The Secretive Family Making Billions From the Opioid Crisis
You’re aware America is under
siege, fighting an opioid crisis that has exploded into a public-health
emergency. You’ve heard of OxyContin, the pain medication to which
countless patients have become addicted. But do you know that the
company that makes Oxy and reaps the billions of dollars in profits it
generates is owned by one family?
Oct 16, 2017
The newly installed Sackler Courtyard at
London’s Victoria and Albert Museum is one of the most glittering places
in the developed world. Eleven thousand white porcelain tiles, inlaid
like a shattered backgammon board, cover a surface the size of six
tennis courts. According to the V&A’s director, the regal setting is
intended to serve as a “living room for London,” by which he presumably
means a living room for Kensington, the museum’s neighborhood, which is
among the world's wealthiest. In late June, Kate Middleton, the Duchess
of Cambridge, was summoned to consecrate the courtyard, said to be the
earth's first outdoor space made of porcelain; stepping onto the ceramic
expanse, she silently mouthed, “Wow.”
The
Sackler Courtyard is the latest addition to an impressive portfolio.
There’s the Sackler Wing at New York’s Metropolitan Museum of Art, which
houses the majestic Temple of Dendur, a sandstone shrine from ancient
Egypt; additional Sackler wings at the Louvre and the Royal Academy;
stand-alone Sackler museums at Harvard and Peking Universities; and
named Sackler galleries at the Smithsonian, the Serpentine, and Oxford’s
Ashmolean. The Guggenheim in New York has a Sackler Center, and the
American Museum of Natural History has a Sackler Educational Lab.
Members of the family, legendary in museum circles for their pursuit of
naming rights, have also underwritten projects of a more modest
caliber—a Sackler Staircase at Berlin’s Jewish Museum; a Sackler
Escalator at the Tate Modern; a Sackler Crossing in Kew Gardens. A
popular species of pink rose is named after a Sackler. So is an
asteroid.
The Sackler name is no less prominent among the
emerald quads of higher education, where it’s possible to receive
degrees from Sackler schools, participate in Sackler colloquiums, take
courses from professors with endowed Sackler chairs, and attend annual
Sackler lectures on topics such as theoretical astrophysics and human
rights. The Sackler Institute for Nutrition Science supports research on
obesity and micronutrient deficiencies. Meanwhile, the Sackler
institutes at Cornell, Columbia, McGill, Edinburgh, Glasgow, Sussex, and
King’s College London tackle psychobiology, with an emphasis on early
childhood development.
The Sacklers’
philanthropy differs from that of civic populists like Andrew Carnegie,
who built hundreds of libraries in small towns, and Bill Gates, whose
foundation ministers to global masses. Instead, the family has donated
its fortune to blue-chip brands, braiding the family name into the
patronage network of the world’s most prestigious, well-endowed
institutions. The Sackler name is everywhere, evoking automatic
reverence; the Sacklers themselves, however, are rarely seen.
The descendants of Mortimer and Raymond Sackler, a
pair of psychiatrist brothers from Brooklyn, are members of a
billionaire clan with homes scattered across Connecticut, London, Utah,
Gstaad, the Hamptons, and, especially, New York City. It was not until
2015 that they were noticed by Forbes, which added them to the
list of America’s richest families. The magazine pegged their wealth,
shared among twenty heirs, at a conservative $14 billion. (Descendants
of Arthur Sackler, Mortimer and Raymond’s older brother, split off
decades ago and are mere multi-millionaires.) To a remarkable degree,
those who share in the billions appear to have abided by an oath of
omertà: Never comment publicly on the source of the family’s wealth.
That may be because the greatest part of that $14 billion fortune tallied by Forbes
came from OxyContin, the narcotic painkiller regarded by many
public-health experts as among the most dangerous products ever sold on a
mass scale. Since 1996, when the drug was brought to market by Purdue
Pharma, the American branch of the Sacklers’ pharmaceutical empire, more
than two hundred thousand people in the United States have died from
overdoses of OxyContin and other prescription painkillers. Thousands
more have died after starting on a prescription opioid and then
switching to a drug with a cheaper street price, such as heroin. Not all
of these deaths are related to OxyContin—dozens of other painkillers,
including generics, have flooded the market in the past thirty years.
Nevertheless, Purdue Pharma was the first to achieve a dominant share of
the market for long-acting opioids, accounting for more than half of
prescriptions by 2001.
According to the Centers for Disease Control,
fifty-three thousand Americans died from opioid overdoses in 2016, more
than the thirty-six thousand who died in car crashes in 2015 or the
thirty-five thousand who died from gun violence that year. This past
July, Donald Trump’s Commission on Combating Drug Addiction and the
Opioid Crisis, led by New Jersey governor Chris Christie, declared that
opioids were killing roughly 142 Americans each day, a tally vividly
described as “September 11th every three weeks.” The epidemic has also
exacted a crushing financial toll:
According to a study published by the
American Public Health Association, using data from 2013—before the
epidemic entered its current, more virulent phase—the total economic
burden from opioid use stood at about $80 billion, adding together
health costs, criminal-justice costs, and GDP loss from drug-dependent
Americans leaving the workforce. Tobacco remains, by a significant
multiple, the country’s most lethal product, responsible for some
480,000 deaths per year. But although billions have been made from
tobacco, cars, and firearms, it’s not clear that any of those
enterprises has generated a family fortune from a single product that
approaches the Sacklers’ haul from OxyContin.
Even
so, hardly anyone associates the Sackler name with their company’s lone
blockbuster drug. “The Fords, Hewletts, Packards, Johnsons—all those
families put their name on their product because they were proud,” said
Keith Humphreys, a professor of psychiatry at Stanford University School
of Medicine who has written extensively about the opioid crisis. “The
Sacklers have hidden their connection to their product. They don’t call
it ‘Sackler Pharma.’ They don’t call their pills ‘Sackler pills.’ And
when they’re questioned, they say, ‘Well, it’s a privately held firm,
we’re a family, we like to keep our privacy, you understand.’ ”
To the extent that the Sacklers have cultivated a
reputation, it’s for being earnest healers, judicious stewards of
scientific progress, and connoisseurs of old and beautiful things. Few
are aware that during the crucial period of OxyContin’s development and
promotion, Sackler family members actively led Purdue’s day-to-day
affairs, filling the majority of its board slots and supplying top
executives. By any assessment, the family’s leaders have pulled off
three of the great marketing triumphs of the modern era: The first is
selling OxyContin; the second is promoting the Sackler name; and the
third is ensuring that, as far as the public is aware, the first and the
second have nothing to do with one another.
If
you head north on I-95 through Stamford, Connecticut, you will spot, on
the left, a giant misshapen glass cube. Along the building’s top edge,
white lettering spells out ONE STAMFORD FORUM. No markings visible from
the highway indicate the presence of the building’s owner and chief
occupant, Purdue Pharma.
Originally known as Purdue Frederick, the first
iteration of the company was founded in 1892 on New York’s Lower East
Side as a peddler of patent medicines. For decades, it sustained itself
with sales of Gray’s Glycerine Tonic, a sherry-based liquid of “broad
application” marketed as a remedy for everything from anemia to
tuberculosis. The company was purchased in 1952 by Arthur Sackler,
thirty-nine, and was run by his brothers, Mortimer, thirty- six, and
Raymond, thirty-two. The Sackler brothers came from a family of Jewish
immigrants in Flatbush, Brooklyn. Arthur was a headstrong and ambitious
provider, setting the tone—and often choosing the path—for his younger
brothers. After attending medical school on Arthur’s dime, Mortimer and
Raymond followed him to jobs at the Creedmoor psychiatric hospital in
Queens. There, they coauthored more than one hundred studies on the
biochemical roots of mental illness. The brothers’ research was
promising—they were among the first to identify a link between psychosis
and the hormone cortisone—but their findings were mostly ignored by
their professional peers, who, in keeping with the era, favored a
Freudian model of mental illness.
Concurrent
with his psychiatric work, Arthur Sackler made his name in
pharmaceutical advertising, which at the time consisted almost
exclusively of pitches from so-called “detail men” who sold drugs to
doctors door-to-door. Arthur intuited that print ads in medical journals
could have a revolutionary effect on pharmaceutical sales, especially
given the excitement surrounding the “miracle drugs” of the
1950s—steroids, antibiotics, antihistamines, and psychotropics. In 1952,
the same year that he and his brothers acquired Purdue, Arthur became
the first adman to convince The Journal of the American Medical Association, one of the profession’s most august publications, to include a color advertorial brochure.
In the 1960s, Arthur was contracted by Roche to
develop an advertising strategy for a new antianxiety medication called
Valium. This posed a challenge, because the effects of the medication
were nearly indistinguishable from those of Librium, another Roche
tranquilizer that was already on the market. Arthur differentiated
Valium by audaciously inflating its range of indications. Whereas
Librium was sold as a treatment for garden- variety anxiety, Valium was
positioned as an elixir for a problem Arthur christened “psychic
tension.” According to his ads, psychic tension, the forebear of today’s
“stress,” was the secret culprit behind a host of somatic conditions,
including heartburn, gastrointestinal issues, insomnia, and restless-leg
syndrome. The campaign was such a success that for a time Valium became
America’s most widely prescribed medication—the first to reach more
than $100 million in sales. Arthur, whose compensation depended on the
volume of pills sold, was richly rewarded, and he later became one of
the first inductees into the Medical Advertising Hall of Fame.
As
Arthur’s fortune grew, he turned his acquisitive instincts to the art
market, quickly amassing the world’s largest private collection of
ancient Chinese artifacts. According to a memoir by Marietta Lutze, his
second wife, collecting, exhibiting, owning, and donating art fed
Arthur’s “driving necessity for prestige and recognition.” Rewarding at
first, collecting soon became a mania that took over his life. “Boxes of
artifacts of tremendous value piled up in numerous storage locations,”
she wrote, “there was too much to open, too much to appreciate; some
objects known only by a packing list.” Under an avalanche of “ritual
bronzes and weapons, mirrors and ceramics, inscribed bones and archaic
jades,” their lives were “often in chaos.” “Addiction is a curse,” Lutze
noted, “be it drugs, women, or collecting.”
When Arthur donated his art and money to museums,
he often imposed onerous terms. According to a memoir written by Thomas
Hoving, the Met director from 1967 to 1977, when Arthur established the
Sackler Gallery at the Metropolitan Museum of Art to house Chinese
antiquities, in 1963, he required the museum to collaborate on a
byzantine tax-avoidance maneuver. In accordance with the scheme, the
museum first sold Arthur a large quantity of ancient artifacts
at the deflated 1920s prices for which they had originally been
acquired. Arthur then donated back the artifacts at 1960s
prices, in the process taking a tax deduction so hefty that it likely
exceeded the value of his initial donation.
Three years later, in
connection with another donation, Arthur negotiated an even more unusual
arrangement. This time, the Met opened a secret chamber above the
museum’s auditorium to provide Arthur with free storage for some five
thousand objects from his private collection, relieving him of the
substantial burden of fire protection and other insurance costs. (In an
email exchange, Jillian Sackler, Arthur’s third wife, called Hoving’s
tax-deduction story “fake news.” She also noted that New York’s attorney
general conducted an investigation into Arthur’s dealings with the Met
and cleared him of wrongdoing.)
In 1974, when
Arthur and his brothers made a large gift to the Met—$3.5 million, to
erect the Temple of Dendur—they stipulated that all museum signage,
catalog entries, and bulletins referring to objects in the newly opened
Sackler Wing had to include the names of all three brothers, each
followed by “M.D.” (One museum official quipped, “All that was missing
was a note of their office hours.”)
Hoving said that the Met hoped that Arthur would
eventually donate his collection to the museum, but over time Arthur
grew disgruntled over a series of rankling slights. For one, the Temple
of Dendur was being rented out for parties, including a dinner for the
designer Valentino, which Arthur called “disgusting.” According to Met
chronicler Michael Gross, he was also denied that coveted ticket of
arrival, a board seat. (Jillian Sackler said it was Arthur who rejected
the board seat, after repeated offers by the museum.) In 1982, in a bad
breakup with the Met, Arthur donated the best parts of his collection,
plus $4 million, to the Smithsonian in Washington, D. C.
Arthur's
younger brothers, Mortimer and Raymond, looked so much alike that when
they worked together at Creedmoor, they fooled the staff by pretending
to be one another. Their physical similarities did not extend to their
personalities, however. Tage Honore, Purdue’s vice-president of
discovery of research from 2000 to 2005, described them as “like day and
night.” Mortimer, said Honore, was “extroverted—a ‘world man,’ I would
call it.” He acquired a reputation as a big-spending, transatlantic
playboy, living most of the year in opulent homes in England,
Switzerland, and France. (In 1974, he renounced his U. S. citizenship to
become a citizen of Austria, which infuriated his patriotic older
brother.) Like Arthur, Mortimer became a major museum donor and married
three wives over the course of his life.
Mortimer had his own feuds with the Met. On his
seventieth birthday, in 1986, the museum agreed to make the Temple of
Dendur available to him for a party but refused to allow him to
redecorate the ancient shrine: Together with other improvements,
Mortimer and his interior designer, flown in from Europe, had hoped to
spiff up the temple by adding extra pillars. Also galling to Mortimer
was the sale of naming rights for one of the Sackler Wing’s balconies to
a donor from Japan. “They sold it twice,” Mortimer fumed to a reporter
from New York magazine. Raymond, the youngest brother, cut a
different figure—“a family man,” said Honore. Kind and mild-mannered, he
stayed with the same woman his entire life. Lutze concluded that
Raymond owed his comparatively serene nature to having missed the worst
years of the Depression. “He had summer vacations in camp, which Arthur
never had,” she wrote. “The feeling of the two older brothers about the
youngest was, ‘Let the kid enjoy himself.’ ”
Raymond
led Purdue Frederick as its top executive for several decades, while
Mortimer led Napp Pharmaceuticals, the family’s drug company in the UK.
(In practice, a family spokesperson said, “the brothers worked closely
together leading both companies.”) Arthur, the adman, had no official
role in the family’s pharmaceutical operations. According to Barry
Meier’s Pain Killer, a prescient account of the rise of
OxyContin published in 2003, Raymond and Mortimer bought Arthur’s share
in Purdue from his estate for $22.4 million after he died in 1987. In an
email exchange, Arthur’s daughter Elizabeth Sackler, a historian of
feminist art who sits on the board of the Brooklyn Museum and supports a
variety of progressive causes, emphatically distanced her branch of the
family from her cousins’ businesses. “Neither I, nor my siblings, nor
my children have ever had ownership in or any benefit whatsoever from
Purdue Pharma or OxyContin,” she wrote, while also praising “the breadth
of my father’s brilliance and important works.” Jillian, Arthur’s
widow, said her husband had died too soon: “His enemies have gotten the
last word.”
The Sacklers have
been millionaires for decades, but their real money—the painkiller
money—is of comparatively recent vintage. The vehicle of that fortune
was OxyContin, but its engine, the driving power that made them so many
billions, was not so much the drug itself as it was Arthur’s original
marketing insight, rehabbed for the era of chronic-pain management. That
simple but profitable idea was to take a substance with addictive
properties—in Arthur’s case, a benzo; in Raymond and Mortimer’s case, an
opioid—and market it as a salve for a vast range of indications.
In
the years before it swooped into the pain-management business, Purdue
had been a small industry player, specializing in over-the-counter
remedies like ear-wax remover and laxatives. Its most successful
product, acquired in 1966, was Betadine, a powerful antiseptic purchased
in industrial quantities by the U. S. government to prevent infection
among wounded soldiers in Vietnam. The turning point, according to
company lore, came in 1972, when a London doctor working for Cicely
Saunders, the Florence Nightingale of the modern hospice movement,
approached Napp with the idea of creating a timed-release morphine pill.
A long-acting morphine pill, the doctor reasoned, would allow dying
cancer patients to sleep through the night without an IV. At the time,
treatment with opioids was stigmatized in the United States, owing in
part to a heroin epidemic fueled by returning Vietnam veterans.
“Opiophobia,” as it came to be called, prevented skittish doctors from
treating most patients, including nearly all infants, with strong pain
medication of any kind. In hospice care, though, addiction was not a
concern: It didn’t matter whether terminal patients became hooked in
their final days. Over the course of the seventies, building on a
slow-release technology the company had already developed for an asthma
medication, Napp created what came to be known as the “Contin” system.
In 1981, Napp introduced a timed-release morphine pill in the UK; six
years later, Purdue brought the same drug to market in the U. S. as MS
Contin.
MS Contin quickly became the gold standard for pain
relief in cancer care. At the same time, a number of clinicians
associated with the burgeoning chronic-pain movement started advocating
the use of powerful opioids for noncancer conditions like back pain and
neuropathic pain, afflictions that at their worst could be debilitating.
In 1986, two doctors from Memorial Sloan Kettering hospital in New York
published a fateful article in a medical journal that purported to
show, based on a study of thirty-eight patients, that long-term opioid
treatment was safe and effective so long as patients had no history of
drug abuse. Soon enough, opioid advocates dredged up a letter to the
editor published in The New England Journal of Medicine in
1980 that suggested, based on a highly unrepresentative cohort, that the
risk of addiction from long-term opioid use was less than 1 percent.
Though ultimately disavowed by its author, the letter ended up getting
cited in medical journals more than six hundred times.
As the country was reexamining pain, Raymond’s
eldest son, Richard Sackler, was searching for new applications for
Purdue’s timed-release Contin system. “At all the meetings, that was a
constant source of discussion—‘What else can we use the Contin system
for?’ ” said Peter Lacouture, a senior director of clinical research at
Purdue from 1991 to 2001. “And that’s where Richard would fire some
ideas—maybe antibiotics, maybe chemotherapy—he was always out there
digging.” Richard’s spitballing wasn’t idle blather. A trained
physician, he treasured his role as a research scientist and appeared as
an inventor on dozens of the company’s patents (though not on the
patents for OxyContin). In the tradition of his uncle Arthur, Richard
was also fascinated by sales messaging. “He was very interested in the
commercial side and also very interested in marketing approaches,” said
Sally Allen Riddle, Purdue’s former executive director for product
management. “He didn’t always wait for the research results.” (A Purdue
spokesperson said that Richard “always considered relevant scientific
information when making decisions.”)
Perhaps the
most private member of a generally secretive family, Richard appears
nowhere on Purdue’s website. From public records and conversations with
former employees, though, a rough portrait emerges of a testy eccentric
with ardent, relentless ambitions. Born in 1945, he holds degrees from
Columbia University and NYU Medical School. According to a bio on the
website of the Koch Institute for Integrative Cancer Research at MIT,
where Richard serves on the advisory board, he started working at Purdue
as his father’s assistant at age twenty-six before eventually leading
the firm’s R&D division and, separately, its sales and marketing
division. In 1999, while Mortimer and Raymond remained Purdue’s co-CEOs,
Richard joined them at the top of the company as president, a position
he relinquished in 2003 to become cochairman of the board. The few
publicly available pictures of him are generic and sphinxlike—a white
guy with a receding hairline. He is one of the few Sacklers to
consistently smile for the camera. In a photo on what appears to be his
Facebook profile, Richard is wearing a tan suit and a pink tie, his
right hand casually scrunched into his pocket, projecting a jaunty
charm. Divorced in 2013, he lists his relationship status on the profile
as “It’s complicated.”
When Purdue eventually pleaded guilty to felony charges in 2007 for criminally “misbranding” OxyContin, it acknowledged exploiting doctors’ misconceptions about oxycodone’s strength.
Richard’s political contributions have gone mostly
to Republicans—including Strom Thurmond and Herman Cain—though at times
he has also given to Democrats. (His ex-wife, Beth Sackler, has given
almost exclusively to Democrats.) In 2008, he wrote a letter to the
editor of The Wall Street Journal denouncing Muslim support for
suicide bombing, a concern that seems to persist: Since 2014, his
charitable organization, the Richard and Beth Sackler Foundation, has
donated to several anti-Muslim groups, including three organizations
classified as hate groups by the Southern Poverty Law Center. (The
family spokesperson said, “It was never Richard Sackler’s intention to
donate to an anti-Muslim or hate group.”) The foundation has also
donated to True the Vote, the “voter-fraud watchdog” that was the
original source for Donald Trump’s inaccurate claim that three million
illegal immigrants voted in the 2016 election.
Former
employees describe Richard as a man with an unnerving intelligence,
alternately detached and pouncing. In meetings, his face was often glued
to his laptop. “This was pre-smartphone days,” said Riddle. “He’d be
typing away and you would think he wasn’t even listening, and then all
of the sudden his head would pop up and he’d be asking a very pointed
question.” He was notorious for peppering subordinates with unexpected,
rapid-fire queries, sometimes in the middle of the night. “Richard had
the mind of someone who’s going two hundred miles an hour,” said
Lacouture. “He could be a little bit disconnected in the way he would
communicate. Whether it was on the weekend or a holiday or a Christmas
party, you could always expect the unexpected.”
Richard
also had an appetite for micromanagement. “I remember one time he
mailed out a rambling sales bulletin,” said Shelby Sherman, a Purdue
sales rep from 1974 to 1998. “And right in the middle, he put in, ‘If
you’re reading this, then you must call my secretary at this number and
give her this secret password.’ He wanted to check and see if the reps
were reading this shit. We called it ‘Playin’ Passwords.’ ” According to
Sherman, Richard started taking a more prominent role in the company
during the early 1980s. “The shift was abrupt,” he said. “Raymond was
just so nice and down-to-earth and calm and gentle.” When Richard came,
“things got a lot harder. Richard really wanted Purdue to be big—I mean really big.”
To effectively capitalize on the chronic-pain
movement, Purdue knew it needed to move beyond MS Contin. “Morphine had a
stigma,” said Riddle. “People hear the word and say, ‘Wait a minute,
I’m not dying or anything.’ ” Aside from its terminal aura, MS Contin
had a further handicap: Its patent was set to expire in the late
nineties. In a 1990 memo addressed to Richard and other executives,
Purdue’s VP of clinical research, Robert Kaiko, suggested that the
company work on a pill containing oxycodone, a chemical similar to
morphine that was also derived from the opium poppy. When it came to
branding, oxycodone had a key advantage: Although it was 50 percent
stronger than morphine, many doctors believed—wrongly—that it was
substantially less powerful. They were deceived about its potency in
part because oxycodone was widely known as one of the active ingredients
in Percocet, a relatively weak opioid- acetaminophen combination that
doctors often prescribed for painful injuries. “It really didn’t have
the same connotation that morphine did in people’s minds,” said Riddle.
A common malapropism led to further advantage for Purdue. “Some people would call it oxy-codeine”
instead of oxycodone, recalled Lacouture. “Codeine is very weak.” When
Purdue eventually pleaded guilty to felony charges in 2007 for
criminally “misbranding” OxyContin, it acknowledged exploiting doctors’
misconceptions about oxycodone’s strength. In court documents, the
company said it was “well aware of the incorrect view held by many
physicians that oxycodone was weaker than morphine” and “did not want to
do anything ‘to make physicians think that oxycodone was stronger or
equal to morphine’ or to ‘take any steps . . . that would affect the
unique position that OxyContin’ ” held among physicians.
Purdue
did not merely neglect to clear up confusion about the strength of
OxyContin. As the company later admitted, it misleadingly promoted
OxyContin as less addictive than older opioids on the market. In this
deception, Purdue had a big assist from the FDA, which allowed the
company to include an astonishing labeling claim in OxyContin’s package
insert: “Delayed absorption, as provided by OxyContin tablets, is
believed to reduce the abuse liability of a drug.”
The theory was that addicts would shy away from
timed-released drugs, preferring an immediate rush. In practice,
OxyContin, which crammed a huge amount of pure narcotic into a single
pill, became a lusted-after target for addicts, who quickly discovered
that the timed-release mechanism in OxyContin was easy to circumvent—you
could simply crush a pill and snort it to get most of the narcotic
payload in a single inhalation. This wasn’t exactly news to the
manufacturer: OxyContin’s own packaging warned that consuming broken
pills would thwart the timed-release system and subject patients to a
potentially fatal overdose. MS Contin had contended with similar
vulnerabilities, and as a result commanded a hefty premium on the
street. But the “reduced abuse liability” claim that added wings to the
sales of OxyContin had not been approved for MS Contin. It was removed
from OxyContin in 2001 and would never be approved again for any other
opioid.
Purdue did not invent the chronic-pain movement, but it used that movement to engineer a crucial shift. Wright is correct that in the nineties patients suffering from chronic pain often received inadequate treatment. But the call for clinical reforms also became a flexible alibi for overly aggressive prescribing practices. By the end of the decade, clinical proponents of opioid treatment, supported by millions in funding from Purdue and other pharmaceutical companies, had organized themselves into advocacy groups with names like the American Pain Society and the American Academy of Pain Medicine. (Purdue also launched its own group, called Partners Against Pain.) As the decade wore on, these organizations, which critics have characterized as front groups for the pharmaceutical industry, began pressuring health regulators to make pain “the fifth vital sign”—a number, measured on a subjective ten-point scale, to be asked and recorded at every doctor’s visit. As an internal strategy document put it, Purdue’s ambition was to “attach an emotional aspect to noncancer pain” so that doctors would feel pressure to “treat it more seriously and aggressively.” The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American.
OxyContin’s sales started out small in 1996, in
part because Purdue first focused on the cancer market to gain formulary
acceptance from HMOs and state Medicaid programs. Over the next several
years, though, the company doubled its sales force to six hundred—equal
to the total number of DEA diversion agents employed to combat the sale
of prescription drugs on the black market—and began targeting general
practitioners, dentists, OB/GYNs, physician assistants, nurses, and
residents. By 2001, annual OxyContin sales had surged past $1 billion.
Sales reps were encouraged to downplay addiction risks. “It was sell,
sell, sell,” recalled Sherman. “We were directed to lie. Why mince words
about it? Greed took hold and overruled everything. They saw that
potential for billions of dollars and just went after it.” Flush with
cash, Purdue pioneered a high-cost promotion strategy, effectively
providing kickbacks—which were legal under American law—to each part of
the distribution chain. Wholesalers got rebates in exchange for keeping
OxyContin off prior authorization lists. Pharmacists got refunds on
their initial orders. Patients got coupons for thirty- day starter
supplies. Academics got grants. Medical journals got millions in
advertising. Senators and members of Congress on key committees got
donations from Purdue and from members of the Sackler family.
It was doctors, though, who received the most
attention. “We used to fly doctors to these ‘seminars,’ ” said Sherman,
which were, in practice, “just golf trips to Pebble Beach. It was
graft.” Though offering perks and freebies to doctors was hardly
uncommon in the industry, it was unprecedented in the marketing of a
Schedule II narcotic. For some physicians, the junkets to sunny locales
weren’t enough to persuade them to prescribe. To entice the holdouts—a
group the company referred to internally as “problem doctors”—the reps
would dangle the lure of Purdue’s lucrative speakers’ bureau. “Everybody
was automatically approved,” said Sherman. “We would set up these
little dinners, and they’d make their little fifteen-minute talk, and
they’d get $500.”
Between 1996 and 2001, the
number of OxyContin prescriptions in the United States surged from about
three hundred thousand to nearly six million, and reports of abuse
started to bubble up in places like West Virginia, Florida, and Maine.
(Research would later show a direct correlation between prescription
volume in an area and rates of abuse and overdose.) Hundreds of doctors
were eventually arrested for running pill mills. According to an
investigation in the Los Angeles Times, even though Purdue kept
an internal list of doctors it suspected of criminal diversion, it
didn’t volunteer this information to law enforcement until years later.
As
criticism of OxyContin mounted through the aughts, Purdue responded
with symbolic concessions while retaining its volume-driven business
model. To prevent addicts from forging prescriptions, the company gave
doctors tamper-resistant prescription pads; to mollify pharmacists
worried about robberies, Purdue offered to replace, free of charge, any
stolen drugs; to gather data on drug abuse and diversion, the company
launched a national monitoring program called RADARS.
Critics
were not impressed. In a letter to Richard Sackler in July 2001,
Richard Blumenthal, then Connecticut’s attorney general and now a U. S.
senator, called the company’s efforts “cosmetic.” As Blumenthal had
deduced, the root problem of the prescription-opioid epidemic was the
high volume of prescriptions written for powerful opioids. “It is time
for Purdue Pharma to change its practices,” Blumenthal warned Richard,
“not just its public-relations strategy.”
It
wasn’t just that doctors were writing huge numbers of prescriptions; it
was also that the prescriptions were often for extraordinarily high
doses. A single dose of Percocet contains between 2.5 and 10mg of
oxycodone. OxyContin came in 10-, 20-, 30-, 40-, and 80mg formulations
and, for a time, even 160mg. Purdue’s greatest competitive advantage in
dominating the pain market, it had determined early on, was that
OxyContin lasted twelve hours, enough to sleep through the night. But
for many patients, the drug lasted only six or eight hours, creating a
cycle of crash and euphoria that one academic called “a perfect recipe
for addiction.” When confronted with complaints about “breakthrough
pain”—meaning that the pills weren’t working as long as
advertised—Purdue’s sales reps were given strict instructions to tell
doctors to strengthen the dose rather than increase dosing frequency.
Over the next several years, dozens of class-action
lawsuits were brought against Purdue. Many were dismissed, but in some
cases Purdue wrote big checks to avoid going to trial. Several
plaintiffs’ lawyers found that the company was willing to go to great
lengths to prevent Richard Sackler from having to testify under oath.
“They didn’t want him deposed, I can tell you that much,” recalled
Marvin Masters, a lawyer who brought a class-action suit against Purdue
in the early 2000s in West Virginia. “They were willing to sit down and
settle the case to keep from doing that.” Purdue tried to get Richard
removed from the suit, but when that didn’t work, the company settled
with the plaintiffs for more than $20 million. Paul Hanly, a New York
class-action lawyer who won a large settlement from Purdue in 2007, had a
similar recollection. “We were attempting to take Richard Sackler’s
deposition,” he said, “around the time that they agreed to a
settlement.” (A spokesperson for the company said, “Purdue did not
settle any cases to avoid the deposition of Dr. Richard Sackler, or any
other individual.”)
When the federal government
finally stepped in, in 2007, it extracted historic terms of surrender
from the company. Purdue pleaded guilty to felony charges, admitting
that it had lied to doctors about OxyContin’s abuse potential. (The
technical charge was “misbranding a drug with intent to defraud or
mislead.”) Under the agreement, the company paid $600 million in fines
and its three top executives at the time—its medical director, general
counsel, and Richard’s successor as president—pleaded guilty to
misdemeanor charges. The executives paid $34.5 million out of their own
pockets and performed four hundred hours of community service. It was
one of the harshest penalties ever imposed on a pharmaceutical company.
(In a statement to Esquire, Purdue said that it “abides by the
highest ethical standards and legal requirements.” The statement went
on: “We want physicians to use their professional judgment, and we were
not trying to pressure them.”)
Fifty-three thousand Americans died from opioid overdoses in 2016, more than the thirty-six thousand who died in car crashes in 2015 or the thirty-five thousand who died from gun violence that year.
No Sacklers were named in the 2007 suit. Indeed,
the Sackler name appeared nowhere in the plea agreement, even though
Richard had been one of the company’s top executives during most of the
period covered by the settlement. He did eventually have to give a
deposition in 2015, in a case brought by Kentucky’s attorney general.
Richard’s testimony—the only known record of a Sackler speaking about
the crisis the family’s company helped create—was promptly sealed. (In 2016, STAT,
an online magazine owned by Boston Globe Media that covers health and
medicine, asked a court in Kentucky to unseal the deposition, which is
said to have lasted several hours. STAT won a lower-court ruling in May 2016. As of press time, the matter was before an appeals court.)
In
2010, Purdue executed a breathtaking pivot: Embracing the arguments
critics had been making for years about OxyContin’s susceptibility to
abuse, the company released a new formulation of the medication that was
harder to snort or inject. Purdue seized the occasion to rebrand itself
as an industry leader in abuse-deterrent technology. The change of
heart coincided with two developments: First, an increasing number of
addicts, unable to afford OxyContin’s high street price, were turning to
cheaper alternatives like heroin; second, OxyContin was nearing the end
of its patents. Purdue suddenly argued that the drug it had been
selling for nearly fifteen years was so prone to abuse that generic
manufacturers should not be allowed to copy it.
On
April 16, 2013, the day some of the key patents for OxyContin were
scheduled to expire, the FDA followed Purdue’s lead, declaring that no
generic versions of the original OxyContin formulation could be sold.
The company had effectively won several additional years of patent
protection for its golden goose.
Opioid
withdrawal, which causes aches, vomiting, and restless anxiety, is a
gruesome process to experience as an adult. It’s considerably worse for
the twenty thousand or so American babies who emerge each year from
opioid-soaked wombs. These infants, suddenly cut off from their supply,
cry uncontrollably. Their skin is mottled. They cannot fall asleep.
Their bodies are shaken by tremors and, in the worst cases, seizures.
Bottles of milk leave them distraught, because they cannot maneuver
their lips with enough precision to create suction. Treatment comes in
the form of drops of morphine pushed from a syringe into the babies’
mouths. Weaning sometimes takes a week but can last as long as twelve.
It’s a heartrending, expensive process, typically carried out in the
neonatal ICU, where newborns have limited access to their mothers.
But
the children of OxyContin, its heirs and legatees, are many and
various. The second- and third-generation descendants of Raymond and
Mortimer Sackler spend their money in the ways we have come to expect
from the not-so-idle rich. Notably, several have made children a focus
of their business and philanthropic endeavors. One Sackler heir helped
start an iPhone app called RedRover, which generates ideas for
child-friendly activities for urban parents; another runs a child-
development center near Central Park; another is a donor to
charter-school causes, as well as an investor in an education start-up
called AltSchool. Yet another is the founder of Beespace, an “incubator
for emerging nonprofits,” which provides resources and mentoring for
initiatives like the Malala Fund, which invests in education programs
for women in the developing world, and Yoga Foster, whose objective is
to bring “accessible, sustainable yoga programs into schools across the
country.” Other Sackler heirs get to do the fun stuff: One helps finance
small, interesting films like The Witch; a second married a
famous cricket player; a third is a sound artist; a fourth started a
production company with Boyd Holbrook, star of the Netflix series Narcos; a fifth founded a small chain of gastropubs in New York called the Smith.
Holding fast to family tradition, Raymond’s and
Mortimer’s heirs declined to be interviewed for this article. Instead,
through a spokesperson, they put forward two decorated academics who
have been on the receiving end of the family’s largesse: Phillip Sharp,
the Nobel-prize-winning MIT geneticist, and Herbert Pardes, formerly the
dean of faculty at Columbia University’s medical school and CEO of New
York-Presbyterian Hospital. Both men effusively praised the Sacklers’
donations to the arts and sciences, marveling at their loyalty to
academic excellence. “Once you were on that exalted list of
philanthropic projects,” Pardes told Esquire, “you were there
and you were in a position to secure additional philanthropy. It was
like a family acquisition.” Pardes called the Sacklers “the nicest, most
gentle people you could imagine.” As for the family’s connection to
OxyContin, he said that it had never come up as an issue in the faculty
lounge or the hospital break room. “I have never heard one inch about
that,” he said.
Pardes’s ostrichlike avoidance
is not unusual. In 2008, Raymond and his wife donated an undisclosed
amount to Yale to start the Raymond and Beverly Sackler Institute for
Biological, Physical and Engineering Sciences. Lynne Regan, its current
director, told me that neither students nor faculty have ever brought up
the OxyContin connection. “Most people don’t know about that,” she
said. “I think people are mainly oblivious.” A spokesperson for the
university added, “Yale does not vet donors for controversies that may
or may not arise.”
The controversy surrounding OxyContin shows little
sign of receding. In 2016, the CDC issued a startling warning: There was
no good evidence that opioids were an effective treatment for chronic
pain beyond six weeks. There was, on the other hand, an abundance of
evidence that long-term treatment with opioids had harmful effects. (A
recent paper by Princeton economist Alan Krueger suggests that chronic
opioid use may account for more than 20 percent of the decline in
American labor-force participation from 1999 to 2015.) Millions of
opioid prescriptions for chronic pain had been written in the preceding
two decades, and the CDC was calling into question whether many of them
should have been written at all. At least twenty-five government
entities, ranging from states to small cities, have recently filed
lawsuits against Purdue to recover damages associated with the opioid
epidemic.
The Sacklers, though, will likely
emerge untouched: Because of a sweeping non-prosecution agreement
negotiated during the 2007 settlement, most new criminal litigation
against Purdue can only address activity that occurred after that date.
Neither Richard nor any other family members have occupied an executive
position at the company since 2003.
The American
market for OxyContin is dwindling. According to Purdue, prescriptions
fell 33 percent between 2012 and 2016. But while the company’s primary
product may be in eclipse in the United States, international markets
for pain medications are expanding. According to an investigation last
year in the Los Angeles Times, Mundipharma, the Sackler-owned
company charged with developing new markets, is employing a suite of
familiar tactics in countries like Mexico, Brazil, and China to stoke
concern for as-yet-unheralded “silent epidemics” of untreated pain. In
Colombia, according to the L.A. Times, the company went so far
as to circulate a press release suggesting that 47 percent of the
population suffered from chronic pain.
In May, a dozen lawmakers in Congress, inspired by the L.A. Times
investigation, sent a bipartisan letter to the World Health
Organization warning that Sackler-owned companies were preparing to
flood foreign countries with legal narcotics. “Purdue began the opioid
crisis that has devastated American communities,” the letter reads.
“Today, Mundipharma is using many of the same deceptive and reckless
practices to sell OxyContin abroad.” Significantly, the letter calls out
the Sackler family by name, leaving no room for the public to wonder
about the identities of the people who stood behind Mundipharma.
The
final assessment of the Sacklers’ global impact will take years to work
out. In some places, though, they have already left their mark. In
July, Raymond, the last remaining of the original Sackler brothers, died
at ninety-seven. Over the years, he had won a British knighthood, been
made an Officer of France’s Légion d’Honneur, and received one of the
highest possible honors from the royal house of the Netherlands. One of
his final accolades came in June 2013, when Anthony Monaco, the
president of Tufts University, traveled to Purdue Pharma’s headquarters
in Stamford to bestow an honorary doctorate. The Sacklers had made a
number of transformational donations to the university over the
years—endowing, among other things, the Sackler School of Graduate
Biomedical Sciences. At Tufts, as at most schools, honorary degrees are
traditionally awarded on campus during commencement, but in
consideration of Raymond’s advanced age, Monaco trekked to Purdue for a
special ceremony. The audience that day was limited to family members,
select university officials, and a scrum of employees. Addressing the
crowd of intimates, Monaco praised his benefactor. “It would be
impossible to calculate how many lives you have saved, how many
scientific fields you have redefined, and how many new physicians,
scientists, mathematicians, and engineers are doing important work as a
result of your entrepreneurial spirit.” He concluded, “You are a world
changer.”
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