For those among you wondering how America’s current opioid crisis may have started, and who may think that drug dealers are mostly inveterate, gun-toting, tattooed criminals working for gangs and cartels, think again: at least in the US, many of them have PhDs, wear suits, have seats in government bodies like the Food and Drug Administration (FDA), and the substances they peddle are what are called “white market drugs.”
Among such “dealers” are the Sacklers, one of America’s most evil and avaricious families who, from 1996 onwards, turned over $10 billion in profit off unsuspecting individuals suffering from chronic pain.
The family behind the Big Pharma giant Purdue Pharma L.P. shamefully and unethically created, aggressively marketed, and motivated the over-prescription of the powerful and highly addictive opioid OxyContin.
Unhindered by financial or moral constraints for three decades, they specifically targeted the communities of hard-labor workers most vulnerable to physical injuries in the workplace: miners, construction workers and any other professions, single-handedly creating what has now become America’s current opioid crisis.
Up until 1996, according to the World Health Organization (WHO), the prescription of opioid medications was restricted to those who were either terminally ill or suffering from severe chronic pain.
Namely, it was prescribed to those for whom addiction would not be a problem (as in the case of the terminally ill), or then for short periods of time under hospital supervision for those suffering from post-surgery pain.
Hungry for profit with their then new patent for Oxycontin, the Sacklers, founders of Purdue Pharma, set about manipulating the medical community’s outlook on the relationship between opioids and pain in order to maximise the use of Oxycontin for various instances of mild pain.
The statistical results of this mercenary enterprise are nothing if not mind-blowing: from 1996 to 2021, 800,000 Americans have died from opioid-related overdoses; a shocking number when we consider that Purdue Pharma used aggressive, multi-pronged campaigns between 1996 and 2004 to ensure that Oxycontin was the most prescribed schedule II drug in America.
Although the Oxycontin prototype MS Contin had been a breakthrough drug for the terminally ill, the Sackler family would have no qualms in crossing the ethical boundary when they shifted their target audience to include anyone suffering from moderate pain or mild discomfort.
Meet the Sacklers
One of the wealthiest families of New York high society, the Sacklers were not exactly newcomers on the scene, and their patriarch, Arthur M. Sackler (1913-1987) placed the family at the front and centre of American medical advertising.
With an astute sense for marketing tactics, Arthur Sackler was quick to realize that the most efficient way to advertise pharmaceuticals was to focus on targeting doctors rather than patients. With his own medical journal, “The Medical Tribune,” he would pay leading physicians of the day to endorse certain medications to medical professionals.
It would be this strategy that would kick the door open and till the landscape for turning small pharmaceutical companies into the international corporate conglomerates know today as Big Pharma.
By the 1960s, with Roche Pharmaceuticals on his list of clients, he would again resort to his own medical journal to promote the indiscriminate prescription of drugs such as Valium and Librium where they were unnecessary.
Resorting to aggressively advertising tranquilizers to women, in a vulgar display of patriarchal misogyny, he marketed the drugs as a “solution” for the “problem” of being female, liberally prescribing them to treat what was, at the time, considered the female “epidemic:” hysteria and depression.
>When Roche’s Valium became the first medication in the history of humanity to ever crack $100 million in revenue, Arthur became aware of the cash cow he had in hands, which would make him into one of the richest New York philanthropists and patrons of the arts.
In a careful operation of spin and concealment, his name became more associated with museums, galleries, works of art and charities instead of tranquillizers and addiction.
Enjoying an unprecedented level of wealth, Arthur and his two brothers, Raymond and Mortimer, would distribute their fortunes across different ventures, and would eventually buy out a small-scale drug manufacturer by the name of Purdue Frederick, which would later be rebranded as Purdue Pharma.
The One Who Got Away
Among the family, it was Raymond’s son (Arthur’s nephew), Richard Sackler, who would spearhead the development of Oxycontin, despite concerns from his uncles that he was vastly overspending in its production. However, Richard remained adamant in the face of criticism, maintaining that Oxycontin would revolutionize pain management and turn out significant profits.
The stated improvement of OxyContin over its predecessor, MS Contin was its duration: on account of its delayed absorption, patients in pain could experience up to 12 hours relief per pill, needing a total of two pills to “get through the day.”
This would turn out in time to be a barefaced lie, as many patients would wake up in the middle of the night in pain.
Knowing no limits to his rapacity, Sackler would revise the pitch and completely invent a medical condition he called “breakthrough pain,” normalizing the situation and instructing his sales representatives to convince doctors to simply “double the dose” their patients were on.
The Highs and Lows of Big Pharma Profits
There are two main factors that determine the amount of profit a Big Pharma conglomerate can make from any single drug in the US: the approval of the Food and Drug Administration (FDA), and the patent on that same drug.
No sooner does a pharmaceutical company propose a new drug than they must immediately patent it, so they and they alone retain the rights to manufacture it. This patent will last on average two decades.
What this means for the pharmaceutical company is that they have a limited window of time within which to make a profit before the patent expires, and other companies can make a generic version of the same drug.
The expiring patent of MS Contin in the late eighties, and the reduced window of opportunity in which to make back the impending $400 million loss in revenue, which would stem from MS Contin going generic, were the prime motivators for Richard Sackler and his new “wonder-drug” OxyContin.
Regarding the role of the FDA in its approval of any new drug, pharmaceutical companies not only have to pay hundreds of millions of dollars in lengthy trials as they can sometimes be put on hold for years, only to see their approval denied by the FDA. The money spent in this period is the sole responsibility of the company, as is the onus to recover costs and make a profit before its patent expires.
With heavy pressure from the remaining family and shareholders, Richard Sackler found himself in a tight spot, but was quick to discover just which strings needed pulling to save face.
I am Wright, and You Are All Wrong
Curtis Wright, the then medical reviewer in charge of FDA approvals—and a known advocate of Purdue Pharma—would approve OxyContin a mere 11 months after the company had submitted it for review under the auspices that, owing to its slow-release method, it was less likely to be abused and cause addiction in patients.
This would later become the talking point on which OxyContin would be aggressively marketed. Based on this, Curtis Wright approved a “low-risk package insert” to go on the bottle, claiming that the risk for addiction was “very rare.”
How ironic that, a mere year after the FDA approval of OxyContin, Curtis Wright would leave the FDA to secure a $400,000 gig at Purdue Pharma itself.
From the release of Oxycontin in 1996, right up to 2001, hundreds of thousands of pain patients were deliberately misguided under the impression that, if taking Oxycontin as prescribed, they would not fall prey to addiction.
At the same time-period, the FDA payroll counted only a small total of 39 FDA employees in charge of investigating the ethical promotion of pharmaceuticals. Taking advantage of this situation, Purdue Pharma saw another window of opportunity and released around 15,000 promotional videos to physicians with no approval or even knowledge on behalf of the FDA.
In the six years it took the FDA to catch on to this, there were no legal consequences other than the pulling of a few ads from medical journals.
Taking a page directly from Uncle Arthur’s book, Richard and the remaining family were quick to realize that the best way to market the drug beyond terminally ill patients was to target the community of physicians, touting it as the new, non-addictive wonder-drug.
Dr. Russel Portenoy, a leading neuroscientist, and professor of neurology at Cornell University was a specialist in pain management, and president of the American Pain Society and the American Pain Foundation.<
Holding a great deal of influence in the medical community, he would speak out against the prevalent “opiophobia” (a term he coined) among the medical community as unfounded, making use of an outdated and misleading study printed in 1980 in the New England Medical Journal.
The four-sentence study written by Jane Porter and Hershel Jick ran thus:
“To the Editor: Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well-documented addiction in patients who had no history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.” Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med 1980;302:123. Again, when looking at why Portenoy may have become such an avid promoter of OxyContin, it is no surprise to find that his clinics had benefitted from multiple hefty donations on behalf of Purdue Pharma and the Sacklers.
What both Portnoy and Purdue Pharma deliberately failed to mention was that the patients cited in the study had been treated strictly under hospital supervision with small dosages and for a brief period only.
Not content with targeting the medical community alone, Purdue Pharma had also set about advertising OxyContin to patients through a series of pamphlets and brochures through what seemed like a grassroots venture but was really a shell company funded by Purdue Pharma itself, called “Partners Against Pain,” with Portenoy himself signing off on the veracity of said pamphlets.
The brochures saw a massive distribution among hospitals across the country from 1996 to 2002, putting on the following spin as a disclaimer to quell concerns about the possibility of addiction: “Drug addiction means using a drug to get high rather than to relieve pain. You are taking opioid pain medication for medical purposes. The medical purposes are clear and the effects are beneficial, not harmful.” To Do No Harm: Strategies for Preventing Prescription Drug Abuse: Hearing Before the Subcommittee on Criminal Justice, One Hundred Eighth Congress, Second Session, Feb. 9, 2004
Maximum Pain for Maximum Gain: Selling Addiction
In a downright manipulative scheme of bribery, Richard Sackler and Purdue Pharma compiled extensive lists of all the physicians who had readily prescribed OxyContin’s predecessor, MS Contin, and set aside millions of dollars so that their sales reps could groom and woo these doctors.
With the help of highly motivated teams of bonus-hungry sales reps, they would tout barefaced lies that stated that “the rate of addiction for patients who are treated by doctors is much less than 1%,” while knowing full well that it only takes under a month of everyday dosage to create a habit.
Some of their criminal persuasion tactics included grooming and wining-and-dining FDA employees to secure personal relationships; creating and divulging deliberately misleading opioid addiction data exclusively for OxyContin; the creation of fake pain-awareness societies; using a team of sales representatives whose aim was to convince both doctors and patients that OxyContin was a keeper.
“From sales representatives with uncapped salary incentives to all-expense-paid 5-star symposiums, millions of dollars were spent sponsoring renowned pain management doctors and pain societies.”
This, coupled with the FDA approval, gave primary care physicians the assurance they needed to confidently prescribe the drug.
Naughty, Naughty: Raised Eyebrows and a Slap on the Wrist
Not until 2003 would the United States General Accounting Office finally sit down to grill the DEA, the FDA and Purdue Pharma over serious concerns on the intensely addictive nature of OxyContin.
This came about on account of a huge influx of instances of “diversion” reported by the DEA that the drug was being tampered with (crushed, snorted and injected) and therefore had a high potential for black market demand, as well as having caught on that most of Purdue’s advertisements had not been approved.
The rates of crime in the communities targeted by Purdue Pharma had spiked tremendously since 1996, with pharmacies being robbed for their stock of OxyContin, and pain management centres having endless queues of people in withdrawal lining up for their prescriptions.
With money comes the ability to buy protection, so it is to a degree unsurprising that the FDA and the DEA did little more than issue the proverbial smack on the wrist to Purdue Pharma, pulling a few advertisements and demoting the drug’s package label to a “black-box” package insert extolling the negative outcomes of the drug.
In another reckless incidence of spin, Richard Sackler played the new “black-box” insert to his advantage, using it to extol the superiority of the drug to other less powerful medications for moderate pain.
In 2006, the Departure of Justice issued a formal accusation accusing Purdue Pharma of mail fraud, money laundering and wire fraud, but for reasons undisclosed, pushed it aside. Being leaked to the public, the document detailed conversations between Dr. Curtis Wright, then of the FDA, and Purdue Frederick during the approval period of OxyContin in 1995.
A Slice of Justice, Please: Half-Baked and Underserved
Due to the usual amount of red tape, Purdue Pharma would not be taken to court until 2008. This gross oversight and interim period had given the Sacklers time aplenty to weave their escape route. Richard Sackler handed in his resignation as president of Purdue Pharma, becoming co-chairman instead, and the remaining Sacklers receded into the background.
To avoid legal action, the Sacklers selected three “fall guys” to take the blame and protect the family: Michael Friedman, who was made President of Purdue and had to pay $19 million in fines; Dr. Paul D. Goldenheim, former medical director; and Howard R. Udell, Purdue’s top lawyer. All three were heavily fined.
Purdue Frederick, a subsidiary of Purdue Pharma, took the brunt of the lawsuits and paid up $600 million, leaving Purdue Pharma free to pursue business as usual.
Having achieved a grand total of $9 billion by 2008, the fines levied at Purdue Pharma amounted to little more than the cost of “doing business.” So much so that a mere month after the trial, the Sacklers behind Purdue Pharma offered themselves a hefty payout of $325 million from the company vaults.
Little Ado About Much
In 2010, minor changes were made to the pharmacological makeup of OxyContin, making it harder to tamper with and divert, with most physicians thankfully becoming once again reluctant to prescribe the drug under threat of lawsuits and scrutiny of medical review boards.
For the patients who had become “legally” addicted to OxyContin, the outcome was nothing if not dire: fresh out of their supply, many turned to street drugs such as heroin and Fentanyl to avoid withdrawals, which caused a further spike in black market opiates, pushing the opioid crisis further down the spiral, with many becoming homeless, and more overdosing.
Though the Sacklers and Purdue Pharma attempted to file for bankruptcy in 2021, their plea was denied by U.S. District Judge Coleen McMahon under pressure of the mounting public outcry that one of the most evil families in the United States be allowed to escape justice and accountability with a mere symbolic fine.
While the Sacklers themselves have never faced criminal charges — brazenly denying any wrongdoing – their alleged role pushing opioid sales have brought a growing public backlash; the connection between Richard Sackler, Purdue Pharma, OxyContin, and America’s current opioid crisis is hard to deny, especially for the families of those who died of OxyContin overdoses.
Museums, universities, and other institutions around the world have stripped the Sackler name from their buildings and programs in a show of solidarity, but aside from large fines, the family remains largely unpunished.
It is indeed a sign of the times we live in that the boundless greed of Big Pharma companies everywhere in the world, but especially in the USA, stand in the way of psychedelic therapies to treat addiction becoming mainstream. For such conglomerates, it is simply not worth it: if they can create a steady stream of revenue from legal black market drug substitutes such as, for example, methadone or buprenorphine or Subutex, which you have to take every day and which are incredibly hard to taper off, how could a plant medicine such as ibogaine, which you only have to take once or twice to successfully break the cycle of addiction stand a chance? It is therefore up to us here at Tabula Rasa Retreat, and other leading psychedelic therapy centres to continue our work in countries where ibogaine enjoys a decriminalized, unregulated status; similarly, it is the responsibility of the psychedelic treatment communities to keep raising awareness and pushing for the legalization of psychedelic plant medicines wherever and however we can, in a hope that, in this deeply fractured society, humane considerations and good sense may eventually trump the force of rampant corporate greed. Here’s to that eventual sea change. Stay strong, safe and informed.