On March 3rd, 2022 Purdue Pharma, the pharmaceutical company producing the highly addictive painkiller OxyContin, reached a new agreement with the group of States that brought it in court for its role in the opioid crisis, a health emergency that has caused an estimate of 500,000 deaths in the US in the last 25 years. This news seems to have got lost in between all the reports on epidemics of the last two years, but it is of a pivotal importance. While Purdue Pharma will be dissolved and pay 6 billion dollars in damages, it will no longer be possible to sue its owners for willingly implementing a deceptive marketing campaign which did not specify that the drug they were selling could be as addicted as heroin. In this article we’ll tell you the story of how a self-made New Yorker family thought of having found the flawless remedy for chronic pain and ended up addicting a whole nation instead – and of the business strategies that made it possible.
“We had many stop signs on our block. They were not always there. There was this woman named Marsha down the street. She was overweight and had hair like a rancher’s widow, a kind of mullet with thick bangs. She would go door-to-door, hobbling on her bad leg, gathering signatures for a petition to put stop signs in our neighborhood. She had two boys herself, she told you at the door, and she wants all the kids to be safe when they play. Her sons were Kevin and Kyle. Kevin, two years older than me, overdosed on heroin. Five years later, Kyle, the younger one, also overdosed. After that, Marsha moved to a mobile park in Coventry with her sister. The stop signs remain.”
- Ocean Vuong, On Earth We’re Briefly Gorgeous
On March 3rd 2022, Purdue Pharma, the pharmaceutical company producing the painkiller OxyContin, reached a new agreement with the group of States that had brought it in court for its role in the opioid crisis that has plagued the US for the last 25 years. According to the deal, the Sackler family, owner of the company which made them billionaire, will pay 6 billion dollars to help communities restore the damages of the disaster. People who suffered the consequences of oxycodone-induced addiction had a chance to speak about their hurt, with members of both the branches of the Sackler family attending. Finally, it won’t be possible to contest the decision of any institution to remove the Sackler name from its centers. But in return, however, the end to all current and future civil claims against them was confirmed, which leaves the Sacklers penally untouched after years of court litigations and at least 500,000 oxycodone-related deaths.
In the past two years, we’ve been hearing about epidemics a lot; however, the dramatic increase in drug-related overdoses which has marked the past twenty years seems to have got lost in between the other, more urgent health crisis of the 21st century in the media narration of our time. In Europe especially, the story of how a self-made New Yorker family thought of having found the flawless remedy for chronic pain and ended up addicting a whole nation is hardly known at all. This is almost startling, considering how well this story mixes up some of the most tragic issues of our century: the unruled and potentially devastating power of marketing on society; the alarming abuse of drugs and tranquillizers habitually prescribed even for minor health problems; the lack of prospects of younger generations in rural areas. If this matter is slowing starting to emerge and now get the attention of a wider public, it is mostly thanks to cultural products such as novels, documentaries and tv series released in the past couple of years, like Empire of Pain by Patrick Radden Keefe, Dopesick on Netflix, and The Crime of the Century on HBO.
“Trevor was put on OxyContin after breaking his ankle doing dirt bike jumps in a wood a year before I met him. He was fifteen. […] After a month on Oxy, Trevor’s ankle healed, but he was a full-blown addict.”
In the autofiction On Earth We’re Briefly Gorgeous, the American poet and writer Ocean Vuong summarizes like this the beginning of the epilogue of his first lover’s life. These two brief sentences describe the first stage of failure for many Americans, as it possible to read from the victims’ relatives hearings of the beginning of March. From 1995 on, when the painkiller OxyContin was commercialized by Purdue Pharma, dozens of thousands of Americans were prescribed this drug, created to improve the conditions of cancer patients in chronic pain, to relieve the pain caused by small injuries and broken limbs. As this kind of treatment turned out be extremely addictive, a real “epidemic” began, with hundreds of thousands of people abusing opioid medications and eventually going for heavier drugs – a phenomenon which resulted in the highest number of drug overdoses from the 1970s occurring in the past decade.
But when this painkiller was initially released on the market, it appeared like a miracle: thought to support chronic pain management (a sector of medicine which was quite disregarded in that moment) it seemed a perfect substitute for morphine, which was problematic as a medication in terms of the duration of its effect and patients’ tolerance. OxyContin’s effects, on the contrary, lasted 12 hours, allowing people in pain to sleep through the night and were 1.5 times stronger than morphine. That its effectiveness was based on oxycodone, a synthetic opioid not quite different from the active ingredients that can be found in addictive drugs such as heroin and fentanyl, was well know; however, the pill was fashioned with a “controlled release” mechanism which prevented the intoxication and high excitement typical of other opioids if the pill was swallowed intact. Problem was, OxyContin turned out to be instead toxic and very addictive; even with the slow-release mechanism, its pain-relief results lasted less and less the more the patient was on it, especially when it was prescribed because of minor injuries.
Moreover, it was soon discovered from its own leaflet that the oxycodone time-release formula could be undone by crushing the pill, and that sniffing or injecting such dust could have the same properties of the most powerful drugs. The outcome of the commercialization of OxyContin was, in the end, disastrous: not only thousands of people got increasingly addicted, but many young teenagers found in it a very cheap and effortless way to get high together. Years later, when Purdue Pharma started to acknowledge the danger of its lead product, the oxycodone time-release feature was strengthened, so that it became almost impossible to crush the pill. But for all the ones already addicted, it was no longer possible to live without it: to avoid withdrawal crises most of them turned to heroin instead.
“Did you know people get rich out of sadness? I want to meet the millionaire of American sadness. I want to look him in the eyes, shake his hand, and say: ‘It’s been an honor to serve my country’”
The opioid epidemic in the US changed the way addiction was seen by public opinion; the victims of opioids were not the wasted junkies or the rebellious rockstars of the 1970s, but common, often disadvantaged people who had found themselves addicted after going to the doctor in their normal life routine. They were fifteen years old boys like the one described by Vuong, desperate in their effort to tighten their phone charger around their arm to shoot up Oxy. In a few words, they were not people looking for disgrace – and rightly enduring the consequences of their choices. This is the reason why a chase for the responsible for such crisis began, led by the relatives of the victims who decided to start an almost impossible battle against one of the biggest and most successful pharmaceutical companies of the world, Purdue Pharma, and its owners. The question tormenting them was indeed the following: how was it possible that a drug invented to treat a kind of pain so acute as cancer pain was prescribed to improve normal backache, broken limbs or toothache?
The answer is to be found in the unprecedented marketing campaign that supported the commercialization of OxyContin and that was carried on even after the management of Purdue was informed by early reports about the addictive effects of the medication. Marketing managers’ declared purpose was the de-stigmatization of opioids in the medical community, an objective that was achieved by funding research aimed at showing the non-addicting nature of OxyContin and targeting doctors non-specialized in pain management. Doctors were then offered free trips in luxurious locations and resorts to discuss and attend conventions on the topic, and they were given coupons to give patients free trials of the treatment. Moreover, local sales representatives were paid incredibly high bonuses the more the sales of the drug increased in their area, which prompted them to push the fake news that Oxy was less powerful than morphine. It is estimated that the sales of OxyContin generated 35 billion dollars to the Sacklers, with them paying as high as 40 millions in salespeople bonuses per year.
The truth was that as early as 1999, just four years after its release, doctors started to send alarmed feedback to Purdue about patients with withdrawal crises after just a few weeks on Oxy and being so desperate to look for it on the black market when they refused prescribing higher amounts – to the point that regular thefts of OxyContin started to occur to pharmacies. The first article about issues with OxyContin abuse in rural areas on the New York Times dates back to 2001; it raised in the following days a heated debate on the value of the drug, as several people taking it to reduce nerve disorders and chronic pain claimed it had unbelievably changed their life. This is another tragic element in all this story: not just well-meaning doctors co-opted in addicting their patients, but a stigma was created around a drug that was, when prescribed in the right situation, of great help – as Patrick Radden Keefe explains in an article on the New Yorker, in the end the real problem was not the drug, but the company. In 2002, the first lawsuit presented by thousands of patients living with addiction was filed, and only in 2003, the FDA criticized OxyContin’s ads for misbranding the drug and disregarding essential information about its potentially addictive and fatal risks.
Soon the Sackler family, owner of Purdue Pharma, was involved in the legal proceeding against the company too, attracting on itself a deep hatred from public opinion – as people wanted to know why local dealers could be sentenced to 20 years in prison, while the people involved in managing the company that had addicted a whole nation was not even heard in court. The story of the opioid crisis comprises indeed a true American dream tale, which tells of the rise and fall of one of the richest families in the US. Purdue, differently from many other pharmaceutical companies, was still privately owned and managed by the descendant of its founders, three physicians who got a fortune out of marketing tranquillizers such as Valium and Librium. The family is also very well-known because a huge part of their wealth was donated in philanthropic enterprises: Sackler institutions existed at the MET, Guggenheim Louvre museums, and at Harvard, Columbia, Oxford and many more universities; after the OxyContin scandal, many of these have started to disappear – the last case being that of the Sackler Wing hosting the Temple of Dendur at MET.
It was indeed found during the last twenty-year litigations that the family and management of the company had being aware of the addictive properties of the drug since the first years of its circulation and had pushed sales and marketing campaigns anyway. Moreover, once Purdue was forced to acknowledge the existence of an opioid crisis, they started to invest and profit from the sale of addiction treatments for patients they had themselves contributed to addict (the so-called Tango Project). But the major source of victims’ anger came from their unchanged denial of having contributed to the major drug overdose crisis of the century, as they still pursue a line of thought according to which if people abused opioids by taking them in ways different from the ones prescribed, it was the people’s fault – not the company’s.
“They don’t mean to, Grandma. They’re just following their family. That’s all. They don’t know it’s a cliff”.
In the same chapter in which Ocean Vuong deals with the death of his fictional-self’s boyfriend and with the epidemic of overdose deaths which hit his town at the beginning of the 2000s, he also recalls watching a documentary with his grandmother where a herd of buffalos threw themselves down a cliff in a single, composed line. It’s a good metaphor to describe the impact of the opioid crisis on the generation of Millennials that found themselves unwillingly addicted or having an unprecedented amount of drugs at disposal at ragged prices.
They didn’t know those drugs were a cliff: and one after the other, they jumped down into the unknown – and found their end. Despite remarkable results in the treatment of opioid addiction achieved in the last few years, the crisis is still going on – and recent data showed that the general situation only worsened during the Covid pandemic. It’s also worth mentioning, with respect to Covid, that the opioid crisis was a primary reason for the distrust of common people in the findings of pharmaceutical companies: the conspiracy theories around the role of Big Pharma in the coronavirus pandemic has its roots in the revelation of the role of Big Pharma in the opioid epidemic. In the meanwhile, thanks to the new deal reached, it will be no longer possible to sue Purdue (which was dissolved and sent into bankruptcy) for its role in the crisis. Families of the victims and rehabilitated people had to settle for seeing the Sackler family removed from some major institution facilities and telling their stories of suffering looking in the eyes the members of the family involved in the firm’s management at the hearing held at the beginning of March. So what about now? Can we elicit something good from this story – is it possible to avoid that such a disaster takes place in the future, as well? The puzzling paragraphs of Ocean Vuong seems to admit for some hope. He writes: “What if my sadness is my most brutal teacher? And the lesson is always this: You don’t have to be like the buffaloes. You can stop. […] Maybe in the next life we’ll meet each other for the first time – believing in everything but the harm we’re capable of. Maybe we’ll be the opposite of buffaloes. We’ll grow wings and spill over the cliff as a generation of monarchs, heading home”.