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Sacklers Directed Efforts to Mislead Public About OxyContin, Documents Indicate (nytimes.com)
207 points by pseudolus 37 days ago | hide | past | web | favorite | 79 comments



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.


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...

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...


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


Remove "probably" and your statement is correct.


Yet more evidence that Rudy Giuliani is literally the worst person in the entire world.


I guess, but he's just representing his client (albeit a reprehensible client). The DOJ appointees who passed on prosecuting felony charges are indistinguishable from corrupt cops.


There's a difference between legal advice and representation in a court of law (which I fully support no matter how bad the accusations), and back-room political dealing.


There is no "just" here. He is representing a monstrous client and that is something he can and should be held responsible for.


Each person who was a member of the board of Purdue Pharma at the time these policies should be charged with a count of manslaughter for each documented case of non-intentional overdose death that can be linked to their product. Bring home to them the body count their reckless decisions have wrought.

Let them rot. Make an example of them. Otherwise, bring out the guillotine because apparently the robber barons of the Neo-Guilded Age need to be taught a lesson in noblesse oblige.


> for each documented case of non-intentional overdose death that can be linked to their product.

The only people who accidentally OD on Oxycontin are going to be either those who for some reason take the highest dose without any previous tolerance, or else toddlers who get into them. The overwhelming majority of people dying from Oxycontin are going to be those who mix it with alcohol, heroin, fentanyl, methadone, benzos, grapefruit juice, etc. It's all but impossible to overdose on if used as directed.


It was never about people OD'ing on Oxycontin. It is about Oxycontin creating an opioid dependency that leads many to cheaper alternatives (read: heroin) once they can no longer afford Oxycontin.


> once they can no longer afford Oxycontin.

When sold legally, it's less expensive than Starbucks even if it's not covered by insurance. If people are forced to access illegal substitutes, that's because of bad government policy and not because of the company.


Non-intentional =/= used as directed.

Non-intentional there is more along the lines of excluding suicides committed using their product.


the counterargument is that the invention of the corporation (along with relatively lenient bankruptcy laws) is what allowed western nations, particularly the US, to dominate the world economy because the corporate veil allowed corporations to take bigger risks in creating new products and industries.

but yes, the corporate veil is too thick, as shown by poor societal outcomes like this one. however, let's not throw out the baby with the bath water--we should lower the burden of proof for prosecuting such wrongdoings without completely losing the innovative effects of the corporate form. (we also need political reform so that policy makers can promote prosocial behavior, like proactively internalizing externalities like this rather than trying to clean it up after the fact).


> signed a corporate integrity agreement with the federal government promising that the company would not violate the law in the future

I don't understand how someone proposed this with a straight face. Signing something agreeing to not break the law more is a confession that you've already done so.


Why hasn't there been a (prominent?) class action civil suit by the parents of all those who died from this? We know the government is going to be corrupt and bought but surely some smart lawyers can see this as the new tobacco. And for that matter why are the states suing like they did for tobacco?


There are. In fact, on 60 Minutes a few weeks ago they were interviewing the main lawyer who actually brought and won the case against big tobacco. Guess whet he's working on now? Multiple states have signed on. :)

https://www.cbsnews.com/news/opioid-crisis-attorney-mike-moo...


I have read quite a bit about class action suits and it's a super high risk business for lawyers and states. Very expensive and you need really strong proof.


product liability is an achilles heel of American business models; try and find information on carcinogenic or Endocrine Disrupting Chemicals and current products, esp. plastics


deaths of hundreds? Try hundreds of thousands.


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.


I am pro using heroin medically (and all/any drugs where trials have shown them to be effective). For heroin, it's a powerful drug that can be used in palliative care situations where nothing else will do. When it's administered in a controlled setting by a medical professional. The risk and danger of addiction is very low in these circumstances.

Overly cautious drug policy (such as an outright ban on heroin (or any drug)) can deny powerful remedies to those who can benefit from them.


> The UK used to use it for medical purposes until very recently.

I believe they still use it as "diamorphone".


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


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.


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

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.


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.


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.


Here's a long read about it from the New Yorker: https://www.newyorker.com/magazine/2017/10/30/the-family-tha...


> 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.


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.


In my old town, where opiate-related deaths have been doubling annually for years, it's considered second-degree murder to facilitate or participate in drug use that leads to someone overdosing.

And it's pretty common: A friend of mine who wasn't even around the person who overdosed, he had simply split an opiate purchase with him and then parted ways, was just arrested on 2nd degree murder charges within the last few months.

If my friend, who bore no ill will, gets sent to prison for murder, while the people who got him in his position (addicted to opiates after receiving prescribed pain medication) walk free, then that's textbook political corruption.


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.


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

Prosecutors press charges.

The general public cannot, never has.


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


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.


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%.


Private citizens cannot initiate a criminal proceeding.

They can SUE, but that's civil, not criminal.


It means that all criminal prosecution is political, or at least, politically-influenced.


Considering the number of lives devastated by OxyContin abuse, I'm surprised there hasn't been even one (successful?) attempt on the alleged perpetrators' lives.


Depraved Heart Murder


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.


Really interesting comments, thanks for taking the time to share.

> become your own advocate

Really resonates with me. Almost every time I go home and hang out with my parents, they share a new horror story about some close call with their medical treatments. (They've both had--and beat--cancer.) Last trip they were telling me about one of the days my Dad was getting chemotherapy; they needed to get a blood draw before the chemo was administered, and the cancer doc had instructed _them_ to make sure the phlebotomist installed a catheter for the initial blood draw, because (if I understood correctly) the extra needle hole in the vein from the blood draw can cause the chemo meds to leak & stagnate near the hand (which risks _the hand_...) But the phlebotomist didn't ask/confirm/want to, apparently because of some damn billing difficulty since the labwork division was different than the oncology division.

My conclusion is that there's a huge opportunity for more patient advocacy to really improve people's lives. Your "data for informed consent" angle sounds like a way more scalable path toward something like that!


Doctors are just technicians these days. Asking about medical studies with most doctors is like asking your cable T.V installer about the implementation details of digital compression algorithms.


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.


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...


What is your view on vaccines, and the debate surrounding them?


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

[2] https://int.nyt.com/data/documenthelper/569-purdue-pharma-do...


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


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?


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


“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?


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.


Thank you for this reasoned reply


I can't tell if you're making a sly joke where "abusers" means the executives, or if you agree with trying to put more blame on the patients/addicts.


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?


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.


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.


My wife suffered a horrific back injury a few years ago. For medical reasons she had to wait about 6 months for a surgery and all that time the doctors she saw were scared to death to prescribe real pain meds even though she was often in tears from the pain, couldn't bear to walk more than a few feet, and couldn't sleep.

My personal story is of a loved one needlessly suffering mind boggling amounts of pain for half a year because the DEA had so scared our doctors.

Luckily the surgery was a 100% success and she doesn't need to rely up on the steaming pile of crap that is the DEA's interference in the medical community.


>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.

This is also a real problem, but I think a strong argument can be made that the Sacklers fraud is responsible for it too. A lot of the fear and under-prescription that now happens is a direct result of a strong backlash that itself was in response to the opioid epidemic and the massive damage that resulted. If that had never happened, then rather then the pendulum swinging way too far towards opioids everywhere and then (as is so often the case) right back over the neutral to suspicious of any opioids allowed for anyone anywhere, it could have been more steady state. Doctors would have known how serious the drugs were and been careful with prescriptions all along. Those who really needed them would get them, those who didn't would be directed elsewhere. If it never became such a political cause with so much rightful public interest and anger, then none of would intrude on the medical process.

So really the Sacklers may well have screwed people over coming and going. People who would have been fine without were turned into addicts and had their lives ruined, and now people with horrendous chronic pain have to suffer with it and have their lives ruined.


They should know better, that's their job. They are expected to have the knowledge and skills needed to know better. The fact that they willfully disregard that knowledge to satisfy the sales goals of a pharmaceutical salesman is egregious.


> [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.


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


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?


How is this relevant to Purdue Pharma's fraud?


Chronic pain sufferers are denied effective pain killers because providers are under pressure to withhold them because law enforcement is aggressively pursuing providers that 'over prescribe' because abuse of prescription opioids is a 'widespread epidemic' because Purdue Pharma knowingly misled regulators and downplayed abuse because the Sacklers and all the political candidates they supported and all the foundations they funded and all the recipients of Sackler grants and endowments really like those big pharma bucks!


Defrauding the public is illegal.

>Purdue Pharma contended that OxyContin, because of its time-release formulation, posed a lower threat of abuse and addiction to patients than do traditional, shorter-acting painkillers like Percocet or Vicodin.

That claim became the linchpin of the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller.

https://www.nytimes.com/2007/05/10/business/11drug-web.html


"When evidence of growing abuse of the drug became clear in the early 2000s, one of them, Richard Sackler, advised pushing blame onto people who had become addicted.

“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.”"

Addiction is a physical and biological process as opposed to a willful individual choice and any company that produces drugs and studies their affects on the body should be at the forefront of understanding that. It appears that Sackler willfully chose to paint people addicted to his product in a negative light in pursuit of profits.

These are people that are prescribed this medication by their doctors whom they trust. These doctors in turn are pressured / bribed by the pharmaceutical companies to act as dispensaries for these pills to the detriment of the patients they are supposed to be protecting.


Making the drug isn't the issue, it was the marketing of the drug using a variety claims they knew to be untrue. Like that it couldn't be abused, or that it lasted twelve hours.


Life and our interactions with other people are not defined solely within the confines of the market. Morality and decency have their place. If a company is in possession of data that shows their product is harmful and they ignore that data and even withhold it from the government then they're in the wrong. If a company, even with the knowledge that their product is harmful, chooses to affirmatively undertake steps to maximize profitability by undertaking practices to increase their product's utilization they are in the wrong. There are literally hundreds of thousands of people who have died to date because of opioids. Firm action has to be taken.


When you or someone you care about are in terrible pain with no relief in sight due to the unwillingness to allow people to make choices for themselves, for their own bodies, then lets talk.


The needless deaths of hundreds of thousands of people can't be whitewashed by claiming that they were expedient so an unknown quantity of people could be offered pain relief. The addictive nature of oxycontin which pharmaceutical firms were aware of and their relentless efforts market the drug through sales channels can't be overlooked.


I couldn't agree more. My wife's doctors were so afraid of the DEA they left her in 6 months of mind boggling agony before she could finally get her back surgery. Never mind her being treated like a criminal every time she went to the office and having to take a drug test.


You should blame the makers of OxyContin for publishing misleading information and pushing it on people who don't need it and creating a big health crisis that way. The people who really need it are suffering from it. Blame the company and not the people who have to deal with the tens of thousands of opioid deaths.


> Why should doctors and others be able to prevent people from treating their pain?

Opioids are not an effective treatment for most people with long term pain. They develop a tolerance for the opioids, and so they end up with an addiction, taking very large quantities of opioids, and still being in pain.


What are the problems with just increasing the dosage over time. This sounds to me like a very reasonable approach to someone with intractable pain.


Opioids relieve pain. They also suppress your breathing.

The pain system in your body gets used to the opioids faster than the breathing system. Over time, the difference between the amount of opioids you need to help the pain and the amount of opioids that make you stop breathing gets smaller and smaller. This has a very predictable bad end result.


Toxicity. As your opioid dose increases so does your risk of side effects such as respiratory depression and arrest.


This isn't about prescribing pain meds to those who need them (post op, broken leg, etc). It is about a company making fraudulent claims about the addictiveness of the drugs.




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