Arthur, Mortimer, and Raymond Sackler are three brothers who may be the most to blame for the nation’s current opioid epidemic. They created a demand for pharmaceuticals, addictive ones, not based on effectiveness but based on increasing sales. In 2016 according to Forbes, the Sacklers ranked as one of America’s richest families, with a collective net worth of thirteen billion dollars—more than the Rockefellers or the Mellons. The bulk of the Sacklers’ fortune has been accumulated only in recent decades. Their company Purdue Pharma made 35 billion dollars from the sale of OxyContin. In 1995 their drug OxyContin received approval from the FDA for use in treating moderate to severe pain.
This is not the story of patients abusing painkillers for fun, this is the story of the systemic coercion of doctors and medical officials including the FDA to enrich a private company.
In 1942, Arthur, the oldest of the Sackler brothers, was an advertising writer, doctor and psychiatrist. In 1997, he was posthumously inducted into the Medical Advertising Hall of Fame. He created ads for medical journals that targeted doctors. The major problem with Arthur’s work was a lack of morality; when the truth didn’t suit his agenda he fabricated the content of his ads regardless of the truth.
In the 1950’s his ad for an antibiotic featured doctors’ business cards, and the text, more and more physicians find this antibiotic the therapy of choice. An investigative reporter tried to contact the doctors whose names were on the business cards. They did not exist.
In 1952, the Sackler brothers bought a small patent-medicine company, Purdue Frederick.
Arthur also became a publisher of a biweekly newspaper that eventually reached 600,000 physicians. Some saw it as a conflict of interest for him to be both the head of a pharmaceutical-advertising company and the publisher of a periodical for doctors. Arthur scoffed at the notion. There is a trail of deception that is synonymous with Arthur’s advertising career. In 1959 it was discovered that a company he owned, MD Publications, paid the chief of the antibiotics division of the F.D.A. nearly three hundred thousand dollars to promote certain drugs. Once the payments were discovered, the chief resigned. Apparently Arthur Sackler was unfazed.
In the 1960’s Arthur got rich writing ads for the tranquilizers Valium and Librium. Valium was promoted by Arthur for such a wide range of symptoms that another Doctor wrote to inquire “When do we not use this drug?” Another ad for the drug encouraged it for people without psychiatric symptoms. “For this kind of patient—with no demonstrable pathology—consider the usefulness of Valium.” There were no studies addressing its addictive potential.
In the early sixties, a senator by the name of Kefauver, chaired a subcommittee that looked into the rapidly growing pharmaceutical industry. Kefauver, who had previously investigated the Mafia, was especially intrigued by the Sackler brothers. His interest at the time was in drug pricing and marketing, believing that patients were paying too much and being misled by extravagant advertising claims. A memo from his staff noted, “The Sackler Empire is a completely integrated operation in that it can
- devise a new drug in its drug development enterprise,
- have the drug clinically tested and secure favorable reports on the drug from the various hospitals with which they have connections,
- conceive the advertising approach and prepare the actual advertising copy with which to promote the drug,
- have the clinical articles as well as advertising copy published in their own medical journals,
- prepare and plant articles in newspapers and magazines.”
Although Arthur testified before Kefauver’s subcommittee no actions were taken specifically against Arthur.
By 1973, over a hundred million tranquilizer prescriptions a year were being written by American doctors, and countless patients were hooked. In 1979 Senator Edward Kennedy in a congressional hearing said benzodiazepines like Valium and Librium “have produced a nightmare of dependence and addiction, both very difficult to treat and to recover from.”
When Arthur Sackler died in 1987 his descendants still owned one third of Purdue. Purdue was already developing a new drug: OxyContin when his brothers Mortimer and Raymond Sackler bought his shares. In 1991 they changed the company Purdue Fredrick to Purdue Pharma. Mortimer, Raymond, and Raymond’s son Richard Sackler launched OxyContin with one of the biggest pharmaceutical marketing campaigns in history, deploying many persuasive techniques pioneered by Arthur.
OxyContin is a pill of pure oxycodone, with a time-release formula. They produced it in doses ranging from 10mg to a 160mg. The potency of largest dose far exceeded other opioids on the market. Barry Meier in his book, “Pain Killer,” describes OxyContin was a nuclear weapon in terms of its strength as an opioid.
Purdue knew, because they used focus groups, the biggest obstacle in marketing the drug was doctors’ concerns about the potential of patients to abuse it. As noted earlier by Senator Kefauver’s staff it was not uncommon for the Sacklers to buy professionals in the medical system to make false claims and present them to others in the field as truth. Russell Portenoy, a pain specialist at the time, at Sloan Kettering Cancer Center, received funding from Purdue. In 1993 in an interview with the Times he stated “There is a growing literature showing that these drugs can be used for a long time, with few side effects.” He popularized the problem of “untreated chronic pain”—and the wisdom of using opioids to treat it. He suggested doctors’ concerns regarding addiction and abuse amounted to a “medical myth.” In 1997, the American Academy of Pain Medicine and the American Pain Society published a statement regarding the use of opioids to treat chronic pain. This statement was written by a committee chaired by Dr. J. David Haddox, a paid speaker for Purdue. In 1996 the American Pain Society introduced the phrase “pain as the 5th vital sign.”
Opioids were not commonly prescribed for chronic pain until the Sackler brothers Mortimer and Raymond following in the footsteps of their eldest brother Arthur created a false narrative accompanied by false science. Sackler sales etiquette was to trick, bribe, and or threaten.
OxyContin was approved by the FDA in 1995, for use in treating moderate to severe pain. The FDA also allowed the company to include a statement in the package claiming OxyContin was safer than rival painkillers due to its time release effect. This was unusual for the agency since Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. Dr. Curtis Wright, the FDA employee who oversaw the drug’s approval, left the agency shortly afterward. Within two years, he had taken a job at Purdue.
The same revolving door between government regulators and big business is also seen with Monsanto and other industries including the mining, oil, and chemical industries.
Sales flourished under the marketing strategy pioneered by Arthur years earlier, which included aggressively selling to doctors and providing free trips to pain-management seminars. Internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t.
According to author Jason Smith “To understand just how the American medical system became corrupted in the 2000s, you have to understand the role of Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the most powerful accreditation institution in the world.”
He explains that the Joint Commission is a nonprofit organization that sets the standards of care for hospitals in this country also accrediting more than 20,000 facilities in all but four states. They inspect hospitals and to ensure adequate care is being given and standards are being met. They also issue directives in care.
Smith writes “In 2001, while the pharmaceutical lobby spent just under $100 million in lobbying efforts, the Joint Commission issued a new directive to its 20,000+ hospitals across the country: Treat pain.
And who did the Joint Commission bring in to teach the hospitals how to treat the pain?
Purdue Pharma. “
Purdue Pharma was allowed by JCAHO to fund the “pain management educational courses” that established the new standard of care for treating pain. Purdue was cited twice by FDA for OxyContin medical journals ads violating the federal Food, Drug and Cosmetic Act. In spite of this Purdue was allowed to provide materials to educate doctors on pain management. Pain suddenly became the 5th vital sign requiring a pain intensity rating (0 to 10) at all clinical encounters. (In 2016 the AMA dropped pain as vital sign.) A book published by the Joint Commission for doctors stated “there is no evidence that addiction is a significant issue when persons are given opioids for pain control”.
Jason Smith in his article Kingpins: OxyContin, Heroin, and the Sackler-Sinaloa Connection explains:
With access to America’s hospitals, Purdue then began funding more than 20,000 pain-related “educational programs” through financial grants and direct sponsorships. They used these grants to provide presentations and demonstrations to entire hospital staffs and present at state and local medical conferences, providing doctors with continuing medical education (CME) units.
With pain management now mandated by the Joint Commission, Purdue began funding groups such as the American Chronic Pain Association (ACPA) and the American Pain Society (APS). These vocal groups began demanding doctors “start taking pain management seriously” (i.e. prescribe opioids), bringing their message everywhere from state legislatures to medical conferences.
Organizations funded by the pharmaceutical industry were created that rated doctors based on their willingness to treat pain and encouraged many family practitioners to begin prescribing outside of their normal scope of practice. The local family doctor suddenly felt pressure to prescribe powerful narcotics he or she might not have fully understood, or else risk a scathing review from a group like the American Pain Society that could irreparably harm his or her practice.
According to internal documents, Purdue officials discovered that many doctors wrongly assumed that oxycodone was less potent than morphine—a misconception that the company exploited. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. Pharmaceutical companies then lobbyied state legislatures to create legal protection for prescribers. Laws were enacted protecting doctors from malpractice claims of overprescribing opioids.
After having their way with JCAHO and state legislators Purdue Pharma set out to capture the minds of the Federation of State Medical Boards (FSMB). An investigation by John Fauber of The Milwaukee Journal Sentinel, found the FSMB accepted a $100,000 donation from Purdue for “printing and distribution” of pamphlets explaining safe use and prescribing of opioid medications. Coincidentally, while it accepted $100,000 from Purdue, the FSMB began calling for doctors to be punished for not “adequately treating pain.”
According to the National Institute of Health, in 2013 nearly 80 percent of heroin users reported using prescription opioids prior to heroin. Purdue paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Centers for Disease Control and Prevention suggest that a hundred and forty-five Americans now die every day from opioid overdoses.
The history of the word addiction dates back to the Roman Empire where it was used to describe the award of one person to another (i.e. slavery). In September of 2018 Purdue’s former chairman and president, Richard Sackler, patented a new drug to help wean addicts from opioids. The Sacklers have generated more profits than Mexican drug lord El Chapo by enslaving people to their drugs. The Sacklers’ next move is to profit off selling people back their freedom. They do this with total disregard for all who overdosed along the way. In fact, Purdue blamed individuals for getting themselves addicted. The CDC states from 1999-2017, almost 400,000 people died from an overdose involving any opioid, including prescription and illicit opioids.
Purdue denies any wrong doing. In February of 2018 Purdue announced they will no longer be sending sales reps to doctors’ offices to push opioids. Although Purdue said that they will stop targeting doctors to push these drugs, sources have told CBS that instead Purdue will now target insurance companies and other parts of the healthcare system to increase sales of OxyContin. Apparently the Sackler family has no remorse for what they have done to individuals and communities.
Additionally, they plan like other corporations to move sales to a new country where this problematic behavior will be allowed to continue. According to reporter Patrick Keefe in The New Yorker magazine “the Sackler family has only increased its efforts abroad, and is now pushing the drug, through a Purdue-related company called Mundipharma, into Asia, Latin America and the Middle East.”
What reforms could be enacted to prevent this kind of corruption from repeating?
1. Prosecute the executives of the pharmaceutical companies the same way the judicial system prosecutes street drug dealers.
2. Prohibit price gouging in the health care industry including pharmaceuticals.
3. Seize profits made by the pharmaceutical companies responsible for this opioid epidemic.
4. Remove pain from the list of vital signs authorized by JHACO.
5. Return to limitations on which doctors can prescribe opioids (i.e. pain specialists and cancer doctors only, not general practitioners.)
6. Remove legal protections for doctors who over-prescribe.
7. Reverse the changes to state medical boards that call for doctors to be punished for not adequately treating pain.
8. Prohibit the advertisement of pharmaceuticals on television.
The solution mostly entails undoing all the ways that the Sacklers changed how we address pain and prescribing and prosecuting those responsible.
Listen to ‘The Daily’: How the Opioid Crisis Started
Read The New Yorker “The Family That Built an Empire of Pain”
Read Kingpins: OxyContin, Heroin, and the Sackler-Sinaloa Connection By Jason Smith
Read A Pain-Drug Champion Has Second Thoughts By Thomas Catan and Evan Perez
OxyContin goes global — “We’re only just getting started”By Harriet Ryan, Lisa Girion and Scott Glover
The Sackler’s corruption and Oxycontin history at a glance
1952 Sackler brothers buy a small medicine company, Purdue Frederick
1959 Arthur Sackler’s other business bribes FDA official to promote certain drugs
1960’s Arthur Sackler’s ads push the tranquilizer Valium for people with no demonstrable pathology
1973 over a hundred million tranquilizer prescriptions were written each year
1979 congressional hearing states drugs like Valium produce a nightmare of dependence and addiction
1987 Oxycontin in development. Arthur Sackler dies. Brothers Mortimer & Raymond buy Arthur’s shares
1991 Mortimer and Raymond change the company Purdue Fredrick to Purdue Pharma
1993 Sacklers fund Doctor at Sloan Kettering who popularizes “untreated chronic pain” and opioids
1995 FDA approves OxyContin to treat moderate pain. Allows to state it is safer than competitors
1996 Purdue realizes OxyContin is prescribed 2x more by Docs who attend Purdue sponsored seminars
1996 American Pain Society (APS) introduced the phrase “pain as the 5th vital sign”
1997 the FDA employee who oversaw the Oxycontin’s approval left the agency to work at Purdue
1997 Am Acad of Pain Mngmt & APS endorses opioids to treat chronic pain. Authored by Purdue
1998 FSMB tell doctors there is no punishment for prescribing even large amounts of narcotics
1999 VA starts “Pain as the 5th Vital Sign” requiring a pain rating (0 to 10) at all clinical encounters
2001 Pharmaceutical lobbys almost $100,000,000. JCAHO directs its 20,000+ hospitals to treat pain
2002 Purdue budget plan “broaden” the use of OxyContin for pain management
2004 FSMB told state medical boards to make under-treatment of pain punishable for the first time
2013 Nearly 80 percent of heroin users report using prescription opioids prior to heroin
2017 since 1999 almost 400,000 people die from an overdose involving any opioid prescription or illicit
2018 Purdue’s former president, Richard Sackler, patents a new drug to help wean addicts from opioids