Purdue Pharma: How one corporation started the opioid crisis in the US – Culture

car accidents? shootings? No: The leading preventable cause of death among Americans under 50 is drug overdoses. Between April 2020 and April 2021, more than 100,000 people died within a year for the first time – over 270 a day. That is the devastating record of the so-called opioid epidemic that has raged in the United States for two decades. As their name suggests, opium-related substances are responsible for three out of four fatal overdoses, along with heroin and most recently fentanyl, which is up to fifty times stronger.

But the crisis is not primarily the product of black markets and dubious drug dealers. It was triggered by the pharmaceutical company Purdue with a prescription painkiller called OxyContin – and with methods that are less reminiscent of medicine than of the mafia. In his book “Empire of Pain”, the investigative journalist and writer Patrick Radden Keefe reveals on a hitherto unknown scale how the renowned Sackler family, which owns it, plunged hundreds of thousands of Americans into drug addiction and enriched themselves unmolested.

The representatives urged doctors to prescribe the drug in high doses even for moderate pain

When Purdue launched OxyContin in 1996 under the leadership of Richard Sackler and other family members, the company praised the innovative formula: the opioid oxycodone, known for its pain-relieving effects but also for its addictive potential, was to be coated in a special pill form distributed evenly in the patient’s bloodstream. This prevents that peak concentration in the supply of the active ingredient that makes you dependent. Purdue did not conduct any studies on this. Instead, the company invested in good relations with Curtis Wright, the regulator of the US Food and Drug Administration. Within just one year, they not only approved the drug, but also advertising for its particularly low risk of dependency in the leaflet. Another year passed before Wright joined Purdue with a $400,000 entry bonus.

After approval, the company sent out an army of pharmaceutical representatives with instructions to woo the supposed miracle drug to those doctors who were either unusually willing to prescribe or inexperienced in dealing with opioids. On orders from above, the representatives told the doctors the old wives’ tale that the risk of dependency on OxyContin was less than one percent. They also urged the drug to be prescribed in high doses and for long periods of time, even for moderate pain. To help, Purdue gave them an annual budget of $9 million just for dining out to doctors.

This aggressive sales strategy, unusual for a pharmaceutical company, had a long tradition in the Sackler clan. As Keefe describes in the first part of “Empire of Pain,” Arthur Sackler, the family patriarch, had revolutionized pharmaceutical marketing since the 1950s. As a busy, multi-talented immigrant child, Sackler soon not only managed the neurobiological research of a psychiatric facility, but also his own advertising company McAdams. This made the sedative Valium the most profitable drug of all time by focusing the campaign not on patients but on the prescribing doctors. In addition, the company generously distributed the supposed trade journal Medical Tribunefounded and run for his own benefit by Arthur Sackler himself.

Just like Valium, which became the world’s most abused prescription drug, OxyContin soon began to have unpleasant side effects. In structurally weak regions of the American Northeast, such as the former coal mining areas of West Virginia, cases of abuse of the painkiller increased. The police learned of addicts who circumvented the security mechanism in the most simple way: they crushed the pills or sucked off the coating. What remained was pure oxycodone, which they either sniffed or injected. Alternatively, the pills could simply be chewed up.

Not abuse, but proper intake made the patients addicted

Contrary to what Purdue claimed, however, the abuse was not the cause of the addiction: In fact, taking OxyContin properly as prescribed by a doctor is what drove many patients into addiction in the first place. This was due to the company’s misrepresentation that one tablet would numb the pain for twelve hours. In fact, the effects wore off after just eight hours, creating the very fatal irregularity in oxycodone intake that Purdue prided itself on overcoming. As internal documents show, the company knew about this even before OxyContin was approved.

The spread of addiction into the big cities, along with its devastating consequences for entire families and communities, is described in the 2018 book report “Dopesick” by Beth Macy, adapted last October as an eight-part series with Hollywood stars Michael Keaton and Rosario Dawson (in this country via Disney available). In “Empire of Pain” Patrick Radden Keefe chooses a complementary approach: he doesn’t primarily mourn the victims, but aims to hold the perpetrators accountable. His detailed exposure of the scandal – on the one hand character study, on the other hand criminal files – received the renowned Baillie Gifford Prize for Non-Fiction in 2021.

Open detailed view

As early as 2007, a Virginia court had condemned the fraudulent labeling and marketing of OxyContin. Purdue accepted a $600 million fine, but the Sacklers got off scot-free. Richard, Arthur’s nephew, had officially retired as managing director, but retained control of the group. Repeatedly, middle employees and top managers alike have complained about his continued interference in operations, even on weekends and after midnight.

Arthur, who had his name from the imprint of the Medical Tribune kept out “in order to be able to do things the way I want” – i.e. to cover up conflicts of interest. However, Keefe not only portrays him as an obscure fraudster, egoist and absent husband and father, he also emphasizes his inventive genius, his eagerness to work, his tenacity and his education.

A wealthy businessman in his forties, Arthur developed a passion for collecting that grew into an obsession, resulting in the world’s largest private collection of Chinese art. Arthur Sackler donated parts of these and his fortune to museums and universities, together with precise instructions on the placement of his name. The Metropolitan Museum in Manhattan dedicated an entire “Sackler Wing” in 1978. So the name became a synonym for philanthropy – which is only at first glance a contradiction to the concealment of business interests.

Less light comes Richard Sackler of it, the son of Arthur’s youngest brother Raymond, born in 1945. Keefe attests to his intelligence, but excessive overconfidence and a lack of empathy. Richard’s internal reaction to the early news that 59 people had died of OxyContin in a single state is particularly impressive: “It’s not that bad. It could have been a lot worse.” Instead of self-criticism, Richard relied on offensive PR strategies and legions of lawyers to dispel doubts about his product – even after the 2007 verdict.

Data indicate that the abuse of opioids has long been a serious problem in Germany

Three years later, Purdue changed OxyContin in such a way that the active ingredient could no longer be extracted. But this seemed to be due more to economic motives than moral insight: the patent expired. As addicts subsequently switched to heroin and fentanyl, sales dropped suspiciously. The Sacklers tried their luck in global business with the company Mundipharma and flushed OxyContin into the Chinese market – using the same methods as in the USA. In the epilogue to “Dopesick”, the anaesthesiologist Christoph Stein warns against opioid addiction in Germany as well: The available data indicate that “the consumption and abuse of opioids in the USA, Europe and other regions is now taking place to a comparable extent”. .

In September 2019, Purdue filed for bankruptcy after the Sacklers paid out tens of billions of dollars in dividends. Earlier, the Massachusetts Attorney General had personally indicted Richard and seven other members of the family for the first time. Two dozen other states followed suit. As a result, numerous institutions removed the family’s name and stopped accepting donations. In December, the Metropolitan Museum in New York announced that it would be renaming the “Sackler Wing”. center On January 1, London’s Serpentine Gallery removed the name Sackler from its facade.

Once again, however, the family appeared to be escaping: the Sacklers and their plaintiffs agreed last fall to a $4.5 billion payment and immunity from further prosecution. Shortly before Christmas, however, a New York court overturned this deal: Not all plaintiffs agreed. Neither the amount of the fine nor the acquittal adequately reflected the Sacklers’ guilt. The family plans to appeal.