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Meet the Sacklers: The Family That's Killing Millions (Maybe More Than Stalin)

The U.S. has a massive opioid addiction problem. According to the U.S. surgeon general, more Americans now use prescription opioids than smoke cigarettes,1 and addiction to narcotic pain relievers now costs the U.S. more than $193 billion each year. The Manchester, New Hampshire, fire department recently said it now responds to more calls for drug overdoses than fires.2 That's not so surprising when you consider that opioids are now the leading cause of death among Americans under the age of 50.3

The following graph by the National Institute on Drug Abuse shows the progressive incline in overdose deaths related to opioid pain relievers between 2002 and 2015.4 This does not include deaths from heroin addiction, which we now know is a common side effect of getting hooked on these powerful prescription narcotics. In all, we're looking at just over 202,600 deaths in this 13-year time frame alone.5

Misleading Marketing Created the Opioid Epidemic

How did we get into this mess? Part of the problem, from the very beginning, has been false advertising. This past summer I wrote about how a single paragraph in a 1980 letter to the editor in the New England Journal of Medicine became the basis of a drug marketing campaign that has since led hundreds of millions of people straight into the arms of addiction and/or death.

In 2015, the U.S. Food and Drug Administration (FDA) approved OxyContin (an extended-release version of oxycodone) for children as young as 11,6 thereby opening the gate for narcotic addiction among children and young teens as well. In July 2015, The Fix7,8 wrote about the Sackler family, owners of Purdue Pharma, who that year made it onto Forbes' Top 20 billionaires list9 — in large part due to the burgeoning sales of OxyContin.

About 80 percent of heroin drug addicts report starting out on painkillers such as OxyContin.10 Indeed, prescription opioids are now recognized as the primary gateway drug to heroin and other illicit drug use, and prescription painkillers — not illicit drugs — are the most commonly abused drugs in the U.S. As noted by Zachary Siegel, writing for The Fix,11 "It's easy to get rich when health care providers write 259 million prescriptions for painkillers, enough for every American adult to have a bottle full of pills."

The massive increase in opioid sales has been repeatedly blamed on an orchestrated marketing plan aimed at misinforming doctors about the addictive potential of these drugs. Purdue Pharma was one of the most successful in this regard, driving sales of OxyContin up from $48 million in 1996 to $1.5 billion in 2002.12

Purdue's sales representatives — who received handsome incentives and bonuses for OxyContin sales — were extensively coached on how to downplay the drug's addictive potential, claiming addiction occurring in less than 1 percent of patients being treated for pain.

As noted by Dr. Irfan Dhalla, a drug safety researcher, "Purdue played a very large role in making physicians feel comfortable about opioids."13 Statistics reveal this marketing claim to be an outright lie. In reality, studies show addiction affects about 26 percent of those using opioids for chronic noncancer pain, and 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription!14

A Fortune Built on Dangerous Misrepresentations

In 2007, Purdue Pharma pleaded guilty to charges of misbranding "with intent to defraud and mislead the public," and paid $634 million in fines — an amount said to represent 90 percent of its profits from OxyContin sales during the time of the offense.15 Fast-forward a decade, and it seems this fine did little to alter the company's moral compass. Opioids are still massively misrepresented, misused and abused by tens of millions of Americans.

A potential part of the problem is the fact that no specific individuals have ever been charged. None of the members of the Sackler family was ever charged with any kind of misdeed, for example, and owners and corporate leaders of other drug companies have also walked away scot-free.

The Sacklers' profiteering from the opioid abuse epidemic they helped engineer was again highlighted in Esquire16 in mid-October, as well as The New Yorker.17 After recounting the family's extensive philanthropic endeavors18 and notorious "pursuit of naming rights," Esquire journalist Christopher Glazek writes:

"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 … came from OxyContin, the narcotic painkiller regarded by many public health experts as among the most dangerous products ever sold on a mass scale …  

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' …

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 second have nothing to do with one another."

Opioid Epidemic Equates to 9/11 Massacre Every Three Weeks, Year-Round

According to President Trump's Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey governor Chris Christie, opioids kill an estimated 142 Americans each day, a death toll equivalent to a "September 11th every three weeks," and Purdue Pharma was one of leading engineers of this still ongoing massacre.

You may want to believe that the Sackler family, while being the sole owners of Purdue Pharma, personally had nothing to do with the corporate decisions that fueled the epidemic but, according to Glazek, that's not true.

"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," he writes. In other words, Sackler family members were fully aware of, and involved with, the marketing machinations behind OxyContin.

Sackler Marketing Specialty — Inflated Claims

Glazek provides a summarized history of the Sackler family's rise to wealth and power. In 1952, Arthur Sackler, son of immigrants living in Flatbush, Brooklyn, bought Purdue Frederick, a company founded in 1892 that sold patent medicines. It's flagship product back then was Gray's Glycerine Tonic, a remedy peddled as a general cure-all.

Arthur's two brothers, Mortimer and Raymond, ran the company. Arthur made a name for himself in drug advertising, which at the time was relegated to "detail men" who sold medicines to doctors by going door-to-door.

Arthur believed, and rightfully so, that print ads in medical journals would be a great way to boost drug sales, and in 1952 published the first color drug ad in the Journal of the American Medical Association (JAMA). He later went on to develop an ad campaign for Valium, made by Roche. Glazek writes:

"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." 

As a result of this campaign, Valium became the most widely prescribed drug in the U.S., making a record-breaking $100 million in sales. According to Glazer, it was this "original marketing insight" that drove OxyContin's success as well — "That simple but profitable idea was to take a substance with addictive properties … and market it as a salve for a vast range of indications."

Marketing Messaging Was No Mistake

Glazer also notes that one of the Sackler family members that appears to have been heavily involved in the marketing of OxyContin was Raymond's eldest son, Richard Sackler.19

"'At all the meetings, that was a constant source of discussion — 'What else can we use the Contin system [editor's note: a slow-release 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' …

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.'"

Despite his close involvement in the business, heading up the firm's research and development division, as well as its sales and marketing division, Richard's name does not appear anywhere on the Purdue Pharma website. Between 1999 and 2003 he also served as company president, after which he became co-chairman of the board.

Arthur's daughter, Elizabeth Sackler, described by Glazer as "a historian of feminist art who sits on the board of the Brooklyn Museum and supports a variety of progressive causes," has "emphatically distanced" herself from her cousin, Richard, and Purdue Pharma, noting in an email to Glazer that "Neither I, nor my siblings, nor my children have ever had ownership in or any benefit whatsoever from Purdue Pharma or OxyContin."

The Rise of Narcotic Entitlement for Every American 

As noted by Glazer, while Purdue didn't invent the movement incited by pain specialists in the mid-'90s, who were calling for more and better pain management strategies, the company certainly took full advantage of it. Purdue and other drug companies in the business of making painkillers created patient advocacy front groups such as the American Pain Society, the American Academy of Pain Medicine, and Purdue's own group, Partners Against Pain.

These groups were instrumental in pressuring regulators into making pain assessment one of the vital signs20 recorded at every doctor's visit. The inclusion of pain as "the fifth vital sign" has since become one of the hidden drivers behind opioid prescriptions, as nothing lowers a patient's pain score as much as a narcotic pain reliever, thereby assuring the doctor will maintain a higher patient satisfaction rating.

"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," Glazer writes.

This "universal narcotic entitlement" is now killing an unprecedented number of Americans.21,22 According to the latest data from the National Center for Health Statistics, life expectancy for both men and women dropped between 2014 and 2015 for the first time in two decades, and drug overdose deaths appear to be a significant contributor.23,24,25

In 2015, 33,091 Americans died from an opioid overdose. Nearly one-third of them, 15,281, were by prescription.26,27,28   Back pain, which is of the most common health complaints across the globe, has also become one of the most common reasons for an opioid prescription. And, if you have back pain and suffer depression or anxiety you're at particularly high risk for opioid abuse and addiction, research shows.29

Opioids Are by Far the Most Lethal Medications Available

The most common drugs involved in prescription opioid overdose deaths include30 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®). As noted by Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention (CDC): "We know of no other medication routinely used for a nonfatal condition that kills patients so frequently."31

Despite its many risks, which include birth defects and the risk of addiction, nearly one-third of American women of childbearing age are now prescribed opioid painkillers32 and more than 14 percent of pregnant women were prescribed opioids during their pregnancy.33 Clearly, if you are planning a pregnancy or are pregnant, you should go to great lengths to avoid narcotic drugs. If you wouldn't consider taking heroin, you really should not take a narcotic pain reliever either.

Knowing that these drugs carry the serious risk of addiction, abuse and overdose, they should be prescribed sparingly and only for the most severe cases of pain, for which no other options are available. Unfortunately, the current medical system heavily discourages doctors from making much-needed changes in their prescription habits. As mentioned, patient pain assessment plays a significant role in a doctor's quality of care indicator, and nothing will eliminate pain as effectively as a narcotic.

Additionally, and in the midst of this epidemic of opioid overdose deaths, drug companies are still paying physicians to boost opioid sales by writing more prescriptions. According to a study published in the American Journal of Public Health,34 between August 2013 and December 2015, more than 375,000 non-research opioid-related payments were made to more than 68,000 physicians, totaling in excess of $46 million.

This amounts to 1 in 12 U.S. physicians collecting money from drug companies producing prescription opioids. The top 1 percent of physicians received nearly 83 percent of the payments, and the drug fentanyl, a synthetic opioid that can be anywhere from 500 to 1,000 percent more potent than morphine, was associated with the highest payments.

Many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, were also those showing the most opioid-related payments to physicians.

This suggests there's a direct link between doctors' kickbacks and patient addiction rates and deaths. It's also worth noting that a significant amount of people get their first opioid prescription from their dentist.35 This is particularly true for teenagers and young adults.36 Half of all opioids are also prescribed to people with mental health problems.37

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