America’s staggering opioid epidemic, the secretive family making billions from the crisis, and how Congress undermined efforts to restrict the flow of pain pills that have led to tens of thousands of deaths. President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis has said, quote, “America is enduring a death toll equal to September 11th every three weeks.”
But this week, his nominee for drug czar, Republican Congressmember Tom Marino, had to withdraw from consideration, after a Washington Post/60 Minutes investigation found he led a drug industry-backed effort to pass a law that weakened the U.S. Drug Enforcement Administration’s ability to crack down on addictive opioids and keep them off the black market. The Ensuring Patient Access and Effective Drug Enforcement Act passed in 2016. It made it nearly impossible for the Drug Enforcement Administration to intervene in cases where large, suspicious shipments of opioids are delivered to pharmacies bound for the black market. The drug industry lobbied heavily to win passage of the bill, contributing $1.5 million to its 23 congressional co-sponsors. Marino alone accepted nearly $100,000 in campaign cash from the industry.
Christopher Glazek talking:
the Sackler family is very interesting, because, in some ways, it’s extremely public, and then, in other ways, it’s extremely private. So, you’ll see their name on university campuses. Almost every Ivy League school has an institute or a museum named for the Sacklers. like at Yale, at Tufts, at Columbia, at NYU, at Cornell, at King’s College London, at Edinburgh, at Sussex. I mean, the list really goes on and on and on. And in the museum world, too. I mean, there’s named rooms or wings for the Sacklers at the Guggenheim, at the Louvre, at the Tate, at the Met. You know, so people know the Sackler name. But the Sacklers themselves are rarely interviewed. They basically never give interviews. They’re rarely seen in public. And almost nobody in the world, in the art world or in the world of higher education, understands that the major source of their fortune is OxyContin. And one reason for that is that the Sacklers never put their name on their company, never put their name on their product.
So, you know, as you mentioned, I mean, the reason I wanted to do the piece, we have an opioid crisis in this country, and more than 200,000 people have died from prescription drugs since OxyContin was released in 1996, and w have an accountability crisis also. You know, we tend to think of big social problems, like drug epidemics, as the product of these large, impersonal forces that are hard to understand. And there’s some truth to that. But that can also distract from the fact that a lot of social problems also have their origins in actions taken by individuals. So, that was something I wanted to shine a light on.
I had read quite a bit about Purdue Pharma, which had manufactured OxyContin and which, in 2007, had to plead guilty to criminal charges for what was called criminally misbranding a prescription drug. And they had to pay a huge fine, and three of their top executives went down. And there had been a ton of writing about that, but almost no writing about the fact that the company was actually 100 percent owned by one family, and that family filled more than half of the board seats and actually supplied top executives for the company.
You know, one thing that kind of emerged is that when they signed onto this huge settlement, which got a ton of press in 2007, it seemed like the top leaders of the company took the fall, because the CEO at the time had to plead guilty to a misdemeanor. But he wasn’t the CEO during the period covered by the settlement or during the crucial period of OxyContin’s promotion and marketing. During that period, the top executive was actually a member of the Sackler family who owned the company. And yet the Sackler name appeared nowhere in the guilty plea. It was like a hundred pages. It appeared all over this other document that was attached, which was a nonprosecution agreement. And so, basically, the government said, “We’re not going to prosecute any of these 200 entities related to the Sackler family.”
the Sacklers were basically three brothers from Brooklyn who were—came from a Jewish immigrant family. And they got their start, really—I mean, the eldest brother, Arthur Sackler—in medical advertising. So he was a really important pioneer in the field of medical, and specifically pharmaceutical, advertising. He was one of the first people ever inducted into the Medical Advertising Hall of Fame, actually.
So, basically, when he came on the scene in the ’40s, there really wasn’t much pharmaceutical advertising. There were these door-to-door salesmen. They were called “detail men,” and they would basically try to push their drugs on doctors. What Arthur realized is that you could use print advertising to reach a much larger number of doctors more efficiently. And he was actually the first person to convince the Journal of American Medicine to insert a color brochure advertising a particular drug, which, at that time, was an antibiotic—and then actually got involved in this big scandal about overprescription of antibiotics, you know, another public health problem. His big, huge first influx of cash came with Valium, because he was the one who designed the marketing campaign for Roche, which was the manufacturer, and he made Valium the most widely prescribed drug in America.
So the trick, basically, was that, you know, Valium—there was another drug that had already been on the market that was the same as Valium. It was called Librium. I mean, almost indistinguishable. And so it was like this big question: Well, how are we going to market this one? Librium had been marketed pretty narrowly for a specific anxiety function. His idea was to take Valium, a new drug with a new name, and market it for every kind of problem. And so he kind of—they played with this concept called “psychic tension,” which was purported to be the source of indigestion, of depression, of sleep problems, of restless leg syndrome.
It was kind of like what we now think of maybe as stress. You know, so he was, in this way, able to vastly expand the range of potential patients and indications, and, in that way, made the first $100 million drug.
it was used by people who were suffering kind of what are called “somatic problems,” so different kind of physical manifestations which may or may not have their root in something related to anxiety. Librium was narrowly targeted to people who had like a specific kind of anxiety issue, which at that time was not quite the thing that it is today. So Valium was prescribed much, much more than Librium. And it became, actually, the most prescribed medication of all time, you know, at that time.
Arthur also became a huge art collector, kind of established the family’s foothold in the art world. And throughout his entire life, he had actually passed on jobs and businesses to his younger brothers. So he was involved in the purchase of this really tiny pharmaceutical company in 1952 which was called Purdue Pharma, which was on its last legs. It had basically been a kind of patent medicine peddler. It had this drink called Gray’s Glycerin Tonic, which was—you know, in the patent medicine era, it was also marketed for all kinds of purposes—if you have a headache, if you have sex problems, if you have whatever problem. So, they bought this kind of shell, financially troubled shell.
And for years and years, Purdue Pharma didn’t really—wasn’t a major player in the pharmaceutical world. It had one really good product, which was Betadine, which it acquired in the ’60s, which was a disinfectant. And they kind of had this great fortune of acquiring the rights to Betadine just as the Vietnam War was amping up. So the government had bought huge quantities of Betadine to treat wounded soldiers. But still, you know, a midget in the pharma scene.
Then they got into the pain business, and that’s when the real money started flowing in. And they developed—you know, so the kind of company lore is that there was a doctor in London—because some of the family members moved to London—and who was associated with the hospice movement. And they said, “You have a time-release asthma pill that isn’t really selling very much. What if you made a time-release morphine pill?” And they said, “You know, we have these hospice patients who have these IVs, and it’s hard to give them enough pain medication to sleep through the night.” And so, he said, you know, “A time-release morphine pill could really be transformational.” So they made this, and it came out in the United States in 1984 as MS-Contint, which is kind of the predecessor of OxyContin. And it was targeted exclusively at the cancer market. And really, it was an amazing drug. It helped cancer patients sleep through the night without needing to redose. And, you know, addiction didn’t matter if you’re a terminal cancer patient.
There was a problem with MS-Contin: Its patent was going to expire in the ’90s, and the company didn’t have anything to replace, and that was really the company’s, you know, golden goose. So, basically, younger relatives of Arthur’s at the company, other executives at the company were brainstorming: What can we do about MS-Contin having its patent expire? And they said, “Well, what if we created a new time-release pain pill, but we don’t use morphine, we use another derivative of the poppy plant, oxycodone, and we create a time-release oxycodone pill, and instead of marketing it to cancer patients, we market it to 30 million back pain patients, we market it to people with menstrual problems, we market it to people with toothaches? So, what if we take this powerful drug that we know works for this one purpose, but then kind of give it to everybody?” And that was the billion-dollar idea, the $14 billion idea, that gave the Sacklers what is likely the largest fortune in pharmaceutical history.
– confusion between oxycodeine, oxycodone and the OxyContin.
I talked to employees at the company, you know, and there’s some reference to this also in some internal company documents. OxyContin and MS-Contin—one’s morphine, one’s oxycodone—they’re basically the same. They’re kind of—like Librium and Valium, they’re virtually indistinguishable. But morphine had a stigma, which is that people thought if you’re on morphine, that means you’re dying. And ordinary doctors, general practitioners, family practitioners, they weren’t going to prescribe morphine. Like that sounded like some really serious stuff. Oxycodone, though, had a very different brand, because it was in Percocet and Percodan. And so, thousands of doctors, you know, ordinary doctors, general practitioners, would prescribe Percocet for injuries. And so they were familiar with it, and they were comfortable with it. But Percocet has a very small dose of oxycodone in it.
As you allude to, there was another confusion: People thought that “oxycodone” sounded like “codeine.” And codeine is another weak opioid. Doesn’t sound like morphine. Morphine sounds strong. So, they were basically playing on this misconception that doctors had, and they acknowledged this when they had to plead guilty, that doctors thought that oxycodone was weak, even though it’s actually more powerful than morphine.
the opioid epidemic has many different actors in different parts of the chain. And this investigation focused on the distributors, who are basically the people who carry the opioid pills from the manufacturer and give it to specific pharmacies. And there’s been a lot of litigation focused on them. Some thought that, you know, they knew, that they had had reason to know, that certain pharmacies maybe were involved in diversion. And they have this ongoing struggle with the DEA about what’s appropriate to seize and under what circumstances.
In my view, what you want to do when you look at the opioid crisis is look at where the real profits are. And it’s actually not with the distributors. It’s really with the manufacturers. And, you know, people kind of think they’re following the money. And McKesson and Cardinal are these huge, giant companies. But you really want to follow the margin, because that’s going to tell you who’s controlling a market and who’s kind of like a minor toll taker. And the fact is that the manufacturer, Purdue Pharma, which really created this market, created all this business for Cardinal and McKesson, etc., they had much more detailed information about where pills were going. They knew down to the prescription level, you know, what doctors were prescribing what. The distributors didn’t know that. The distributors—all distributors knew was about pharmacies. So they really are just one part of this giant chain. But Purdue had the aerial vision of the entire thing. Purdue is based in Stamford, Connecticut.
we live in a billionaire democracy, and billionaires exert tremendous control not only over business, but also over the arts and higher education and over politics. And, you know, different members of the Sackler family have very different political leanings. Richard Sackler, who was the top executive during the time that OxyContin was mainly promoted, has given money to a variety of anti-Muslim groups. He’s actually given money to several groups designated hate groups by the Southern Poverty Law Center. He’s also given money to this organization called True the Vote, which was the original source for Trump’s claim that 3 million illegal immigrants voted in the election. You know, if you go what appears to be his Facebook page or his YouTube page, he seems to have some affection for Geert Wilders in the Netherlands and kind of Brexit types, so a lot of kind of—he also seems to be a gold bug, very concerned about inflation and things like that. Other members of the Sackler family are not right-leaning. Some are them are quite left-leaning, actually. But Richard’s foundation, you know, and the money that came from OxyContin has gone to a number of causes that raise some eyebrows.
drug czar change by Trump. it’s quite a complex issue. Whether it really is the most important aspect of the opioid crisis is something that one could debate. It does seem pretty galling, though, that Trump nominated Marino, who was so involved in this legislation, to be the drug czar. Like you don’t want the fox guarding the chicken coop. So, that did seem pretty outrageous, and it’s a great thing that that has been exposed and brought to light.
But the key point about the opioid crisis is that what triggers addiction—you know, people talk a lot about diversion, the black market, drug dealers. That’s part of it. It’s kind of a small part. Most people become addicted to OxyContin by just taking it as prescribed. So, really, it’s the number of prescriptions, who is driving the prescriptions, and the total volume of opioid that’s circulating through the market.
OxyContin has run into a lot of regulatory problems in the United States and a lot of bad press. And, you know, kind of borrowing from the Big Tobacco playbook, it’s like when you run into problems in your home market and you’ve got all these lawsuits, maybe it’s time now to go abroad. And that seems to be what the Sackler family is doing. They have all these international companies that are related to Purdue which sell pain products abroad.
And, you know, the CDC, in this country, actually issued this warning last year, basically saying that we’re not sure that opioids are good for long-term pain at all, that maybe opioid use is not an effective treatment for chronic pain, because it changes your pain threshold and, over time, it becomes less and less effective. So, I mean, this was like a really—you know, a kind of death blow for the chronic pain market here. But now you have the company going abroad, kind of reprising all of its greatest hits from the ’90s. They released a study in Colombia saying that we believe that more than 40 percent of the population suffers from chronic pain.
the big question is complicity, and it’s a really tricky question. You know, is Tufts University complicit in the opioid epidemic because they’ve taken huge amounts of money from the Sacklers? You know, is a third-generation Sackler heir, who maybe is a documentary filmmaker or restaurateur—do they have some burden or complicity to address here? And I think that’s a complicated question. But the solution to complexity is not secrecy. And what we’ve seen again and again is that people who have taken Sackler money, and the Sacklers themselves, have concealed their connection to OxyContin. And that cannot be the solution to the problem.
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Christopher Glazek
journalist and editor at Esquire.
— source democracynow.org 2017-10-20