
How the Sacklers shifted $10.8B of an opioid fortune built on OxyContin - pseudolus
https://www.bloomberg.com/graphics/2020-sackler-family-money/
======
peter_d_sherman
Look at this article.

10.8 Billion Dollars (not million, _billion_ with a 'b'), of which _4.6
Billion, close to half of it, went to the Government as tax payments_...

And yet the article seems to imply fault of some sort that various Sacklers
moved millions (millions with an 'm') -- an _order of magnitude less money_ of
their post-tax-paid-for money, when _4.6 Billion, close to half of it, went to
the Government as tax payments_.

I mean, with respect to the people that paid for the opioids, the Government
doesn't give that tax money they collected, that _$4.6 Billion_ back to the
opioid purchasers, does it?

Also, why is it that federal investigators seem to have no problems finding
all sorts of ways that big corporate entities misspend millions of dollars --
but simultaneously overlook government misspending in the _billions_ of
dollars?

I for one ( _and I realize my opinion is in the minority!_ ), think the opioid
addicts should get their $4.6 Billion dollars directly _back_ from the
Government -- and in _cash_ \-- not in political promises, treatment programs,
hammers, or government cheese...

You know, like give them all a "hey, you were an opioid addict and here's the
money we took from you (as Sackler tax money!) back as an opiod stimulus
package, an opioid stimulus check!" <g>

 _And yes, I realize my opinions are politically incorrect._ <g>

~~~
summitsummit
what is "<g>"

------
songshu
I never understand why doctors are not blamed for prescribing these. Are
doctors not supposed to be responsible for prescriptions? If they are not,
should we stop allowing them to prescribe? Why don’t doctors unions throw out
members who would claim to have been hoodwinked by pharmaceutical companies?

~~~
blendergeek
> Why don’t doctors unions throw out members who would claim to have been
> hoodwinked by pharmaceutical companies?

If the companies are lying about safety, how are the doctors supposed to know?
The only ones with the data necessary to know the dangers of these drugs are
the manufacturers and the manufacturers were lying and covering up the
dangers.

~~~
songshu
They are supposed to have learned about it in medical school. If not, that's
fine, maybe doctors shouldn't be allowed to prescribe and maybe only
pharmacists should be allowed. My point is that it's a very valuable
professional quality and we should put the responsibility where the quality
is.

~~~
vanderZwan
This is (well, was) a new drug. Doctors cannot have learned about a drug in
medical school when that drug did not exist when they were studying.

My parents are retired Dutch GPs who also ran a small pharmacy[0], so I know a
little about how this works, at least in the Netherlands (I admit that this is
a pretty big caveat, because (aside from the obvious biases that this
introduces) the opioid crisis doesn't exist here - it seems to be a US-only
thing. On the other hand, that only gives me more reason to suspect that the
problem is systemic, not something to be blamed on individual doctors).

Every year doctors (or any other medical professional as well) have to attend
a mandatory amount of lessons to update their knowledge of recent developments
in their medical field. In my parents case this also was true for
pharmaceutical knowledge. This is where they learn about new medications and
their usage. So yeah, they do in fact learn which drug is supposedly safe to
prescribe under which circumstances. But you know what is required for all of
that to work? _An authoritative source of trustworthy information on drug
use_.

Doctors only start prescribing a drug after it has been approved by the
relevant governmental bodies for their usage. So if OxyContin got through the
FDA, and was marked as safe for the usage it was advertised for, then I do not
understand why you suggest that it's the fault of doctors that they prescribed
it in those cases.

Sure, there might have been some stories going around that this drug might not
be quite as safe as claimed, but keep in mind that at any given moment
hundreds of quack medicine scaremongering stories are making the rounds. When
given a choice between believing those, or the official body that is supposed
to verify which drugs are safe or not, doctors will usually pick the latter,
and in most cases rightly so.

[0] in the Netherlands this is relatively common in small countryside villages
that are too small to sustain a pharmacist, who typically needs at least 5000
clients to be sustainable

~~~
Scoundreller
> Doctors only start prescribing a drug after it has been approved by the
> relevant governmental bodies for their usage. So if OxyContin got through
> the FDA, and was marked as safe for the usage it was advertised for, then I
> do not understand why you suggest that it's the fault of doctors that they
> prescribed it in those cases.

The caveat is that once a drug is approved for XYZ, doctors can, and do,
prescribe it for anything else in their judgement.

Oxycontin wasn’t approved for chronic non-cancer pain, because it’s a poor
choice for that, but that’s where the recurring revenue is and somehow
accounted for most of its usage.

Short-term post-operative pain and cancer pain just isn’t that big of a
market.

~~~
chimeracoder
> The caveat is that once a drug is approved for XYZ, doctors can, and do,
> prescribe it for anything else in their judgement. The caveat is that once a
> drug is approved for XYZ, doctors can, and do, prescribe it for anything
> else in their judgement.

Yes, but pharmaceutical companies cannot market the drug for non-approved uses
or discuss off-label use when promoting or selling the drug. That is illegal.

That illegal activity is exactly what the courts determined Purdue did -
bribery, fraudulent marketing, and more. The issue is that Purdue broke the
law (and that their sentences for breaking the law were way too light).

------
JumpCrisscross
TL; DR The Sacklers extracted about $6.1bn after taxes but before capital
gains or losses and propose to pay $3bn in their settlement. To my knowledge,
none of them have been arrested yet, though the wheels of criminal justice
turn slower than those of civil law.

~~~
downrightmike
This would be a awesome time for Cops tv show to go get them.

~~~
programbreeding
I know you're making a joke but FYI, Cops was just canceled after 31 years due
to all the recent police protests.

[https://www.nytimes.com/2020/06/09/business/media/cops-
cance...](https://www.nytimes.com/2020/06/09/business/media/cops-canceled-
paramount-tv-show.html)

------
iorrus
What this family did was pure evil, they should all be in jail not negotiating
a settlement that will leave them financially secure and amongst the richest
Americans.

Imagine if this scenario played out in China.

~~~
naringas
I imagine a couple ways this would play out in china

1\. nobody ever hears nor finds out anything because it's all kept within the
party.

2\. they are publically shamed and they are sent to a re-education camp never
to be seen or heard again.

my 2 cents...

~~~
DSingularity
Where would you likely get away with this crime? In a system where you must
strike a deal with a party that must maintain loyalty to ideological
principles most violated by your crime? Or in a system like ours, where you
must strike a deal with some prosecutors? The chief concerns of these
prosecutors is so often their conviction rates, public optics, and personal
careers.

The political structure in the west encourage these kinds of crimes. If you
can exploit millions to make billions then you can settle in the event of
criminal persecution, hire a pr firm to take care of public optics, and donate
generously to parties in power to ensure that the pesky prosecutor/attorney-
general is sufficiently motivated not to attempt to make an example out of
you.

~~~
gruez
>If you can exploit millions to make billions then you can settle in the event
of criminal persecution, hire a pr firm to take care of public optics, and
donate generously to parties in power to ensure that the pesky
prosecutor/attorney-general is sufficiently motivated not to attempt to make
an example out of you.

In this case it doesn't look like they even bothered hiring a PR firm (or
they're doing a piss poor job), and they seem to be getting off "fine".

------
pauljurczak
Put all Sacklers actively involved in opioid business on trial under criminal
RICO statute and confiscate their property including offshore assets.

------
onetimemanytime
Not just the Sacklers: the government and the doctors are equally at fault.
There should not be a trust system here, checks and balances.

------
adolph
SlateStarCodex's "Against Against Pseudoaddiction" is an enlightening read for
some of the complexity involved.

[https://slatestarcodex.com/2019/09/16/against-against-
pseudo...](https://slatestarcodex.com/2019/09/16/against-against-
pseudoaddiction/)

~~~
brandonmenc
In a similar vein, this video titled, "OxyContin patients, then and now" [0]
is worth a watch.

The music suggests the drug is horrible, but of the five patient cases: two
are doing well on the drug and require it to function normally, one did well
but died of a (not determined to be related) heart attack, one got off the
drug with some difficulty, and one died after falling asleep while driving.

Opioids are a miracle drug for people living with chronic pain. More people
die every year from alcohol - which has absolutely zero therapeutic benefit.

[0]
[https://www.youtube.com/watch?v=pkeQifzvSNE](https://www.youtube.com/watch?v=pkeQifzvSNE)

~~~
GordonS
I'm on regular opioids for chronic pain, and they have possibly saved my life.
But I tried many, many alternatives. For the majority of chronic pain
sufferers, there will be a better alternative to opioids.

Part of the problem in the US is that doctors were reaching for opioids as
first or second line drugs, when they should be further down the line.

------
wombatmobile
If we had a justice system, that $10.8 billion would be recoverable, and used
to try to rehabilitate the victims.

But we don't have a justice system. We have a legal system, and a financial
system.

~~~
casraso
This is why I am puzzled when people say 'you should fight your battles in the
courts, not through protests'. It has always been about who can afford better
lawyers, who can win the war of attrition, and a whole lot of luck along the
way. Quite a few articles have showed up on HN the past week that reinforce
this.

~~~
WJW
Fighting battles through protests seems like it is mainly a case of who can
afford better PR companies, win the war of attrition and has a whole lot of
luck along the way. In addition, at least with a court case you can be sure
public opinion doesn't just forget about it in a few months and moves on to
the next hot item to protest.

~~~
me_me_me
Yeah, cuz that how every social change occurred in the world. Via two people
talking in the room...

Give me a break, legal system never changes itself.

From Ghandi, Bolshevik revolution, Solidarity, French revolution to MLK.

Change only occurs due to mass civil dissonance or armed revolutions.

Never because you talk in a court and all people in power agreed you make
sense.

~~~
WJW
You're arguing a different point than I made. Legal systems are as averse to
change as the large masses of society (ie very averse). They do move
eventually btw, but it's more on the scale of decades than months.

What I was getting at is that protesting is not a very reliable way to effect
change either. The "other side" of any protest is also trying to change the
narrative and can often just wait out the protests. Look at how the various
Occupy movements eventually dissolved after a few months because they weren't
getting anywhere. Even the "main" camp (if one can talk about such a thing
with Occupy) was eventually cleared by the police and didn't bother reforming
somewhere else anymore. The gilets jaunes in France are currently experiencing
the same problem.

I'd be quite interested in a way to reliably bring about societal change in a
reasonable amount of time and in a morally defensible way, but I have not
found any yet. Since philosophers have been debating this since the days of
the ancient Greeks I'm a bit doubtful that this is the time when we'll finally
figure it out.

~~~
shirakawasuna
Protesting is very effective when you do actual direct action and civil
disobedience. Americans have gotten used to running ignorable police-
sanctioned parades and calling them protests.

------
Havoc
Almost half to tax seems quite high actually compared to other major companies

------
mschuster91
I totally get and support that said profits should be seized by the government
and distributed to help affected communities.

But doing only this is like beheading hydras: you cut one head off and nine
new appear in its place. And with drugs, it's even worse than that - as users
who previously were on medical quality clean stuff from legit pharmacies paid
for by insurance, they are moving on to street stuff with all the side effects
associated (criminal behavior to finance the addiction, contamination due to
cutting agents, overdoses due to inconsistent dosing, gang fights, ...).

The opioid crisis must be tackled at the root level, and that is a lack of
physical and mental healthcare combined with the lack of a social security
network and appropriate governmental aid to regions devastated by 30 years
worth of globalization, modernization and rabid capitalism - to continue with
the hydra analogy, the US needs to burn off the necks and then kill the body
of the beast.

------
rscho
All-around-tech-bro-knowledge is strong in this thread.

Doctors prescribe opiates all over the world, including oxycontin. Nowhere
else is it a problem as big as in the US. Before wanting to withdraw
prescription rights and sue MDs on a personal basis, perhaps people could
think about the american exception?

The US opiate problem is cultural and the responsibility is on both sides of
the doctor-patient fence. The more people will be able and willing to sue MDs,
the bigger the problem. Legal action on a personal basis is _so_ the wrong
path. This is depressing.

~~~
nickff
There are huge problems with opiods in many countries, but the USA has the
most data. Canada has major issues, but only some provinces are tracking
it.[1]

[1] [https://www.cbc.ca/news/canada/british-columbia/bc-
overdose-...](https://www.cbc.ca/news/canada/british-columbia/bc-overdose-
deaths-world-ranking-1.3961024)

~~~
rscho
Yes, Canada... a country with a similar healthcare culture.

What about Europe, Asia? They also have oxycontin. How about Germany, for
example? How do they manage?

I've practiced both in Europe and in the US. I wouldn't go back to care for
americans even for a million bucks. Healthcare culture in the US is incredibly
toxic.

~~~
nickff
What? Canada has a similar healthcare culture? Canada is one of very few
single-payer-only systems. Canada and the USA have polar opposite healthcare
systems.

~~~
rscho
Yep, completely different system. Same attitude, though.

~~~
nickff
I really don't understand what you mean by 'culture' and 'attitude'; please
explain.

~~~
rscho
By culture and attitude, I do not mean the objective criteria defining the
healthcare system. I mean how things go when you have a patient encounter.
American patients are perceived as far more legally agressive and vindicative.
True or not, this results in an overly defensive response from american MDs.
Unfortunately, medicine has that in common with war that a dead patient is
less problematic than an injured patient. Hence, the opiate crisis.

This is purely cultural. European patients and MDs are much less aggressive.

~~~
nickff
The USA is definitely very litigious, but I am not sure that Canada is
similar. Cultural explanations are interesting, but they can be molded to
explain almost anything. I could for instance say that US doctors are
motivated to prevent overdoses, as their patients are a source of recurring
revenue, whereas Canadian and European doctors and systems see their patients
as cost centres.

~~~
rscho
Yes, of course my assertions are subjective and based upon personal
experience. However, here is a very objective thing: you're a US doc and your
patient is in pain. Very simple, you prescribe oxycodone and it solves the
immediate problem. Then, your patient dies of overdose. But most of the time,
you won't even be aware of the cause of death and simply archive the file.
And, most important of all: _the patient did not overdose on your
prescription, but on self-medication/street drugs_.

So in fact the difference is how MDs solve the immediate pain problem. In the
US, they would try to suppress the pain (and legal threats with it). In
Europe, they would try to make it bearable while keeping the patient
functional, because they are not afraid of their patient.

Everyone benefits from a less tense relationship.

~~~
nickff
I understand that you think it's an incentive problem, and I agree that opiod
issues are probably driven by incentive issues, but I am not sure we have the
data to support your explanation. I also don't think most doctors keep track
of patient fatalities at all, let alone the causes of death.

------
mmrezaie
I am not american and I remember hearing about OxyCotin for more around 10
years. So I wonder why controling this problem which casued so many loses of
lifes (not necessary deaths), took this long to be the target of the
government. I also wonder was there one of these stupid political shows that
US is used to them now that was stopping anyone to handle it.

In the long legal battle I do not think this money is going to be recoverable
(at least most of it).

~~~
senorjazz
I remember it being discussed on drug (recreational) boards 20 years ago. It
is not new

> So I wonder why controling this problem which casued so many loses of lifes

Did you not read $10billion in profit. People point to Mexico and the
corruption the narcos bring to the Mexican state. It is the same in the US for
this case. Just looked at who profited. Drs, lawyers, politicians, lobbists.
Whilst the gravy train is running people are not asking questions at best and
doing their best to stop them being asked.

The corruption regarding oxycotin, ran from the top to the bottom of the
system

------
aronpye
Paywall, didn’t read

~~~
dvduval
Me either. Imagine a world where the poor have no news access, and instead
depend on Facebook for news.

~~~
geodel
I am trying to imagine a world where everyone think they should get for free
other persons' labor. I wonder what that thing is called.

~~~
colmvp
For some reason people online think writers and journalists are paid in
Likes/Retweets

------
nojvek
TIL: Oxytocin and OxyCotin are different drugs that are both pain killers. I
remember being prescribed Oxytocin after my surgery and it was a fun woozy
drug. Never tried OxyContin.

~~~
nate_meurer
Oxytocin is a hormone, completely unrelated. The words you're thinking of are
oxycodone and oxycontin, and they are not different drugs. Oxycontin is a
time-release formulation of oxycodone.

~~~
athriren
Expanding on this, oxytocin has many known (and likely unknown) purposes but
is most closely associated with context dependent social bonding and
exclusion, sex, and childbirth.

Somewhat coincidentally for the purposes of this conversation, it also
inhibits chemical dependence (including opioids, which includes oxycontin and
oxycodone). [1][2]

[1]
[https://www.sciencedirect.com/science/article/pii/S009130571...](https://www.sciencedirect.com/science/article/pii/S0091305713002219)

[2]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089904/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089904/)

This concludes the reply relevant section of my comment.

Sidenote (mostly me screaming into the void): due to excruciating constant
chronic pain from a botched surgery, I took three oxycodone for 4 years (March
2015-August 2019) every single day. It enabled me to work and live a (greatly
diminished) life. For all of the harm the crisis inflicted—and the Sacklers
did great evil for great reward—there is really not another class of
medication that would have kept me functioning.

Fortunately for me, I managed to get a very good job with great healthcare and
I immediately used that to have a corrective surgery with the best surgery
center in the country. This took me from about 65% functional (medicated) to
about 85% functional, unmedicated. That last 15% is never coming back, and I
have to live with the fact a doctor permanently damaged my body in an
uncorrectable way.

But, over the course of my treatment, the backlash against opioids began to
make it difficult for my pain management clinic to provide the treatment I
needed even though I was completely compliant (and had the regular drug tests
to prove it—so many cups of pee). I would be dead without opioids. I would
have killed myself. There are many more like me who still suffer from
unmanageable pain who either cannot get the medication they need. There are
many people who are not here because of opioids as well so I completely
understand the backlash, I just hope we don’t overcorrect.

The Sacklers harm cannot be undone, but their reward can be—expropriate it all
(leave them an apartment with running water and a roof so that it’s
technically legal).

~~~
nate_meurer
Comments like this are really important, and should be a part of every
conversation about opioids. Chronic pain is among the worst of medicine's
unsolved problems.

Curious: how much did your pain affect your sleep? Did you need the pills to
sleep too?

------
IMTDb
The US right now: "Some doctors told us the negative effects of opioids are
not that dangerous compared to the short term benefits on physical pain. We
sell that in pharmacies. This is a billion dollar industry. This was
definitely a bad choice, we should have listened to the people talking about
the danger of that addiction. Let's burn the skarks that were responsible for
that".

Also the US right now : "Some doctors are telling us the negative effect of
THC are not that dangerous compared to the short term benefits on mental
wellbeing. We sell that in dispensaries. This is a billion dollar industry.
This is definitely a good choice, we don't need to listen to the people
showing the danger of addiction. Let's praise the progressist that are
responsible for that".

~~~
civilized
It's a good point to raise - at the same time, I think it's generally accepted
that THC is on the safer side of the "problematic drug" spectrum, while
opioids are on the riskier side?

~~~
IMTDb
I agree that opiods are definitely on the riskier side of the spectrum, while
THC definitely seem on the safer side - at least for adults. But we know that:
that's why opioids are mainly sold after a prescription by a doctor and in a
pharmacy. At least we are trying to limit access to opioids.

On the other hand THC is currently almost advertised as being "good for you"
(see all the papers/studies around it), and a socially acceptable/fun thing to
do. While I don't really see anyone posting on social media a picture of
themselves crushing some oxy pills. Overall we can expect the number of people
negatively impacted by a THC addiction to be significantly higher in the next
few years than for opioids. Even if at the individual level, the effects are
lower.

At the macro level this makes THC widespread use worrying - just like the
opioids use is worrying. The really interesting thing is the difference in
narrative. We know want to lock down one as much as possible, while we want to
open the other as much as possible.

PR wise, it's incredible. The arguments used in this article against opioids
(it was a great business making lots of money !), are exactly the argument
used in favour of THC (it is going a great business making lots of [tax] money
!).

~~~
Nasrudith
The reason THC is even an issue is because the law has insistently been an ass
for over half a century. The DEA has a complete tautology of Schedule 1
classification when its effects are far less dangerous. Yet it is federally
more controlled than cocaine.

The consequences make a huge difference. So a plan to make a million dollars
selling sandwiches vs killing people on the street to rifle through their
pockets should be treated very differently.

~~~
IMTDb
The reason why THC is an issue is...because it's bad for you. At least for 90%
of the population.

If THC has benefits in a narrow range of situation, doctors should absolutely
be able to experiment with it. And the DEA classification should be reviewed
under that light.

But there is a whooooole range of possible options that sit between "it's the
worst substance ever. Anyone consuming it should be put in jail after 3
strikes. No one can even dream of making medical trials with it" and "Meh, it
looks relatively harmless and fun, let's distribute that like candies with
close to no control"

