
Sacklers Directed Efforts to Mislead Public About OxyContin, Documents Indicate - pseudolus
https://www.nytimes.com/2019/01/15/health/sacklers-purdue-oxycontin-opioids.html
======
wonderwonder
From the article:

"As part of the 2007 settlement agreement, the board of Purdue Pharma, which
included members of the Sackler family, signed a corporate integrity agreement
with the federal government promising that the company would not violate the
law in the future."

This is essentially a large driver of America's social and environmental
problems. An individual lacking in resources found guilty of a crime serves
jail time, probation and generally faces life changing repercussions. When a
corporation is found guilty of crimes that may very well include the deaths of
dozens/hundreds of people they pay a fine. Not a business crushing fine, just
a slap on the wrist. The fact that individuals made all of the decisions that
led to the companies crimes is for the most part ignored. Large corporations
are essentially given impunity to pursue 'share holder value'. The only time
individuals are prosecuted is if they negatively affect those same
shareholders such as with Enron, etc.

We allow pharmaceutical companies to addict and destroy lives, chemical
companies to dump carcinogens into drinking water, coal plants to pollute our
air but its ok because its a corporation doing it and they are rich.

Removing the shield that protects individual decision makers from criminal
prosecution would go a long way towards fixing this country. People would be
much more hesitant to order something illegal if they were personally sent to
jail for it.

~~~
GeekyBear
The prosecutors recommended charges that would land Purdue execs in prison.

>Based on their findings after a four-year investigation, the prosecutors
recommended that three top Purdue Pharma executives be indicted on felony
charges, including conspiracy to defraud the United States, that could have
sent the men to prison if convicted.

[https://www.nytimes.com/2018/05/29/health/purdue-opioids-
oxy...](https://www.nytimes.com/2018/05/29/health/purdue-opioids-
oxycontin.html)

However, political appointees at DOJ stepped in.

>Political appointees at the Justice Department, following a closed-door
meeting with a high-powered Purdue Pharma legal team advised by Rudolph
Giuliani, refused to back Brownlee’s recommendations. The prosecutor was left
in the wind, and the executives, who insisted they did nothing wrong, only had
to plea to the misdemeanor charge.

[http://time.com/5311359/purdue-pharma-oxycontin-lawsuit-
opio...](http://time.com/5311359/purdue-pharma-oxycontin-lawsuit-opioid-
crisis/)

~~~
maxxxxx
People like Brownlee who try to do their job are probably the "deep state" the
administration is complaining about...

~~~
ironic_ali
Remove "probably" and your statement is correct.

------
gwbas1c
Sometime around 1999 or 2000 I read the story about Heroin. In summary, Bayer
sold Heroin in the late 1800s as a non-addictive alternative to Morphine.

(At the time, Morphine addiction was a huge crisis, with many people getting
addicted to Morphine when using it as directed by a doctor.)

There was a huge scandal when, about 10 years after Heroin entered the
marketplace, it came out that Heroin turns into Morphine in the brain. It also
enters the brain much faster.

(This, BTW, means that Heroin is an extremely powerful painkiller. The UK used
to use it for medical purposes until very recently.)

I wasn't surprised when it came out that Oxycotin was highly addictive. I knew
it was just the same thing over again. A drug company markets an opiate as
safe until everyone realizes it's not safe at all. It only took about 110
years for most people to forget about Bayer's Heroin scandal for someone to
get away with it again.

~~~
throwaway2048
Sounds like the hype cycle surrounding supposedly "non addictive" or "non
habit forming" sleeping pills.

~~~
jerf
Also reminds me of weight loss pills, which for whatever biochemical reason,
seems to always fry the hearts of whoever takes them. I think I've seen the
cycle "new hot pill -> publically available -> oh crap, people are having
heart attacks" at least three times in my life.

~~~
cc-d
It's because weight loss pills tend to rely on the appetite suppressing
effects of stimulants. Often, the compounds are intentionally chosen because
they behave near identically pharmacologically to traditional stimulants. As
such, they carry similar cardiac risks, if not significantly more because
unlike traditional stimulants, the "diet pill/supplement" market is completely
unregulated. This compounds the issue, because any vendor can provide
incorrect dosage amounts, and also because people tend to treat 'unregulated
diet pills' less seriously than say, methamphetamine.

A good example of this is Ephedrine.
[https://en.wikipedia.org/wiki/Ephedrine](https://en.wikipedia.org/wiki/Ephedrine)

It was widely used in 'weight loss' pills up until 2004, whenever it was
restricted due to a combination of it's chemical similarity to
amphetamine/methamphetamine (allowing for easy clandestine synthesis of more
powerful psychoactive compounds), and people dying because they didn't realize
they were taking completely unregulated substances on par in seriousness with
other, culturally/politically demonized stimulants.

If one were to compare the 2d structures of both ephedrine and
amphetamine/methamphetamine, even with no chemistry knowledge, one can see how
similar these molecules actually are. Not to imply that molecular similarity
necessarily always leads to similar pharmacological effects, but in this case
it certainly does.

~~~
meowface
While using it for weight loss does sound unnecessarily dangerous, how risky
is it really, comparatively? High daily doses of amphetamine are still
regularly prescriped to young children.

~~~
cc-d
The dangers of Ephedrine are benign when used correctly (oral, low dose
amounts), as is both amphetamine and methamphetamine (the United States gives
meth to kids for ADHD, there's a reason it's schedule 2).

Even what one might call a 'high dose' (but still under the prescribing
guidelines max limit) of prescribed amphetamine is still rather benign, unless
one has a pre-existing condition which increases the risk of adverse health
effects.

------
trimbo
Here's a long read about it from the New Yorker:
[https://www.newyorker.com/magazine/2017/10/30/the-family-
tha...](https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-
an-empire-of-pain)

~~~
dmckeon
> prescribing a pill on a twelve-hour schedule when, for many patients, it
> works for only eight is a recipe for withdrawal, addiction, and abuse.

This article is well worth reading for anyone wishing to be informed about the
background before discussing which parties might ultimately be responsible for
abuse.

------
InTheArena
These guys need to be thrown in jail for mass man-slaughter (I would ask for
murder if they can prove that they knew the OxyCotin addiction risk early in
the process).

The number of people who have lost their addiction fueled by this drug is
astounding.

~~~
narrator
The victims won't press criminal charges because then, in the big bucks civil
suit, no witnesses will testify. Why throw a couple patsies in jail when you
can make millions on the litigation? This is the sad reality of the American
legal system where money is the universal solution to all problems.

~~~
TylerE
The victims can't press charges because they can't.

 _Prosecutors_ press charges.

The general public cannot, never has.

~~~
traviscj
Interesting fact, but honest question: What's the usefulness of this
distinction?

~~~
mikeash
It changes who makes the decision, which can be really important. Consider,
for example, an abused spouse who ends up in the hospital but doesn’t want to
press charges. The prosecutor may consider this when making the decision to
prosecute, but it’s ultimately not up to the victim.

~~~
TylerE
Also, prosecutors tend not to take on cases they aren't pretty sure about.

The standard in a criminal trial is much higher ("beyond a reasonable doubt")
than in a civil trial ("preponderance of the evidence").

Basically, in a civil lawsuit, if it goes to the jury they only need to be
50.0000000001% convinced. In a criminal trial it's more like 95%.

------
doitLP
I used to work for an open medical information company that published
publically available conflict of interest data and informed consent
information on a range of medicines and procedures.

I was constantly astounded by the open corruption in the Pharma industry and
complete lack of informed consent as to risk of side effects, how studies data
was presented or skewed when being used, who was paying for studies (almost
always the company making the product), how much advertising was being done at
the med school level and by the economics of a drug with serious side effects
(it’s almost always profitable to sell the drug anyway. The class action
payments usually don’t even come close to the profits generated).

Most of the data in this article about the Sacklers and Oxy has been known and
available for 10+ years. I remember working on a piece about the skewed
addiction numbers. It was literally being marketed as “non-addictive”.
Obviously a lot of good people work in Pharma and there are lifesaving
medicines, yes. But the profits to be made are so vast and the companies so
beholden to shareholders that we should ALWAYS demand full informed consent
from our doctors on ALL medical interventions.

Example: commercials for Lipitor claim a 1/3rd reduction in the risk of heart
attack by taking the drug. Your doctor prescribes it because it’s the
_standard of care_ for your profile. Chances are high he hasn’t read any
studies recently. What you both don’t know is that 1/3rd stat comes from a
company-funded study in which 100 high-risk patients taking Lipitor who had
already had a heart attack were compared to 100 high-risk patients who had not
had a heart attack and who were not taking the drug. Over the course of the
study (years I think) 2 people in the first group had a heart attack, and 3 of
the non-drug group had a heart attack. Ok sure it’s 1/3rd but it’s actually
only a 1% decrease in YOUR risk. Set that against all the side effects of
taking the drug for years including the mental side effects now taking the
spotlight. And those in the study were _high risk patients_ who already had a
heart attack. And they were men only. At the time of the commercials there was
no study on its effects on women. Yet 45% of the entire US adult population as
of 2009 was on a cholesterol lowering medication. 45%! There so much info like
this, on bypass surgery, stents, quitting smoking drugs...the list goes on.

The company I worked for had some smart, dedicated people but they couldn’t
figure out a way to properly monetize it and the company shuttered after a few
years. I think there’s definitely room for some disruption there still and I
hope someone can figure it out. I for one would pay handsomely for a data-
driven service that gives me all the info on offered drugs so I can make true
informed consent. I’m guessing doctors would like it too since none of them
have time to actually read studies and pick them apart.

The point: take whatever medication or do any surgery you need but BE AS
INFORMED AS POSSIBLE before you do. We are often scared of our doctors’
authoritarian pronouncements that are all too often are based on unsound
evidence, even if it is the “standard of care”. Find a doctor you can work
WITH to get the best care for you. If you can’t do that become your own
advocate aknd read as much of the literature is possible. You can’t afford not
to.

~~~
scottlocklin
I've heard this about statins in general, but do you have some bookmarked
citation for this? I would like to have it available if the doctor ever tries
to get me onto this stuff.

~~~
doitLP
I will look. But in the meantime, this is by one of the doctors I worked with
at the company. I know it has that study in the references:
[https://www.amazon.com/No-Nonsense-Guide-Cholesterol-
Medicat...](https://www.amazon.com/No-Nonsense-Guide-Cholesterol-Medications-
Informed-
ebook/dp/B018DB2GJ0/ref=mp_s_a_1_fkmr0_1?ie=UTF8&qid=1547677168&sr=8-1-fkmr0&pi=AC_SX236_SY340_QL65&keywords=dr+moira+dolan)

------
mr_isomies
There was a long form article in the New Yorker two years ago about the
Sackler family and Oxycotin. Quite a good read, in depth history of the drug,
well researched:

[https://www.newyorker.com/magazine/2017/10/30/the-family-
tha...](https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-
an-empire-of-pain)

At this point there is not doubt in my mind that deceit is part of the
"company culture" of Purdue/Sackler, their MO. They should be held
accountable. They should be publicly held accountable.

Everyone should realise that the Sacklers that sponsors this museum, or that
library, or that park, have been for the last decades willingly pushing this
drug while knowing full well that something was wrong. They patented a slow-
release opioid but knew it was impossible to make sure that patient wouldn't
crush the pills; they never reached out to the authorities when small town
doctor ordered more drugs than could ever be needed. I mean, they literally
have just patented a drug (September 2018) that let you go through the
withdrawal of Oxycoting more easily.

They created the problem, leaving tens of thousand dead in their track while
profiting immensely from it, now they want to profit from the recovery as
well? Despicable business practice, despicable business.

------
andrewla
The AP treatment of the same story [1] (a repeat of a feature request -- have
the ability to add "supplemental urls" that can be alternatives to the main
link posted, to both allow auto-correction of blogspam and to provide
alternatives to paywalled sources)

Here are the new documents [1] themselves, as far as I can tell, but I can't
find many of the referenced quotes in there (the "hammered" quote and the
"blizzard" quote are the most colorful ones).

[1]
[https://www.apnews.com/4e2da888ede44c3db129b46d76504778](https://www.apnews.com/4e2da888ede44c3db129b46d76504778)

[2] [https://int.nyt.com/data/documenthelper/569-purdue-pharma-
do...](https://int.nyt.com/data/documenthelper/569-purdue-pharma-
documents/abbd666f51f9fae8bd7a/optimized/full.pdf)

~~~
benbreen
The quotes are on pages 56 and 59 of the full document linked to by NYT.

------
rajacombinator
The real question is why are the Sacklers taking heat for this now. Tptb have
known about this for ages. The Sacklers are preeminent “philanthropists” - who
did they leave off their list?

------
cwkoss
They should be charged with 1000s of counts of Depraved Heart Murder.

------
alottafunchata
“We have to hammer on abusers in every way possible,” Mr. Sackler wrote in an
email in 2001, when he was president of the company, Purdue Pharma. “They are
the culprits and the problem. They are reckless criminals.”

\--but was he incorrect?

~~~
elipsey
I think that's an important philosophical question.

Sackler was correct by definition. It is evidenced that people become addicted
to oxycontin _while_ taking it as instructed. Then they get physically sick
when they stop, and have been powerfully psychologically conditioned to seek
opioids.

If abuse means succumbing to the physiological compulsion to re-dose a drug
you are addicted to, then one is addicted but not an abuser the day before the
prescription runs out. But the next day they are either an addict in
withdrawal, or an abuser.

Which one would you be? Could you quit a heavy opioid habit cold turkey? Good
for you, but apparently lots of people can't.

People who are given prolonged high-dose self administered opioids should give
informed consent to the serious risk of addiction. It's easy to argue in
retrospect that, in fact, every reasonable person knows about this problem,
but it is well evidenced that Purdue marketed it's product as having a low
risk of addiction. I have never heard of a doctor saying: "You can take these
pain pills for a couple of months. When you stop you'll get really sick for a
very long time, and have a pernicious and overpowering psychological
compulsion to take more opioids." That's what real informed consent would look
like. People are angry at Purdue because they were dishonest.

Returning to the question of personal responsibility for addiction, if huge
numbers of people don't quit a drug they got addicted to while using as
directed, it is true but not helpful call them abusers. If opioid addicts
could just quit anytime, we wouldn't be talking about this in the first place.
How large a fraction of the population must fail in a way that is predictable
by circumstance before we stop attributing failure entirely to a lack of
individual virtue?

Even if your policy position on drug addicts is “kill em all and let god sort
em out”, blaming abusers is not getting it sorted here on earth. If we want to
make progress in this area we might have try something else.

~~~
nielsbot
Thank you for this reasoned reply

------
tomohawk
A company sells a legal, FDA approved, drug. The motives of the company may
not be pure, but so what? Does anyone sell anything with 100% pure motives?

What exactly is wrong with people making the most use of this drug as they see
fit in their own lives? Is it wrong for people with chronic pain to take what
they need? Why should doctors and others be able to prevent people from
treating their pain?

~~~
trimbo
The problem is Oxy was overprescribed relative to the addictive features of
the drug _because_ the Sacklers falsely claimed that it was less addictive.
Doctors believed that and were willing to prescribe a super-strong, easy-to-
abuse drug when they would not have done so previously. From the New Yorker
article I linked in a top level comment:

"Purdue launched OxyContin with a marketing campaign that attempted to counter
this attitude and change the prescribing habits of doctors. The company funded
research and paid doctors to make the case that concerns about opioid
addiction were overblown, and that OxyContin could safely treat an ever-wider
range of maladies."

20 years later, I think we know how it turned out. Something like 75% of
opioid addicts start with pills.

~~~
tomohawk
And people who actually need pain management are unable to get it because
other people insist they know better. And doctors are afraid to prescribe
adequate amounts of pain killers.

~~~
chmod775
> [doctors] insist they know better.

Because they probably do.

Pain is a stimuli people will do a lot to avoid. But pain also exists for a
reason. You generally can't trust people in pain to self medicate.

Evolution did not give humans the ability to feel pain just to fuck with them.

Pain prevents you from unnecessarily straining damaged body parts, keeping you
from harming yourself further and making your condition worse.

On painkillers you might hurt yourself doing something as simple as walking up
a set of stairs, just because you didn't notice you placed your foot badly.

~~~
freedomben
Spoken exactly like somebody who has never suffered from chronic,
debilitating, relentless pain.

~~~
chmod775
Instead of textbook logical fallacies would you care to provide any real
arguments to support your position that people should essentially be allowed
to self-prescribe painkillers? Or at least try to engage me on the points I
made?

