Can one family singlehandedly create a national opioid epidemic? Purdue Pharma and the Sackler family came close.

If you’re a keen observer at the Guggenheim Museum or the American Museum of Natural History, the Metropolitan Museum of Art, the National Gallery in London or numerous other museums, you’ve noticed the Sackler name. The Sackler name has funded various prestigious institutes, wings, centers and the like at museums around the world, but now the name is becoming more synonymous with OxyContin and their role in creating the opioid epidemic.

Temple of Dendur, The Sackler Wing, The Metropolitan Museum of Art (Photo via Juliana Su)

Who Are the Sacklers?

The Sackler family owns Purdue Pharma, and Purdue owns and manufactures OxyContin, one of the most abused prescription opioids on the market.

OxyContin also made members of the Sackler family very wealthy, but to reap the profits of OxyContin, Purdue and Sackler family members themselves pursued an aggressive and illegal sales approach.

Now, a new lawsuit the Commonwealth of Massachusetts filed in January is seeking to hold the Sackler family members accountable for their role in the aggressive sales tactics that Purdue adopted to increase OxyContin revenue, sales tactics that federal prosecutors found deceptive and fraudulent in 2007.

The patriarchs of the Sackler family are three brothers, Arthur, Raymond and Mortimer. Raymond and Mortimer bought Purdue in 1952, Arthur was an owner for a while, but his ownership was sold in 1987 months after he died and years before the company developed OxyContin. Various descendants of Raymond and Mortimer remained involved with Purdue and according to allegations in the Massachusetts lawsuit took an active role in the promotion and deception of OxyContin.

Purdue Pharma Pleads Guilty in 2007

In 2007 Purdue pleaded guilty to misleading doctors and the public about OxyContin’s risk of addiction. The company also agreed on a settlement of $600 million, one of the largest pharmaceutical settlements in history.

Purdue president Michael Friedman, company lawyer Howard R. Udell and former chief medical officer Paul D. Goldenheim all pleaded guilty to charges of misbranding and agreed to pay a total of $34.5 million in fines.

However, the January lawsuit is the first to target Sackler family members themselves and the first to reveal damning information that shows just how far the Sacklers went to push OxyContin and misinform the public.

New Lawsuit Targets Sackler Family

An unredacted copy of the Massachusetts lawsuit was released in full when a judge on Jan. 28 ruled the state attorney general’s office could do so. The lawsuit was released previously but redacted at the request of Purdue and the Sackler family.

The unredacted version reveals the Sackler family was directly involved in developing aggressive and deceptive sales tactics meant to boost OxyContin profits, all while the family paid themselves billions of dollars.

A report from Ars Technica pulled out the biggest revelations from the unredacted lawsuit, listed below. (Ars Technica also provides the full unredacted version here.)

• The spoils of OxyContin allowed the Sacklers, as board members, to vote to pay themselves more than $4 billion between 2007 and 2018. Figures for individual payments during those years are sprinkled throughout the lawsuit.
• Members of the family personally ordered Purdue to increase the sales force on a number of occasions.
• The family was directly involved in pushing for higher—and more dangerous—doses of OxyContin.
• For years the McKinsey & Company consulting firm had worked with Purdue to come up with sales tactics. According to a redacted section, the consultants “had reported to Purdue on opportunities to increase prescriptions by convincing doctors that opioids provide ‘freedom’ and ‘peace of mind’ and give patients ‘the best possible chance to live a full and active life.’”
• Board meetings for the US-based company were held in exotic and luxurious places, such as Bermuda and a castle in Ireland.
• Members of the Sackler family worked on a secret plan code-named “Tango,” which would have expanded Purdue’s business into addiction-treatment drugs.
• Purdue employees actively tried to avoid the Sacklers because of their relentless and aggressive demands.
• Richard Sackler allegedly sought revenge on an insurance company for dropping coverage of OxyContin amid the epidemic of abuse.
• The Sacklers allegedly knew about but did not report suspected cases of diversion and abuse by doctors.

The Massachusetts lawsuit makes three main allegations: that Purdue deceived Massachusetts doctors to get more people on OxyContin, pushed for doctors to prescribe higher doses and for patients to stay on OxyContin for longer and more harmful periods of time.

All the while Purdue “peddled falsehoods” to keep patients away from safer alternatives.

The specific Sackler family members named as defendants in the lawsuit include Richard Sackler, Theresa Sackler, Kathe Sackler, Jonathan Sackler, Mortimer D.A. Sackler, Beverly Sackler, David Sackler and Ilene Sackler Lefcourt.

It’s this group of individuals that Massachusetts claims controlled Purdue as each defendant took a seat on the board of directors, and together, they held the controlling majority of the board.

The lawsuit states the defendants “directed deceptive sales and marketing practices deep within Purdue, sending hundreds of orders to executives and line employees. From the money that Purdue collected selling opioids, they paid themselves and their family billions of dollars.”

In the lawsuit the plaintiffs outline the deadly cost of the opioid epidemic that killed more than 2100 people in Massachusetts in 2016 alone, according to statistics cited in the lawsuit. However, the bulk of the lawsuit provides specific examples of the aggressive and deceptive sales tactics Purdue pushed its sales team to employ.

Opioid Savings Cards

One of the most successful tactics revealed was the implementation of an opioid savings card. Purdue discovered that opioid savings cards kept patients on opioids for a longer time, an internal plan highlighted that with the cards “more patients remain on OxyContin after 90 days.”

Purdue incentivized patients to use the cards by giving them discounts on their first prescriptions, but what Purdue also found was that “opioid savings cards worked like the teaser rate on a long-term and very high-stakes mortgage.

“According to Purdue’s internal analysis, the savings cards had the highest ‘return on investment in the entire “OxyContin Marketing Mix.” The return on investment for Purdue was 4.28, so that every $1,000,000 Purdue gave away in savings came back to Purdue as $4,280,000 in revenue because patients stayed on dangerous opioids longer,’” the lawsuit stated.

When Purdue encouraged doctors to give their patients opioid savings cards, the lawsuit alleges that Purdue did not disclose to the doctors that the cards were designed to keep patients on the drugs longer, which would cause more patients to get addicted and die.

Opioid savings cards were actually illegal in Massachusetts until 2012, but that did not deter Purdue from pushing opioid savings cards in the state. Purdue simply told doctors to tell their patients to go to New Hampshire to fill prescriptions.

And the lawsuit claims Purdue’s approach was proven successful and cites a study published in the Journal of General Internal Medicine, which found that two-thirds of patients who took opioids for more than 90 days were still on opioids five years later.

Falsehoods and Propaganda

To discourage alternatives to OxyContin, Purdue also allegedly spread falsehoods about alternative pain medicine.

“Purdue not only lit the fire that killed so many patients; it also tried to block the exits that patients could have used to escape,” claims the lawsuit.

One of the falsehoods Purdue spread was that OxyContin was safer because it had no “ceiling dose” unlike NSAIDs and acetaminophen. Purdue also spread propaganda that NSAIDs and acetaminophen had life-threatening side effects while opioids were the “gold standard” in pain management.

Another example highlights the perils of the practice of accepting cash for “sponsored content” to be published in a media outlet.

“For example, in 2014 Purdue placed three articles in The Atlantic as sponsored content, including one titled ‘Take My Pain Away…A Physician’s Perspective of Prescription Opioids and Pain Management’ by Dr. Gerald Aronoff. That article calls the tamper-resistant formulations ‘safer alternatives’ and encourages physicians to ’embrace these additional choices, rather than decide to leave opioid prescribing,’” the lawsuit stated.

Incentivizing and Rewarding “High Prescribers”

Individual doctors who were high prescribers of opioids are also named in the lawsuit to portray how Purdue encouraged and rewarded such high-prescribing practices.

In five years Massachusetts’ highest-prescribing doctor prescribed more than 347,000 pills of Purdue opioids alone. Purdue rewarded him with $80,000 to give speeches to doctors on the benefits of opioid prescriptions, a reward that was given to other high-prescribing doctors as well.

Purdue also visited doctors hundreds of times to keep encouraging doctors to prescribe opioids and at more frequent doses and higher levels. According to the lawsuit, the Sackler family pushed a policy requiring sales reps to visit seven prescribers a day, and Purdue tracked results every quarter for at least four years.

Purdue’s own internal documents illustrated to sales reps how much more profit could be made from peddling higher doses of opioids.

“Each Individual Knew”

The list of deceptive practices outlined in the lawsuit goes on and fills out the majority of the nearly 300-hundred-page lawsuit. And behind the scenes controlling, orchestrating and pushing the sales team and their deceptions were the Sackler family members.

As the lawsuit says, “Each individual defendant knew and intended that staff reporting to them would reinforce these misleading acts through thousands of additional acts in Massachusetts.

“Each individual defendant knew and intended that staff reporting to them would pay top prescribers tens of thousands of dollars to encourage other doctors to write dangerous prescriptions in Massachusetts.

“Each individual defendant knew and intended that prescribers, pharmacists and patients in Massachusetts would rely on Purdue’s deceptive sales campaign to prescribe, dispense and take Purdue opioids.”

When Purdue began to be confronted by the public and its own sales representatives with the dangerous and lethal consequences of opioids, Richard Sackler himself directed a coverup.

According to the lawsuit, “Richard Sackler wrote down his solution to the overwhelming evidence of overdose and death: Blame and stigmatize people who become addicted to opioids. Sackler wrote in a confidential email: ‘[W]e have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminal.’”

The full scope of coordination, manipulation and deception Purdue allegedly employed, the Sacklers and their co-defendants can’t be adequately summarized in one article. To really understand how one family and one pharmaceutical company almost singlehandedly engineered the opioid crisis read the full unredacted court documents here.

A gallery of selected documents from the lawsuit is below: