Posts Tagged ‘Purdue Pharma’

Book Review: Empire of Pain: The Secret History of the Sackler Dynasty

This book, by Patrick Radden Keefe, will make you angry, especially if you’ve lost anyone to opioid use disorder or have suffered from it yourself.

The entire book is about how the Sackler family, owners of the pharmaceutical company Purdue Pharma, ruthlessly marketed OxyContin in the face of growing opioid use disorder and opioid overdose deaths. The book details the legal maneuvers undertaken by the Sacklers and their lawyers to avoid taking responsibility, either by financial means or an admission of guilt, for OxyContin sales. Those sales primed the pump for our epidemic of opioid use disorder and death in this country.

The first one-hundred and eighty or so pages describe the family lives of the family patriarch and his three sons, along with their descendants. This background is necessary to understand their motivations, but it’s a bit boring. Basically, the immigrant patriarch worked hard and succeeded on two fronts: he became a physician and he became an excellent salesman. The second generation consisted of three sons, all of whom became physicians, but their primary occupation became making money by owning the drug company that made OxyContin. This second generation created many offspring through multiple marriages. Some members of the third generation of U.S. Sacklers went into the family business, but most went in different directions, funded by the money from the family businesses.

Back in the middle of the last century, Sackers owned the drug company that sold Librium and Valium. The latter was marketed as a non-addicting medication for anxiety and sleep.  That was a harbinger of things to come.

Other books have related the tale of how opioids came to a place of dominance in the last part of the twentieth century, with all the hubris spread about opiophobia. But this book is a tour de force about OxyContin’s role. The author has documented painstaking detail what the Sackler family and their privately-owned drug company, Purdue Pharma, did to sell OxyContin.

IN 2007, John Brownlee, a U.S. attorney for the Western District of Virginia, brought a suit against Purdue Pharma. This book describes how Purdue Pharma lawyers tried to out-maneuver Brownlee at the beginning of his investigation (and the end) by going over his head to his bosses at the Department of Justice. That failed, to some degree, and Brownlee was able to find documents showing damning evidence.

He found evidence that the company knew OxyContin could be injected, but they instructed sales reps to tell doctors that it could not be injected. Brownlee found that Purdue executives had been cozy with the FDA employees charged with keeping the public safe. The FDA employee working with Purdue was later offered a job with Purdue for a mid-six-figure salary.

Brownlee found that sales reps were routinely trained to say things to the doctors they were detailing that were known to be untrue, even finding training videos to prove it. Sales reps were required to call on doctors known to have shady prescribing practices (running pill mills) even when they voiced reservations about calling on such doctors.

Brownlee was up against some powerful attorneys for Purdue Pharma. In the end, Purdue Pharma and three executives, Friedman, Goldenheim, and Udell, pled guilty to fraudulently marketing OxyContin. Purdue paid over $600 million in fines, and the executives got three years’ probation and community service. It was a large fine, but small in relation to the billions in profits Purdue was making. And the Sackler family had no charges brought against them.

It was a valiant attempt to hold Purdue Pharma accountable, and probably a miracle that any guilty plea at all could be gotten with the degree of influence that the Sackler family appeared to have over the government. But it was a disappointing finish.

And if you thought the legal problem was enough to make the Sackler family and Purdue Pharma change their ways…you would be dead wrong. They did not.

The Sacklers and their lawyers continued to trot out tired old lies and half-truths about their part in the opioid use disorder epidemic, while continuing to aggressively market OxyContin.

This present book presents information debunking all the excuses made by the Sackler family to shroud their involvement in the U.S. opioid epidemic

First, defenders of OxyContin, Purdue Pharma, and the Sacklers still claim that OxyContin sales accounted for a small percentage of the vast amounts of pain pills prescribed early in the opioid epidemic. They say it’s unfair to place all the blame on their shoulders. Like most of their arguments, there’s a scrap of truth to their claims, but they ignore inconvenient facts. For example, as the author points out, OxyContin contained much higher doses of oxycodone than other pills made by other companies. Therefore, Purdue Pharma’s OxyContin, though only accounting for a minority of total prescription opioid pills sold, represented a much higher percentage of total milligrams sold. Each OxyContin tablet packed up to eight and even (before the 160mg tablet was taken off the market) sixteen times the opioid firepower compared to short-acting oxycodone tablets. Besides that, the Sacklers bought another drug company, Rhodes Pharmaceuticals) to make generic oxycodone just months after the 2007 verdict in Virginia. According the book, the family wanted a “landing pad” in case they ever needed a fresh start. This facility made generic versions of OxyContin, and well as immediate release oxycodone. It became the seventh-largest manufacturer of opioids in the U.S. But the Sacklers didn’t acknowledge this to the public.

Second, the Sackler family has claimed in the past that their liability for the crimes of Purdue Pharma should be limited, since they had no role in running the company. But this book points out, repeatedly, that not only did many family members sit on the board of Purdue Pharma, but evidence shows that family members directly micromanaged sales and exhorted sales reps to use tactics to sell ever more OxyContin. Records show the Sackler family members were directly involved in running Purdue Pharma and regularly pressured sales reps to sell more OxyContin.

Third, the Sackler family and top officials at Purdue Pharma repeated said that some rogue pharmaceutical representatives of the company aggressively marketed their drug, without company knowledge or approval. OxyContin was falsely advertised as having a lower risk of addiction than other opioids. However, training videos obtained from Purdue Pharma show drug reps were trained to give inaccurate information. Indeed, that what the 2007 conviction was for: false advertising and false claims of safety.

Even when drug reps feared some physicians were running pill mills, they were told to continue calling of these doctors and to keep selling the OxyContin.

The Sacklers and their associates invented IMS, a company that collects data on doctors about what medications they prescribe, along with the quantities. This data is sold to pharmaceutical companies so they can direct sales pitches about their medications. And of course, Purdue Pharma used this information. They didn’t use it to identify bad apples, doctors who were perhaps inappropriately prescribing, though they certainly could have. They could have used their data to report overprescribing doctors to the DEA for investigation. Instead, they used their IMS data to identify areas with high rates of worker’s compensation injuries, where pain medication might be prescribed by naïve family physicians. The company felt these doctors should be targeted for OxyContin sales pitches.

The most enraging part of the book comes near the end, when the author describes more recent lawsuit settlement negotiations.

Eventually, so many states, cities, counties, hospitals, tribes, and school districts brought suits against Purdue Pharma that the Sackler family wanted to settle them all at the same time. Purdue offered to relinquish control of the drug company to a public trust and the family would donate money if they were guaranteed to be immune from future lawsuits. The total settlement would be $10-20 billion.

That’s a big number, until the details revealed that the Sackler family would only be paying from $3 billion up to a possible $4.5 billion. Given the billions the Sacklers had made over the years from the sale of OxyContin, this agreement didn’t sit well with many of the negotiators. Basically, the family said take this agreement or we will declare bankruptcy. Bankruptcy would freeze litigation against Purdue Pharma.

Talks broke down and true to their threats, Purdue Pharma declared bankruptcy. The bankruptcy judge’s rulings favored the Sacklers, particularly when he ruled that the Sacklers would also be protected by Purdue’s bankruptcy. This decision outraged many people. Our own state’s Attorney General Josh Stein said aptly, “Multi-billionaires are the opposite of bankrupt.” But the judge’s ruling stood, protecting the family from liability.

There’s so much more in the book, such as how the Sackler family’s philanthropic gifts to universities, libraries, and museums were retuned and refused, due to public outcry about where their money came from. The author suggests members of the Sackler family were upset about their charitable gifts being declined and returned. That’s truly a problem of the very wealthy.

The book contains information about brave protesters who brought the Sackler’s association with OxyContin to light and pushed venerable institutions into re-thinking gifts from such sources.

Towards the end of the book, the author asks why the Sackler family couldn’t or wouldn’t admit to their complicity in creating the opioid use disorder challenge we now face. How could they be so blind? Even if they were motivated solely by greed, at some point they must have known their lies were now brought into the sunshine. Why have they never taken a more conciliatory tone, at least pretending to have empathy for the millions of families affected specifically by OxyContin abuse?

The author said the Sackler family wouldn’t talk to him. He also said that during interviews with former Purdue Pharma employees, from executives down to sales representatives, he was struck with their “fog of denial.” He wonders if acknowledging complicity in Purdue’s and the Sackler family’s destructive acts would be too much for human conscience to bear, and so they continue to parrot the same old lies: only drug addicts abused OxyContin, only a few wayward drug reps mis-marketed OxyContin, and the company was driven only by a desire to help patients, and not by greed.

At several places in the book, the author compares the Sacklers to Big Tobacco both in their legal strategies and their refusal to admit their part in marketing a dangerous product.

After reading the book I was left feeling discouraged, disillusioned, and tired. It appears that justice for the very rich happens on a different plane, if at all. I couldn’t help but think about the physician (my blog post of May 11, 2021) indicted by the Department of Justice for – among other things – failing to do random drug screens on the patients he was treating for opioid use disorder.

None of the Sacklers have been criminally indicted for anything. Justice for the Sacklers versus justice for this physician feels…uneven…to put it mildly.

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