Opioid overdose deaths are rising as over 202,000 Americans died from opioid overdoses between 2002 and 2015, and more than 70,000 died in 2017.1 Drug overdoses are now the leading cause of death among Americans under the age of 50,2 and chronic use accounts for 20 percent of the increase in male unemployment.3
Narcotic pain relievers place an enormous economic burden on society, costing an estimated $ 504 billion each year.4 As noted by Dr. Tom Frieden,5 former director of the U.S. Centers for Disease Control and Prevention (CDC), “We know of no other medication routinely used for nonfatal conditions that kills patients so frequently.”
Despite these risks, including birth defects and risks of addiction, nearly one-third of women of childbearing age are prescribed opioids,6 and more than 14 percent of pregnant women are prescribed opioids during their pregnancy.7
In April 2016, the CDC published a paper noting opioids have not been proven safe or effective beyond six weeks of treatment.8 “In fact, several studies have shown that use of opioids for chronic pain may actually worsen pain and functioning, possibly by potentiating pain perception,” the paper states.
In the most recent turn of events, a Massachusetts state court judge ruled to release an unredacted version of a complaint filed in January with the attorney general’s office naming Purdue, eight in the Sackler family and nine others currently or previously associated with the company as defendants.9
Purdue Pharma Seeks to Expand an ‘Attractive Market’
The Sackler family are owners of the pharmaceutical company Purdue Pharma and have a combined fortune estimated at $ 13 billion. The family received nearly $ 4 billion in profits over the past decade from Purdue, in large part due to the burgeoning sales of OxyContin, an opioid developed in the early 1990s and approved by the U.S. Food and Drug Administration (FDA) in 1995.10
The opioid class of drugs also includes morphine and Fentanyl, as well as illicit drugs such as heroin. It’s also been recently reported in the Financial Times11 that the Sackler family owns Rhodes Pharma, “one of the biggest producers of generic opioids, which never before has been linked to the family.”
This company was launched only four months after Purdue Pharma pleaded guilty in 2007 to charges of misbranding with “the intent to defraud and mislead the public,” paying $ 634 million in fines.12 This is 15 percent of what the company paid the Sackler family over the past decade, and from their actions, it’s clear the company has not changed its ways.
According to documents from the claim in Massachusetts, in an effort to continue to profit from addiction, Kathe Sackler and her staff identified millions of opioid addicted people as their next business opportunity. They identified eight ways the company’s experience in getting patients on opioids could now be used to sell treatment for addiction and wrote:13
“It is an attractive market. Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”
Project Tango Considers Narcan
The recently released unredacted files reveal Kathe Sackler’s involvement in a secret plan to expand the business from selling opioids to including treatment for opioid addiction. In these internal documents, she and her staff wrote what they had publicly denied for decades: Addictive opioids and opioid addiction are “naturally linked.”
They determined that becoming an end-to-end pain provider could help increase revenue. This meant they would reverse blaming addiction on untrustworthy patients. Called Project Tango, the patient and clinical rationale for expanding drug sales to treatment for overdose, the company wrote:14
“This can happen to anyone — from a 50-year-old woman with chronic lower back pain to an 18-year-old boy with a sports injury, from the very wealthy to the very poor.”
Project Tango was another way to profit from the opioid crisis. They first considered Suboxone and then moved to considering selling the antidote Narcan to reverse overdoses, calculating it could provide a growing source of income, eventually tripling to net Purdue $ 24 million in sales.15
The complaint claims documents confirm Purdue Pharma saw the opioid epidemic as a money-making opportunity and identified Narcan as a “complementary” and “strategic fit” to their opioid product. Their plan called for studying “long-term script users” to “better understand target end patients” for Narcan.
Eventually the company decided against acquiring the rights to sell Suboxone or Narcan.16 However, while those initiatives appear to have stalled, in January 2018, Richard Sackler was listed as one of six inventors on a patent issued for a reformulation of buprenorphine, shown to help those suffering with opioid addiction.17
Additionally, Purdue Pharma has separately contributed $ 3.4 million to a company working on the production of a low-cost naloxone nasal spray as a cheaper opioid overdose antidote. In other words, Project Tango appears to be in full swing.
Purdue Pharma Claims Persecution for Opioid Crisis, Sackler Blames Addicts
The documents allege the Sackler family engaged in a decade of deception to push OxyContin on doctors and patients despite knowing it was highly addictive, resulting in overdoses and deaths. Purdue Pharma spokesperson Bob Josephson released a statement making it appear Purdue was being persecuted, claiming the unredacted complaint filed in Massachusetts was:18
“[P]art of a continuing effort to single out Purdue, blame it for the entire opioid crisis, and try the case in the court of public opinion rather than the justice system.
Massachusetts seeks to publicly vilify Purdue, its executives, employees and directors while unfairly undermining the important work we have taken to address the opioid addiction crisis by taking out of context snippets from tens of millions of documents and grossly distorting their meaning. The complaint is riddled with demonstrably inaccurate allegations.”
However, in 2001, faced with concern from executives at the company about sales tactics to gain a stronger foothold in the market, the complaint alleges19 Richard Sackler’s “solution to the overwhelming evidence of overdose and death: blame and stigmatize people who became addicted to opioids.” A confidential email from Richard Sackler read:20
“We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.”
In 2007, when the Sacklers agreed to plead guilty to misbranding, they also entered into a series of agreements. They admitted to a Statement of Facts, which stated that for six years they intentionally deceived doctors about OxyContin, and entered a Corporate Integrity Agreement, which required the Sacklers to ensure Purdue would not deceive doctors and patients and promise to comply with rules prohibiting deception.
Under the agreement they were required to complete hours of training, report any deception and certify in writing that they had read and understood the rules. However, since 2007, the complaint alleges Purdue has continued a deceptive sales campaign and directed the company to hire hundreds more sales reps to visit doctors across the country.
Purdue Targeted Prescribers Most Susceptible to Over Prescribing
According to the complaint, multiple times when Purdue Pharma sought information about physicians, they had reason to believe they were inappropriately prescribing OxyContin. Richard Sackler asked for detailed reports of those suspected of misconduct and how much money Purdue netted from those prescriptions.
In 2012, an employee went to the company’s head of sales with a request to alert health insurers of the data the company had collected about doctors suspected of illegally prescribing or abusing OxyContin.21 This list of physicians was codenamed Region Zero. The employee allegedly wrote:22
“it seems to make sense for a number of reasons for us to share the information on Region 0 doctors with payers. At a basic level, it just seems like the right and ethical thing to do.
Doing so could help those companies identify those physicians that may be of a concern, not just with respect to our products, but also other CII and CIII therapies. As a result, if it reduces abuse and diversion of opioids then it seems like something we should be doing.”
The suggestion was rejected. Region Zero remained secret and the employee behind the suggestion left the company a month later. In 2012, Richard Sackler suggested sales results were “bad” and as a result his director of sales should consider firing all sales reps in the Boston district to send a message to the rest.
Although they didn’t fire all the reps, those who failed to meet their sales objectives were placed on probation. The complaint alleges one sales rep was ordered to visit 10 prescribers twice a week to increase prescriptions by 43 percent; another was ordered to increase prescriptions by 62 percent.
Purdue reportedly issued a plan to another sales rep that said,23 “Anticipated Challenges: Dr. trying to cut down on opioid prescribing due to abuse.” “Action Steps: Sell for patients they are willing to Rx opioids … (elderly).”
Purdue Kept a List of ‘Super Core’ Prescribers
The complaint goes on to allege the Sackler family discussed threats to their finances, as data from long-term opioid use indicated danger to patients. Sales dropped and the staff recommended increasing the number of sales visits to doctors.
The company hired global consulting firm McKinsey & Company to recommend strategies to boost sales and polish the image of the company, in order to offset emotional messages from mothers whose children had overdosed.24
McKinsey allegedly urged Purdue to direct sales reps at the most prolific opioid prescribers, “because prescribers in the most prolific group wrote 25 times more OxyContin scripts than the less prolific prescribers.”25 This group of physicians were classified as “Super Core.” Purdue allegedly ordered sales reps to make visits to these prescribers every week.
The complaint claims that within the notes of the sales reps are recorded more than 1,000 visits to providers, in which the reps recommended pitching opioids to elderly patients with ailments such as arthritis. The complaint goes on to describe how the consulting firm recommended sales reps convince doctors to prescribe opioids:26
“McKinsey had reported to Purdue on opportunities to increase prescriptions by convincing doctors that opioids provide ‘freedom’ and ‘peace of mind’ and give patients ‘the best possible chance to live a full and active life.’ McKinsey also suggested sales ‘drivers’ based on the ideas that opioids reduce stress and make patients more optimistic and less isolated.”
Philanthropic Gifts Being Returned
While the Sackler family’s role in the opioid epidemic has been exposed during litigation, historically they have been known for their philanthropic efforts. The family has donated a wing at the Metropolitan Museum of Art, gifted a wing at the Louvre, a courtyard at Victoria and Albert Museum, a center for feminist art at the Brooklyn Museum and an Arts Education Center at the Guggenheim Museum.27
Their profits from Purdue Pharma have funded educational programs, medical research and professorships at Cornell, Stanford, and Columbia Universities, Massachusetts Institute of Technology and Yale Cancer Center.28
However, as the family faces continued pressure and litigation following complaints and lawsuits surrounding their role in the growing opioid crisis, many of these same institutions are facing their own pressure to return the gifts and remove the family name from their institutions.
Patrick Radden Keefe, investigative journalist for The New Yorker, notes that, considering the depth and breadth of the family donations, there is a conspicuous lack of philanthropic donation in funding addiction treatment.29 Daniel Weiss, president and CEO of the Metropolitan Museum of Art, suggests they will revisit the Sacklers’ support, saying:30
“The Sackler family has been connected with the Met for more than a half century. The family is a large extended group, and their support of the Met began decades before the opioid crisis. The Met is currently engaging in a further review of our detailed gift acceptance policies, and we will have more to report in due course.”
Struggling With Opioid Addiction? Please Seek Help
Regardless of the brand of opioid, it’s vitally important to realize they are extremely addictive drugs and not meant for long-term use for nonfatal conditions. Chemically, opioids are similar to heroin. If you wouldn’t consider shooting up heroin for a toothache or backache, seriously reconsider taking an opioid to relieve this type of pain.
The misconception that opioids are harmless pain relievers has killed hundreds of thousands, and destroyed the lives of countless more. In many cases you’ll be able to control pain without using medications. In my previous article, “Treating Pain Without Drugs,” I discuss several approaches to consider that may be used separately or in combination.
If you’ve been on an opioid for more than two months, or if you find yourself taking a higher dosage, or taking the drug more often, you may already be addicted. Resources where you can find help include:
- Your workplace Employee Assistance Program
- Contact the Substance Abuse Mental Health Service Administration31 24 hours a day at 1-800-622-HELP