The Opioid Crisis Isn’t Just the Sacklers’ Fault – and Making Purdue Pharma Pay Isn’t Enough on Its Own to Fix the Pharmaceutical Industry’s Deeper Problems

John here. Experts and the media have documented the effects of the opioid crisis, but when it comes to the causes, it’s easy to pin it on the big villains and overlook the bigger criminogenic environment. As this article highlights, the focus on the Sackler family often effectively exculpates all the other industries, state bodies, and politicians involved. This pattern is particularly strong in television and film portrayals, even before getting to the fact that Richard Sackler is a corporate bad guy from central casting. But these simple morality tales often work at cross purpose to developing programs for systemic change.

By David Herzberg, Associate Professor of History, University of Buffalo. Herzberg, a U.S. historian of drugs and addictive medicines. Originally published at The Conversation.

You may have heard of the Sackler family and the role that they and their privately held company, Purdue Pharma, played in the opioid crisis. One TV series depicting the family as a villainous clan has earned 14 Emmy nominations. Another is in the works.

Purdue is infamous for its hard-sell marketing of its powerful, long-acting opioid OxyContin. Among its troubling tactics: co-opting legitimate medical organizations to spread messages overstating the drug’s effectiveness and understating its addiction risks. Sales boomed, making its owners fabulously wealthy and building what journalist Patrick Radden Keefe memorably calls an “empire of pain.”

Purdue’s profit-seeking became a model for other drugmakers, distributors and pharmacy chains. The ensuing sales frenzy led to skyrocketing rates of opioid addiction and related harms by the early 2000s – perhaps the worst pharmaceutical crisis in U.S. history.

So when Purdue Pharma’s bankruptcy settlement was revised in March 2022 to make the family pay US$6 billion, mostly to local and state governments, the news was greeted with at least some satisfaction. Although it looks as though no members of that family will go to prison, the people often regarded as the saga’s primary villains were at least paying a price for their misdeeds.

But as a historian of addictive pharmaceuticals, I see a danger in associating the opioid crisis too closely with the Sackler family. My research has shown that the crisis isn’t an aberration caused by the individual misdeeds of bad actors. Punishing people who broke the law, and making business leaders pay to repair the harms they caused, surely helps. Yet broad reforms are also needed to prevent similar disasters from happening again.

Who Are ‘the Sacklers’?

Despite the many individuals and companies involved, the Sacklers became the public face of the opioid crisis. In part this acknowledged their status as pioneers: They were the first to hypermarket strong opioids, and they led the pack in blaming the resulting catastrophe on consumers who became addicted to those prescription painkillers.

But who are they? Their story began with Arthur, Mortimer and Raymond Sackler, three brothers who were all doctors and made a collective fortune in medical marketing. They acquired what was then called Purdue Frederick Co. in 1952.

After Arthur died in 1987, Mortimer and Raymond bought their brother’s stake in the company from his family for $22 million. For that reason, Arthur Sackler’s heirs aren’t involved in opioid-related litigation that’s on track to be resolved through Purdue’s bankruptcy settlement.

“The Sacklers” I refer to here – and when you read about them elsewhere – are Mortimer and Raymond and their heirs who benefited from Purdue’s profit machine, many of whom worked there, served on its board – or both.

Richard Sackler ran the company for years and subsequently became a micromanaging board member. His cousin Kathe Sackler, another former Purdue executive, repeatedly claimed that OxyContin was her idea, Patrick Radden Keefe has reported. Pinpointing exactly how much money they collectively extracted from Purdue is impossible, but in 2021 those two branches of the Sackler family were estimated to hold about $11 billion in assets.

Pop Culture Villainy

The Sacklers used their profits to protect the family’s reputation through lavish charitable donations to museums like the Guggenheim and the Louvre, and several universities – including Tufts and Yale.

Their philanthropy produced an aura of respectability but also made them highly visible. Eventually journalists connected the dots, leading to a cottage industry of books and media coverage of the opioid crisis casting the Sacklers as the bad guys responsible for historic levels of addiction and overdose.

The Sacklers-as-comic-book-villains story is on full display in actor Michael Stuhlbarg’s Emmy-nominated performance as a remarkably creepy Richard Sackler in the Hulu series “Dopesick,” based on Beth Macy’s book by the same name.

Viewers can probably expect similar fare from Michael Broderick, who will play Richard Sackler in “Painkiller,” an upcoming Netflix limited series about how the opioid crisis began.

‘White Market Drugs’

As satisfying as it may be, focusing on the Sacklers’ misdeeds can obscure as much as it reveals about the deeper causes of the opioid crisis.

Purdue did not invent the tactics it used to sell OxyContin. Pharmaceutical companies discover and sell genuinely miraculous products, but they also routinely wield troubling influence over every step of the production and circulation of knowledge about drugs, which can make it difficult to understand the true value of a medicine. They oversee the research that demonstrates drug effectiveness. They write or help write the publications based on the research.

Drugmakers script or influence the professional guidelines that encourage prescribing. They underwrite professional organizations and pay medical experts to spread the word. They fund and channel patient advocacy organizations into supporting the medicines they manufacture.

And then they lobby for legislation, regulations and anything else that can gin up more demand for their drugs.

Until the Food and Drug Administration approved OxyContin in 1995, these marketing techniques were forbidden for opioids, which authorities considered to be too dangerous for them.

As I explain in my book, “White Market Drugs,” federal regulators, supported by cautious medical authorities, appointed leading pharmacologists to test the addictiveness of new opioid products. They scrutinized advertisements to make sure the risks were fully and accurately conveyed.

Pharmaceutical companies tried to outfox regulators with a parade of now-forgotten “miracle opioids” long before OxyContin. Indeed, one of these would-be wonder drugs was none other than oxycodone, OxyContin’s main ingredient.

Oxycodone, discovered in 1916, had been sold in the U.S. for most of the 20th century.

In 1949, Endo Products claimed that Percodan, its new oxycodone product, shouldn’t face strict federal controls because it was chemically similar to codeine, a relatively weak opioid used in cough syrups. The company insisted it wasn’t addictive when used as prescribed.

Expert pharmacologists working with federal regulators pushed back. Noting that oxycodone produced an “intense” addiction, they pointed out that people did not always follow doctors’ orders – especially with addictive drugs.

Purdue’s real innovation with OxyContin was commercial, not scientific. The company was the first to market a powerful opioid using the most aggressive strategies other drug companies regularly used to get pharmaceutical innovations into bodies with great speed and efficiency – while maximizing profits.

Once Purdue showed it could be done, competitors quickly followed suit. The industry replaced U.S. medicine’s century-old habits of opioid precautions with a reckless boosterism.

Complicity of Many Industries

Purdue, that is, didn’t act alone.

Other drugmakers such as Endo and Janssen imitated and even surpassed Purdue’s example once the taboo had been broken.

Generic manufacturers such as Allergan and Teva then profited by expanding and prolonging the boom, as did wholesale drug distributors and retail chain pharmacies. Even the prestigious McKinsey consulting firm got into the game, advising others how to maximize sales.

The complicity of so many industries makes opioid litigation complex and hard to follow. Cities, states and other plaintiffs didn’t just sue Purdue. They turned to the legal system to make sure that all the other companies pay to repair the harms they caused in building the historic opioid boom that has contributed to more than 500,000 overdose deaths since 1996.

To date the largest national opioid settlement is with the three main opioid distributors and Johnson & Johnson, manufacturer of the Duragesic and Nucynta opioids. It totals $26 billion, significantly more than what Purdue and the Sacklers are paying.

But financial settlements cannot solve every problem that made this crisis possible. Purdue and its competitors were able to put profits over consumer safety for so long, in part, because their marketing strategies closely approximated how other medicines are sold in the U.S.

The opioid crisis, in other words, revealed in an exaggerated fashion problems prevalent in the pharmaceutical industry more generally. Until those broader problems are resolved, the unhappy history of addictive prescription drugs will keep repeating itself.

Disclosure statement: David Herzberg has served as a paid consultant and expert witness for plaintiffs in U.S. opioid litigation. He has received funding from the National Institute of Health.

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  1. thoughtfulperson

    I’d not known how widespread the efforts of the pharmaceutical industry to profit through sale of addiction has been. I suspect we could look at all of pharma as an effort to put profits through pills over prevention and longterm health.

    True for covid response.

    Personally I have psoriasis and have been offered pills I’d need to take forever to suppress not cure.

    No doubt the paradigm of profits first, health results 2nd, is widespread all across the usa healthcare system.

    Helps to explain the declining rates of life expectancy (quality of life as well)

  2. orlbucfan

    It’s not called the U.S. Deathcare System cos it’s a joke. The title is accurate, and unfortunately very true and disgusting. Exceptionalism? Riiiiight! More like absolute greed feeding on stupidity!

  3. Rob

    Re the Sacklers, please see just published “American Cartel” or for the short hand story listen to the Terri Gross interview with one of the authors. This is a much bigger story than the Sacklers.

  4. Carla

    Hasn’t experience proven that civil judgements and fines are not effective punishments? Only when we see significant jail time for each of the executives of these miscreant corporations, in addition to stripping them of their assets, will things begin to change.

    1. Will

      Or a strong, well funded and politically independent regulator who can prevent the harm in the first place?

      1. Stephen V

        I want more: I haven’t analyzed the Sackler bankruptcy–beyond the fact that the punishment did not fit the crime. My BK lawyer friend informs me however, that restructuring in bk is possible. What bizness is Big Pharma in? Their main biz is patent / IP speculation. This is the income stream which provides Tony and his FDA buddies a max of $125k per year in royalties. This needs to stop. Some think the jab fraud and injury scandal may lead to huge bk (after being sued by Life Insurance co’s etal.) An excellent re-structuring opportunity. Throw some Congressional Hearings into the mix…who knows?
        This paper gives a good overview:

  5. The Rev Kev

    This post makes lot of sense and I can see how it would be useful to so many groups of people and institutions that the Sacklers be depicted as just “bad apples.” But it is true that they did provide the accelerants to the Opioid crisis and I am not talking about just the drugs but how they pushed to make what they did just “normal” procedure. Still think that they should have ended up against a brick wall though but that is just me.

    1. Questa Nota

      The Sacklers had plenty of help in DC, in and out of office, so that brick wall could should get crowded.

      People see the pharma ads plastered all over the evening news. They don’t see, until it is too late, that the system is so totally rigged against them and that getting cured would be bad for the business model.

    2. Susan the Other

      If the Sacklers had provided highly refined opioids they could have been modern day heroes. Instead they gave people cheap, poorly refined products that were difficult to process and therefore difficult to monitor (which was virtually nonexistent anyway) – but perfect for profiteering. They poisoned people right and left. They cut corners. For profit. Whereas drugs that are properly produced and distributed, under strict control, are more expensive to produce in order not to be as toxic – in order to actually be beneficial. That never happened. Ergo “the bigger criminogenic environment.” Let’s just poison all this human trash, make a profit and continue our war effort in Afghanistan, or previously, Viet Nam. Etc. Not to mention the greater society that only needed a small excuse to castigate any druggie and “who gives a shit if they live and die on the street?” That’s what is disgusting. That attitude that permits such blatant exploitation. Gee, let’s not mince words here.

  6. Arizona Slim

    When I read posts like this one, I say to myself, “Could’ve been me.”

    I could have been one of those pain patients who was put on drugs like the opioids described above. But, thanks to a one-hour session with a massage therapist, I went in a different direction.

    The therapist recommended Dr. John Sarno’s book, Healing Back Pain, and I am ever grateful that she did. It’s a book about pain that’s psychological in origin, and oh, did that fit me to a tee.

    Within a few days of reading that book, I started taking steps toward recovery. Two and a half years later, here I am. Pain-free.

    There is a different way, people. I’m living proof.

    1. Alex Cox

      Arizona is right! Dr Sarno’s book is really worth reading, and if you approach it with an open mind it offers an antidote to ‘chronic’ back pain.

      1. Arizona Slim

        Me? I was so desperate, I was ready to crack that book and read it like my life depended on it. In a way, it did.

        Now, I can’t be Arizona Slim, a card-carrying bookworm, without recommending another book. It’s Dr. Howard Schubiner’s book, Unlearn Your Pain.

        This book will give you writing exercises that are, well, difficult because they really plumb your mental state and your upbringing, but once you’re done? Wow. You’ll be a different person. I know I am.

  7. Will

    Perhaps related, the Guardian has a myth-buster style article on mental health from its science writer. I can’t speak to any of the truths offered, but found this part on anti-depressants rather odd.

    SSRIs, which include Prozac, were thought to address a “chemical imbalance” in the brain, by correcting levels of the neurotransmitter serotonin that is thought to be involved in mood regulation, among other functions. The recent paper, however, examined the evidence to date and concluded that there was no clear link between levels of serotonin and depression.

    But there are many other ways that they may help relieve symptoms – by reducing inflammation, which is another potential contributor to depression, for example. Importantly, a recent meta-analysis in the Lancet, considering multiple clinical trials, confirmed that SSRIs are effective at relieving depression. While they do not work for everyone, they are about 50% more likely to produce a response than placebo pills. In the words of Prof Cathryn Lewis of King’s College London and Prof Andrew M McIntosh of the University of Edinburgh, the clinical benefits are now “beyond reasonable doubt”. [Emphasis added.]

    So, unclear on the cause of and how SSRIs address (are they an anti-inflammatory now?), but it’s a coin flip whether they produce (presumably, a good) “response” so SSRIs provide a “clinical benefit…’beyond a reasonable doubt’”?

  8. Screwball

    Netflix had a TV series called “The Pharmacist” that I thought was well done. I don’t know if it is still available, but worth the watch IMO. Prepared to be sickened and pissed.

    I have a family member who got caught up in this mess. Luckily, she is now fine and doing well, but we lost track of her for years. Started with the opioids in pill form, but like many, moved on to heroin. She has a story to tell and maybe someday she can share. It’s gut wrenching.

    I have not the words for these people. I only hope their day comes. The lives and families they ruined is unconscionable over pure unadulterated greed. I’ll stop there.

    1. jobs

      Thanks for the recommendation, I just watched the whole thing. What a travesty of justice, proving that the medical community has no real interest policing itself. And don’t get me started on the government agencies involved. Ugh.

  9. Lex

    Didn’t Bayer market heroin as not only not addictive but as a means to address morphine addiction? I think DEA should shoulder a great deal of the blame in this. It knew how much was reaching people and even which doctors were prescribing specific quantities. So either DEA leadership decided to look the other way for years or it was told to look the other way by the executive branch. There is simply no way the numbers wouldn’t have raised every red flag. And now it’s swung back the other way with all sorts of draconian controls on doctors prescribing pain medication so that DEA looks like it’s doing something (which is the primary organizational directive of DEA).

    1. jobs

      I find it exceedingly difficult to believe that the DEA wasn’t slow-walking this, or worse, on orders from above.

      What are we as a society, when we let monsters like the Sacklers get away with it? And away with it they did – none went to prison for their role in this.

      1. drumlin woodchuckles

        I heard the Mary Gross interview that Rob referrenced several comments above. According to the author of that book American Cartel, critical key people in DEA were in fact fast-walking the anti-opioid effort against major drug making and drug distributing companies, and then Pharma Lobbyists paid Congress to change a key word in the wording of the law in order to disconnect and stand-down DEA’s efforts.

        Here is the podcast title: ” New book chronicles how America’s opioid industry operated like a drug cartel”

        Here is link to the listenable podcast its own self.

        1. jobs

          Wow. So the DEA was in fact trying to limit harm but was neutered by actions from above.

          Thanks for the link!

  10. Ana Claybourne

    The carnage also extends to people such as myself who have serious unfixable physical damage who can find no other means of pain management. Plus those who are dying, such as cancer sufferers.

    We need help and it’s very fashionable now to be refused help. The paperwork and federal pressure on doctors is immense.

    Fighting the docs and federal rules is exausting and eats up a big piece of the energy I still have. Two friends have chosen to check out rather than live in horrible pain.

    Ana in Sacramento

    1. General Jinjur

      The migraines I had some years ago, often three days of unremitting pain, were so excruciating that had not opioids been available to me I might have killed myself. Menopause ended the migraines, and the timing was purest luck. Now I worry that end of life care may be problematic…

    2. Arizona Slim

      Indeed you do need help, Ana.

      Three years ago, while my mother was dying, there was quite the hesitancy to give her the morphine that she truly needed. The people taking care of her didn’t want to risk addiction.

      I was appalled. She was down to, oh, 77 pounds, and had multiple comorbidities.

      Why not just let her trip out of this world on morphine? That was done with my aunt back in 2016 and she died the next day.

  11. Robin Kash

    Ralph Nader featured Washington Post investigative reporters, Sari Horowitz and Scott Higham, authors of “American Cartel: Inside the Battle to Bring Down the Opioid Industry,” with a similar theme on his Radio Hour for 8/6/22.
    Nader begins by asking them to comment on “demand side” issues, e.g., what is the pain opiods and other drugs are meant to address? They don’t answer and he doesn’t press the issue.

  12. barefoot charley

    The article compiles a long, damning list of activities and institutions perverted by big pharma profiteering, but overlooks one of the biggest: medical education. Recent generations of doctors are trained to slather drugs over symptoms rather than investigating underlying conditions. I’ve decided to trust no doctor under 50 or 60 if I can help it, simply because the youngsters’ first resorts are simply not constructive. Sure, they have to diagnose and data-enter in 7 minutes so who has time to investigate, I get it–down with insurance and hospital systems too–but I feel a loss of simple investigative curiosity that impairs real medical service.

  13. flora

    Raymond Sackler was knighted by Queen Elizabeth.

    Raymond Sackler: The Philanthropist Who Helped Spawn the Opioid Crisis

    “Around the world, the Sackler name graces medical schools as well as museums, including a wing of the Metropolitan Museum of Art. Raymond Sackler donated millions of dollars to institutions performing medical research and was knighted by Queen Elizabeth II. A minor planet is named for him and his wife, Beverly, in honor of his funding of astronomical research. Raymond’s son Richard served for a time as president of Purdue Pharma.”

    1. flora

      “They were careless people, Tom and Daisy- they smashed up things and creatures and then retreated back into their money or their vast carelessness or whatever it was that kept them together, and let other people clean up the mess they had made.”

      ― F. Scott Fitzgerald, The Great Gatsby

  14. HotFlash

    Prof. Herzberg’s article applies equally well to non-addictive pharmaceuticals many other pharmaceuticals, eg: non-sterilizing vaccines, statins, Champix, the list goes on and on. Some of them even got spanked. Not only pharmaceuticals, but other big industries use the same methods, famously Big Tobacco, Big Oil, and of course, Big Ag and Big Food, who are joined at the hip. amfortas linked to this article in Grist on how that happened under Ag Sec Earl Butz, well worth a read.

  15. Brunches with Cats

    OK, so the Sacklers aren’t to blame for the opioid crisis. Everyone else was doing it, too, and they all were/are enabled by a sick system. This isn’t news to NC readers. Nor is it original thinking that history will keep repeating itself until something is done about.

    The news, IMO, is that “history” already is repeating itself. We’re on the cusp of even deadlier “fourth wave” of opioid deaths. The CDC just released data showing an alarming rise in opioid deaths among Blacks and Native Americans — ironically (or maybe not), six months after issuing new prescription guidelines making it easier for doctors to prescribe opioids “for those who truly need them.”

    Meanwhile, the new narrative has been set in place to remove blame from Big Pharma and doctors: Opioid prescriptions are actually down, so if deaths are rising, it’s not due to abuse of prescription opioids, but to the burgeoning street market for illegal synthetic opioids. Indeed, in totally up-is-down logic, the CDC says its new guidelines will help reduce opioid deaths, because now people who really need them for chronic pain can get them legally from their doctors, whereas under the previous guidelines (2016), doctors feared getting busted for over-prescribing, and those who really needed them were buying those vewy vewy bad stweet dwugs.

    Some links, with few more to follow:
    A coming tidal wave: The opioid epidemic is about to get a whole lot worse [Think Big, Aug 2, 2022]

    Amid backlash from chronic pain sufferers, CDC drops hard thresholds from opioid guidance [USA Today, Feb. 10, 2022]

    1. Brunches with Cats

      Additional links:
      Fourth Wave of Opioid (Illicit Drug) Overdose Deaths and Diminishing Access to Prescription Opioids and Interventional Techniques: Cause and Effect [Pain Physician, Mar 22 (via PubMed]

      CDC finds significant increase of opioid overdoses among minority groups [ABC News, July 20, 2022]

      The full CDC report:
      Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020 [July 19, 2022, CDC]

      Process for Updating the Opioid Prescribing Guideline [CDC website]

      Synthetic Opioids [DOJ/DEA Drug Fact Sheet, April 2020]
      “Clandestinely produced … “counterfeit” … “believed to be synthesized abroad and then imported into the United States.” How dare they try to steal our grift?

  16. Tommy S

    Am I reading wrong, or is the CDC wacky? ..this article says..”.the historic opioid boom that has contributed to more than 500,000 overdose deaths since 1996.”….CDC on that link says, “More than 564,000 people died from overdoses involving any opioid, including prescription and illicit opioids, from 1999-2020.1″….In 20 years really, only a half million??…then do another CDC page and it says, “The new data documents that estimated overdose deaths from opioids increased to 75,673 in the 12-month period ending in April 2021, up from 56,064 the year before.”….that from OD’s 100,000 a year page. Yeah, real number from 1999 is probably more like over a million….

  17. Deb Schultz

    My family was living overseas in the early 1990s. When we returned home, I was shocked to see advertisements for prescription drugs on television. I’m not sure when or how this began but surely it’s a major factor in pushing patient clients to pressure doctors/prescribers for specific drugs. In a way, this was the forerunner of using the internet to self-diagnose.

    The odd thing is that while there is a kind of push-back against googling one’s disease, I never heard much if any criticism of the ubiquitous advertising of prescription drugs.

    Much of radio broadcasting is also filled with spots for wonder drugs and full body cancer scans and similar stuff which is often outright quackery. People are inundated with noise about drugs and cures and fixes but there is little if any oversight of the information pumped out there. Or so it seems to me.

    I think medicine has been thoroughly suborned by money. The country has given power to the private equity investors and under or un-funded those once public powerhouses of medical knowledge, research, and expertise. Now that profit rules the purpose of care, it’s to the advantage of the moneymakers to keep everyone worried and potentially a customer, to pit scarcity of resource against the certainty of pain and suffering.

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