donate to that? I’m not a tax law specialist, especially in foreign (to me) countries.

    I like your thinking though. They owe it to everyone to become part of the solution. Easy availability of OxyContin 80s is what started my opioid career.

    Reply

  10. Posted by John Hanley on June 27, 2019 at 3:40 am

    I think everyone who has been negatively affected by the prescription opiate epidemic should be able to sue the manufacturers and distributors regardless of whether they were Rxed them or not.

    Reply

  11. Posted by Charlene Jordan on October 3, 2019 at 4:44 pm

    I have never done oxycontin,. However I have been on buprenorphine treatments since 2005 ..I have been following the sackler family for the use of their medication for pain management doctor to prescribe…..and all the law suits their company is in trouble with…what brought my attention to them is I follow a blog on medschat groups..one group is about buprenorphine what’s the best and not the best use of the 6 generics of buprenorphine without naloxone….. my dosage has always been 8mg…and have had the chance to do any of these 6 generics…what I can say is Purdue pharmaceuticals company has good medications, but now in trouble for probably one of the best meds..oxycontin..oxycodone..they got American addicted to one of those drugs..SO WHAT do they do??. ….they now have one of the best generics buprenorphine for use to use..and it’s Purdue pharmaceuticals distributors RHODES 8mg buprenorphine…its the best I have had since 2005 started out on brand name subutex..even the inactive ingredients for their buprenorphine is almost identical to brand name subutex…my point is first the sackler family addict’s us, gets into trouble and turns around to profit from people like me who are in treatment…not to mention that along the way since 2005 I have had a few different doctors because I’m on disability and I have state insurance….some doctors don’t seem to understand the difference 6 generics on how they effect each other differently…for instant Walgreens always has the actavis Elizabeth LLC ,..8mg half moon, orange in color..something about them dosent agree with me and I will avoid it at all cost…..if anyone who is on buprenorphine you can Google btodrems.com..and it will have everything you need info on…on the page you will notice how some seem to have a bit more or less buprenorphine ingredient…actavis has 8mg bup…Hi-tech has 8.64mg bup equivalent to 8mg….Hikma has 8.84mg bup equivalent to 8mg….Mylan has 8.624mg bup equivalent to 8mg…Rhodes has 8.64mg bup equivalent to 8mg….sun pharma has 8mg bup…..its the same way if you take 2mg buprenorphine….Actavis Elizabeth has 2 bup….. Hi- tech has 2.16mg equivalent to 2mg…Hikma has 2.16mg equivalent to 2mgbup…Mylan has 2.156mg bup equivalent to 2mg…Rhodes 2.16mg bup equivalent to 2mg..and sun pharma has 2mg bup…noticed the difference in all..so let’s say I have been doing Hikma or better Rhodes 8mg..for months and all of a sudden the pharmacy tells you they are out of them and you have to stoop to Walgreens orange half moon…I will be very sick and hoping the month goes by quickly and before my refill I will do my hunt for my buprenorphine because I will have to ask the doctor for something to help me out..she gave me clonadine a few times..it help but..we should not have to hint like an animal to find q good buprenorphine products. I did that long ago in the 80s and on. Back then it was easy to fill rx or even doctor hop…all I’m saying is a far as bup 8mg the only two worth using are hikma brand or new Rhodes which came out oct.2017 I believe…so the story is sackler family addict’s us, profits from us, they turn around and give us the best generic Rhodes 8mg, 2mg … anyone can compare original brand subutex active and inactive ingredients and match them up..like you said the sackler family didn’t get rich by stupidity, the came up with a great product of buprenorphine..

    Reply

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