In November 2018, The Quintessential Centrist’s inaugural issue covered the opioid crisis and the efficacy of fast acting antidotes such as Narcan and Evzio to counter overdoses. At the time of publication, there had been plenty of ongoing media coverage as to the role of Purdue Pharma in perpetuating the opioid epidemic. Purdue’s legal troubles began in 2001 when the company was sued by the state of West Virginia, which was effectively ground zero for the opioid crisis. The state claimed that Purdue inappropriately marketed their drug, OxyContin, and hid “from doctors the extent to which OxyContin's morphinelike qualities could lead to addiction.”
At the Quintessential Centrist, we have sometimes been a vocal critic of the government for regulatory and judicial overreach, which, we believe can stifle economic growth, innovation and job creation. But with respect to Purdue Pharma and its role in propagating the opioid epedemic, both state and federal governments are right to prosecute the company to the full extent of the law.
According to the CDC, 400,000 people perished from opioid overdoses between 1999 and 2017. Beyond just the death toll, the economic and social costs have been stunning. An article penned in 2016 in The Science Daily approximated the economic cost of the opioid crisis at over $78 billion dollars. The numbers are certainly much higher today. The social costs have been equally if not more enormous as the nuclei of tens of thousands of families have been hallowed out, the fabric of entire communities shredded.
Purdue Pharma is certainly not the only company to produce opioids; publicly listed firms such as Johnson & Johnson (JNJ), Teva Pharmaceuticals and Allergan are involved in the space. Indeed, every pharmaceutical company found to be complicit in monetizing the opioid crisis should be held accountable. Recently, Teva quietly settled a related lawsuit while JNJ continues to fight in court; next month a ruling is expected. The outcome should be carefully watched as it will set precedent. But Purdue, a private company controlled by the prominent Sackler family, is disproportionately to blame for this societal disaster. From their unscrupulous marketing tactics, refusal to accept responsibility and then to plan to profit from the very crisis they spawned, their actions are reprehensible.
The Depths of Depravity
In 2007 Purdue Pharma settled lawsuits and paid fines to the tune of $635 million. The New York Times reported that the "drugmaker admitted in 2007, when confronted with evidence gathered by prosecutors, that it trained sales representative to tell doctors that OxyContin was less addictive and prone to abuse than competing opioids, claims beyond the one approved by the F.D.A.” Unfortunately, the costly fines were no deterrent to Purdue. It is apparent they viewed the legal settlement, simply, as a cost of doing business. For the company did not stop promoting OxyContin through an aggressive sales and marketing campaign while continuing to downplay the extent of its addictiveness.
Post 2007, despite the CDC and regional health authorities increasing concern about the growing numbers of opioid-related deaths, the Sacklers continued to brazenly bolster their bottom line. Without an inkling of doubt, they consistently claimed that OxyContin was a longer-release pain drug with minimal risk of addiction. Richard Sackler even went on the offensive by squarely placing blame on addicts! "The attorney general's complaint says that in a ploy to distance themselves from the emerging statistics and studies that showed OxyContin's addictive characteristics, the Sacklers approved public marketing plans that labeled people hurt by opioids as 'junkies' and 'criminals.'"
The next chapter of this sad story was a scheme called Project Tango, where Purdue sought to profit by engineering a revenue generating cure for the very problem their company helped to create: addiction to opioids. “Purdue Pharma knew opioids would cause addiction and considered getting into the business of selling drugs to treat addiction." Sackler argued that the market for addiction treatment was attractive due to the “large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”
Purdue board member Dr. Kathe Sackler presented the opportunities that could be reaped from Project Tango to the company’s board in 2014. It was deliberated and then (probably) because of the number of lawsuits beginning to pile up, halted. That this underhanded revenue driver was so seriously considered is quite troubling.
Just What the Doctor Ordered
Generally speaking, adults have an obligation to take ownership of, and face the consequences for their actions. Specific to this case, we are more sympathetic. People, especially those in the demographic typically associated with opioid abuse, often place tremendous trust in their doctors. When a physician instructs a patient to take OxyContin or another opioid, writes a prescription for the pills but fails to properly warn of the potential for addiction, or adequately monitor for abuse (or worse still, if they are dishonest and prescribe the pills like candy) it is understandable how the average person might fall into the trap of addiction and misuse, especially when severe pain has ravaged their body.
Opioids are overprescribed. “More than one out of three average Americans used a prescription opioid painkiller in 2015…92 million U.S. adults, or about 38 percent of the population, took a legitimately prescribed opioid like OxyContin or Percocet in 2015.” “Many people receive opioids they don't need and pass them on to relatives who aren't getting the treatment they need for chronic pain.” “…That tells us there are a lot of leftover medications. In many cases, physicians could write smaller prescriptions, or avoid them completely for those who benefit from ibuprofen or acetaminophen."
It would be irresponsible if we did not point out that a disproportionate amount of unnecessary opioid prescriptions are written by a small minority of dishonest physicians. While certain legitimate doctors probably have to do a better job rationalizing the amount of opioids they prescribe, and when they prescribe them, make a satisfactory effort to follow up with their patients and check to see if their are obvious signs and symptoms of misuse or abuse, we must keep in mind that Oxycontin and other opioids do have an array of legitimate uses. Despite the unprecedented levels of addiction and death, most opioids, OxyContin included, are used appropriately. Of course, rogue physicians must be held accountable and prosecuted for their role in perpetuating the opioid crisis.
Hypocrisy
The Sackler name is on proud display in the wings of several museums in the United States and overseas, the most prominent being the famed Temple of Dendur at the Metropolitan Museum of Art. Until very recently, the Sacklers enjoyed premier social and philanthropic status in the upper echelons of society.
Most of the unsavory information regarding Purdue and the Sacklers has been readily available for over a decade. This begs the question as to why the family is only being shunned now? Our view is that most philanthropic organizations behave like for-profit corporations. They employ a cost benefit analysis. A decade ago, the Sackler’s misdeeds were a matter of public record. But museum patrons, other clients, “friends,” etc. did not seem to care. As long as the Sackler’s were willing to write checks, the checkered past of the Sackler’s was overlooked. However, when the cost of being associated with the Sackler’s became too high or, put another way, when the money that would have been forgone by other donors for accepting funds from the Sackler’s became greater than the money the Sackler’s had pledged to donate, then and only then did most philanthropic organizations decide to say thanks but no thanks - even its banker, JP Morgan, cut ties with the family – and former “friends” absolve themselves of any further relationship.
We would be remiss in not calling out the timing of the individuals, corporations and not for profit organizations, who benefited handsomely from their connections with the Sacklers, for severing ties with them only when the docket in the court of public opinion was finally in session.
Self-Reflection
Regrettably, the Sackler family still persists in being obstreperous, belligerent and almost dismissive. Indeed, David Sackler’s recent Vanity Fair article exemplifies this attitude and was a shoddily misguided attempt to save the family name despite substantial evidence to its culpability.