In 1914, the U.S. government passed the Harrison Narcotics Act which was the first act in American history to control drugs. Rather than a ban, the act worked to tax Americans with a public health interest in mind. The U.S. opium commissioner, Hamilton Wright, skewed data to inflate the number of heroin addicts and cause public panic over narcotic use according to Rachel Nolan, a professor of international relations at Boston University. This is just the start of officials misleading the public and creating an addiction crisis. The Sackler family must have taken a page from Wright’s book when creating their advertising campaign for their new drug, OxyContin. What is key is that the Sackler family knew about the drug’s addictive properties and continued its marketing campaign to doctors for the drug’s usage.
The most important members of the Sackler family are Arthur Mortimer and Raymond Sackler. Mortimer died in 2010 and Raymond died in 2017. The Sackler family is the 30th richest family in the United States, according to Forbes. However, until recently, most people did not know how the Sackler family became so wealthy. The answer is through their company Purdue Pharma, which created the painkiller OxyContin.
Purdue Pharma released OxyContin in 1995 and was a medical marvel, as one of the first long-lasting pain medicines to help those with moderate-to-severe pain. However, the active ingredient is oxycodone, closely related to heroin and twice as strong as morphine. OxyContin was approved by the Food and Drug Administration (FDA) in 1995, for treating moderate-to-severe pain. However, this approval is surprising, as Purdue Pharma had conducted no clinical studies to determine if the drug was addictive or prone to misuse. Dr. Curtis Wright, an FDA examiner who managed the approval, left the agency soon after and took a job at Purdue Pharma.
Despite the FDA approval, some doctors remained skeptical of OxyContin. The Sackler family knew the best way to sell the drug to doctors is to appeal to who doctors trust most, their peers. They paid prominent doctors to endorse the drug and cited scientific studies to convince doctors. Many doctors did not realize the scientific studies that Purdue was citing were their own. In 1997, Purdue Pharma paid David Haddox, the chair of the American Academy of Pain Medicine and the American Pain Society to release a statement endorsing opioid use to treat chronic pain. The company also paid clinicians to attend conferences and deliver presentations in support of the drug. Doctors were provided with all-expense-paid trips to learn more about the drug. These trips worked. Doctors who attended these seminars in 1996 were more than twice as likely to prescribe OxyContin when compared to doctors who did not attend, according to internal Purdue documents.
It is not necessarily that the unethical marketing and pay structure lead to an opioid crisis.
However, with Purdue, the drug OxyContin turned out to be highly addictive, a fact they were well aware of. OxyContin was originally marketed as less addictive when introduced in 1906, due to its time-release attribute. This means when someone takes OxyContin for pain relief, it works slowly over time, so ideally individuals would have to take fewer pills when compared to other painkillers. However, an exposé by the Los Angeles Times revealed that an initial study conducted by Purdue with ninety women from Puerto Rico showed that the 12-hour time-release formula did not work. About half the women needed more pain medication before the twelve-hour mark. Even though Purdue conducted this study, the results were never published. The company knew the 12 hour time-release was faulty but continued the time-release marketing campaign. In reality, the time-release only lasts about 7 hours, which can lead patients to take more OxyContin and get addicted. Furthermore, the time-release can get overridden if people crush and snort the pills, according to Professor Nolan. This expensive and addictive drug often leads people to switch to a cheaper substitute, heroin. Four out of five people who try heroin today started with prescription painkillers, according to the National Institute on Drug Abuse. Furthermore, nearly 50,00 people died from opioid-related overdoses in the U.S. according to the National Institute on Drug Abuse.
Internal Document from 1992, where Purdue Pharma says that OxyContin controls pain for 90% of patients for 12 hours.
Professor Nolan also explains how OxyContin was able to avoid regulation and being tied with the War on Drugs. The fact that the drug was introduced into the legal market, first, was a major factor. Another was who was taking the drug. OxyContin was mostly prescribed to white users, according to Professor Nolan. Nonwhite communities dodged the opioid crisis because they were not getting access to the kind of health care that white people were getting access to. Also, Purdue Pharma did not want the drug in nonwhite communities due to the association with the war on drugs, so the for-profit drug companies targeted white communities to try to avoid the drug from being racialized, according to Professor Nolan.
Despite the Sackler Family’s name being plastered on many historic buildings, the Purdue website rarely mentioned their name and until recently, many did not know the family’s association with the drug. In fact, the north wing of the Metropolitan Museum of Art is called The Sackler Wing. While some of the profits of Purdue Pharma may be going towards philanthropy, it does not excuse the number of deaths directly caused by the drug company.
Last year the company was dissolved and the Sackler family had to pay $4.5 billion to settle opioid addiction disputes, according to the New York Times. This payment is to compensate for the family's losses and cover some government recovery costs, it also means that no further investigation into Purdue Pharma will take place in court. This is because the settlement freed the company from any further lawsuits related to opioids, according to the Guardian.
While the Sackler family played a major role in causing the Opioid Crisis, the crisis was not by just the family alone, but rather a pharmaceutical environment that allowed OxyContin to remain unchecked for a significant period. Professor Nolan teaches a course called Drugs and Security in the Americans. In the course, she explains how the drug industry’s lobbying arm fought hard in the 1990s to allow mass prescription. The pharmaceutical industry, which has about two lobbyists for every member of Congress, spent $152 million on influencing legislation in 2016, according to the Center for Responsive Politics. From 1999 to 2018, the pharmaceutical industry recorded $4.7 billion—an average of $233 million per year—in lobbying expenditures at the federal level, more than any other industry, according to Professor Nolan.
The Sackler family played a significant role in causing the opioid crisis. However, the marketing strategy and financial contributions of the pharmaceutical industry are a larger systematic problem. To prevent a future crisis, we need to hold our elected leaders accountable and develop regulations to better protect ourselves and the medical community from misinformation.