Author charts how greed and deceit fuelled the rise of OxyContin and an addiction crisis
Patrick Radden Keefe writes about Purdue Pharma and the opioid crisis in his book Empire of Pain
Originally published on May 3, 2021.
The makers of OxyContin may not have set out to get people addicted to the drug, but "their heads were in the sand" when it came to thinking through its "colossal downsides," says American journalist Patrick Radden Keefe.
"For thousands of years there's been this paradox of opioids, that ... they have therapeutic benefits, but also dangers," said Keefe, a staff writer for the New Yorker who has spent years examining the OxyContin crisis.
"I think there was this sense that they'd cracked it — they'd figured out how to uncouple those two aspects of this drug — and that they would relieve pain for millions of people and make billions and billions of dollars at the same time," Keefe told The Current's Matt Galloway.
But eventually, there were indications that they were wrong, Keefe said. And his research suggests they worked hard to keep it quiet.
Pharmaceutical company Purdue Pharma developed the opioid medication OxyContin in the mid-1990s as a solution for moderate to severe pain.
According to the U.S. Centers for Disease Control, OxyContin is one of the most common drugs involved in prescription opioid overdose deaths in the United States.
The CDC says the opioid crisis killed nearly 500,000 people in the U.S. between 1999 and 2019. Canada reported more than 19,000 opioid-related deaths between January 2016 and September 2020.
Last November, Purdue Pharma pleaded guilty to three criminal charges related to its role in the opioid epidemic, including impeding the U.S. Drug Enforcement Administration's efforts to combat the addiction crisis. No criminal charges were ever filed against the Sackler family, which owns the pharmaceutical company. However, the family agreed to pay $225 million US to the American federal government, to settle civil claims.
In 2017, Purdue made no admission of liability, but agreed to pay $20 million to settle a Canadian class-action lawsuit that argued the company was underreporting the addictiveness of OxyContin. The lawsuit was launched in 2007 on behalf of hundreds of Canadians who became addicted to the prescription drug.
The company is now in bankruptcy court, with plans to restructure itself by dissolving the current business and starting a new one dedicated to tackling the opioid crisis. Meanwhile, the Sackler family has agreed to pay $4.28 billion US to settle thousands of lawsuits.
Keefe writes about the Sackler family and the opioid crisis in his new book, Empire of Pain: The Secret History of the Sackler Dynasty.
The Sackler family and Purdue Pharma
The OxyContin story begins with the Sackler family, who immigrated to the United States from Europe during the Great Depression. By 1952, the family's three sons, Arthur, Raymond and Mortimer Sackler, had purchased a small pharmaceutical company, which they named Purdue-Frederick.
Arthur, the eldest son, would die before OxyContin was ever created. But he "invented the wheel when it came to the way in which pharmaceuticals are advertised," Keefe explained.
"One of his big revelations was [that] the consumer is kind of secondary," said Keefe. "The person you really need to sell is the doctor, and ... you want to get an army of sales representatives to go out and persuade doctors that these drugs are safe."
Keefe said those tactics made Arthur "fabulously wealthy" from selling Valium, "the most lucrative kind of blockbuster pharmaceutical" at the time, and helped build up the family name.
By the 1980s, Purdue-Frederick began to move into more ambitious territory with the development of MS Contin, a new, morphine-based painkiller.
Just before the medication's launch in North America, Purdue invited doctors from around the world to participate in a conference on pain, sponsored by the pharmaceutical company itself. The main takeaway: that physicians should be prescribing more morphine, said Keefe.
For a long time, he explained, doctors had been cautious about prescribing opioids because of their addictive nature.
One message that got repeated again and again … [was that] if a doctor prescribes them to you, they're not addictive at all.- Patrick Radden Keefe, author
"There was a movement underway in the '80s to re-evaluate this and say, 'Maybe we've been too cautious about using these drugs to relieve pain, and maybe we should be prescribing them more freely,'" said Keefe.
"So one message that got repeated again and again at that conference … [was that] if a doctor prescribes them to you, they're not addictive at all."
MS Contin became a very financially successful drug, Keefe said. And as Purdue looked at what product to develop next, it turned to an even stronger opioid: oxycodone.
Oxycodone is more powerful than morphine. But in developing its brand-name version of the drug, OxyContin, Purdue gave it a coating that works to release the drug into the bloodstream more slowly. The company claimed this made the drug less addictive, New York magazine wrote.
Expanding the market for OxyContin
While Purdue's previous pain medication had been sold to cancer patients, the company was after an even bigger market.
"There are these amazing emails that I found where they talk about this very explicitly, and they say, 'Oh, cancer is a niche market. We want a drug that we can sell to anyone who has even moderate pain,'" Keefe told Galloway.
That market could reach 40 to 50 million people in the U.S., alone, they estimated.
Keefe said Purdue was "extremely" aggressive in promoting OxyContin, marketing it as the drug of choice for anything from a sport or work injury to post-operative pain when it launched in 1996.
What the company didn't tell people, he said, was how addictive it was.
Sales representatives fanned out across the U.S. and Canada to pitch the drug to doctors, nurses, hospitals and pharmacists, claiming it was addictive less than one per cent of the time, he said.
"I've interviewed all these former sales reps and they said, 'We just repeated that like a mantra all day, every day,'" said Keefe.
The company also invited doctors to "all-expenses-paid junkets in resorts" where they would hold seminars on pain management and the "virtues of OxyContin" for treatment.
[There was] internal knowledge at the company, at high levels, that there were real problems, that people were abusing these pills and becoming addicted.- Keefe
Over time, said Keefe, "huge numbers" of people began abusing OxyContin. Pill mills eventually popped up in places like Myrtle Beach, S.C.
Keefe said Purdue claimed they didn't know there was a problem until several years after the drug hit the market. But he was able to find "a really extensive paper trail dating back as far as 1997" that suggested otherwise.
"[There was] internal knowledge at the company, at high levels, that there were real problems, that people were abusing these pills and becoming addicted," he said.
Keefe said he believes greed and a "refusal to admit error" prevented Purdue and the Sacklers from responding differently to the emerging opioid crisis.
Sackler family denies allegations
The Current asked Purdue Pharma to comment on Keefe's book, but the company declined.
The Sackler family has never been charged with offences related to the sale of OxyContin. A representative for the family said they deny allegations made against them in litigation.
A spokesperson for the late Mortimer Sackler's family also provided a statement, saying their focus is on "a resolution that will provide help to people and communities in need, rather than on [Keefe's] book."
Keefe said he expects the Sacklers will end up paying billions of dollars to help remedy the opioid crisis, but that they'll walk away with "vastly more wealth," and "probably never face criminal charges."
However, he argued that they'll be hard-pressed to regain the reputation their ancestors worked to build.
"They fought so hard to hold onto the fortune and to grow the fortune, I think with a kind of blindness to the human costs associated with doing so, that they're going to keep the fortune," said Keefe.
"But I don't think they'll ever get the good name back again."
Dec. 17, 2021 Update: A September ruling ordered the Sackler family to pay a $4.5-billion settlement, and gave them immunity from any liability over the opioid epidemic. But that ruling was thrown out by a New York Court Dec. 16. The judge said the order shielding the family from future lawsuits was not permitted under the bankruptcy code. Purdue Pharma said it would appeal the decision.
Patrick Radden Keefe's book, Empire of Pain, was recently shortlisted for the Financial Times and McKinsey Business Book of the Year Award. He announced he would donate the prize money due to McKinsey's association with the Sacklers and Purdue Pharma.
Written by Kirsten Fenn. Produced by Howard Goldenthal.
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