Imagine a medical industry that is supposed to keep a nation healthy but becomes so completely corrupted that it causes an epidemic. This is a reality in the United States where Opioids have caused just under 50,000 deaths, and that’s just the tip of the iceberg, countless other lives that have been destroyed through addiction. more than 214 million prescriptions for opioid pain with more than 11 million people abusing their opioid prescriptions. Drug overdoses are the leading cause of deaths in people under 50. The Sackler family is not only partly responsible for the epidemic but has also made a billion-dollar empire from it. You might not know about them, but you’ve surely heard of OxyContin before. They have gone to great lengths to keep their family name and their brand separate. Welcome to the story of how billionaires and doctors became the drug dealers that caused an epidemic. The opioid epidemic in the US was caused by a variety of factors, but one of the main ones was the involvement of the Sackler family, and their infamous opioid painkiller, OxyContin. In 2017, opioids caused just under 50,000 deaths. That same year, president Trump declared the opioid crisis a national emergency. Here’s the problem: Patients are often given strong painkillers when in the hospital for surgery or chronic pain. While the drugs are life enabling for many patients to avoid excruciating pain from injury or otherwise, many others fall into addiction cycles from withdrawals. Some people enter addition to opioids directly through street heroin, never having tried any pharmaceuticals before and others go graduate from prescription pharmaceuticals and onto cheaper more potent alternatives like heroin or fentanyl. The cases and causes come from far and wide. But research indicates that there is a strong correlation between regions of high opioid prescription rates and high overdose rates geographically. The Sacklers pushed OxyContin to everyday people who had little use for the drug. They corrupted the entire supply chain, Employing armies of sales reps, paying off doctors, lobbying for favourable regulation and making billions while masses fell into devastating addiction. They didn’t care much about the addictive properties of their drugs, they were more concerned with their bottom line. Their name is everywhere, yet not many people know about them. The Sackler family have invested a substantial portion of their 14 billion dollar net worth into many museums, art galleries and universities. The world-famous Louvre Museum in Paris has the Sackler wing, which hosts oriental antiques. Kate Middleton was stunned as she opened the Sackler courtyard in the Victoria and Albert Museum, which consists of 11,000 handmade porcelain tiles. London’s famous gothic church Westminster Abbey even has a window named after the Sackler’s. And while the family is happy to put their name on any prestigious institution that will let them donate money, it isn’t the same for their golden product, OxyContin. In fact, the family has done as much as they can to separate their name and the narcotic, the reason why will soon become very obvious. The Sackler story starts in 1952 when three psychiatrist brothers Arthur, Mortimer and Raymond purchased a small pharmaceutical company called Purdue. The brothers had worked together in the same hospital previously and followed older brother Arthurs lead. Together they co-authored over a hundred research papers on the biochemistry of mental illness. Arthur doubled as an advertising pioneer in pharmaceuticals. He was the first to convince The Journal of the American Medical Association to run an ad brochure in colour. Arthur would go on to be named in the medical advertising hall of fame. In the 60s, the pharmaceutical company Roche had developed a new drug called Valium which was very similar to a drug that the company already had on the market called Librium. Librium was used as a medication for common anxiety, so it was difficult to promote Valium without a unique selling point. Step in Arthur Sackler, who positioned the drug to medicate against something he called “psychic tension”, which he simply made up to cover the day to day stresses of average people. This allowed doctors to prescribe Valium for a range of conditions which were much wider than ever before. Effectively increasing the number of Valium prescriptions and it soon became America’s most prescribed medication. Arthurs payment depended on the number of sales, hence it was in his interest to get as many people prescribed as possible. Valium was the first drug to pass 100 million in sales. The Sacklers new acquisition, Purdue, had been a small player in the pharmaceutical industry for years. The company’s climb to richest began in 1966 with the acquisition of the antiseptic, Betadine. At this time the Vietnam war was beginning to escalate and would continue for another 9 years. During which the US military would purchase massive stockpiles of betadine for the war effort. Meanwhile, heroin addiction was widespread among returning soldiers from Vietnam. In Vietnam, over a quarter of soldiers used hard drugs such as heroin, which mostly poured in from neighbouring Cambodia. The US military itself also feed their front lines with drugs such as speed, steroids and painkillers to help them handle the long, intense combat periods and prevent mental breakdowns. The returning veterans in part created a fear of opioids in the public, among an already growing heroin epidemic, donned “Opiophobia”. Due to this, doctors would rarely prescribe heavy pain medication to their patients. However, in hospice, where it doesn’t really matter if terminal patients get addicted or not, the medication would be welcomed. During the 1980s a recent movement in medicine was taking place, it was called hospice. The hospice sector takes care of terminal or end of life patients. Around this time, The Sackler’s company Perdue would release a released morphine-pill called MS Contin that could help cancer patients sleep. In the hospice market, addiction wasn’t an issue because the patients would soon pass., would take this one step further. They would release MS Contin for general use, unfortunately, MS Contin would be the precursor to the drug that would help create an epidemic. In the US, MS Contin became the benchmark for pain relief among cancer patients. During the 80s, several papers and articles claimed that the link between opioids and addiction was minimal and previously over-stated. A letter published in The New England Journal of Medicine that the risk of addition was less than 1%. And even though this letter was later retracted by the author, it didn’t stop over 600 citations of the letter in medical journals. But the misinformation had already spread, and it was difficult to stop. Advertising genius and co-founder of Purdue Arthur Sackler had a nephew named Richard. Richard would later become president of Purdue but got his start One of the original founding brothers of Purdue, now SIR Raymond Sackler, who was knighted by the queen, had a son named Richard, who worked as a research scientist at Purdue. Richard would constantly be brainstorming ideas, trying to find new uses for MS Contin. Much like his uncle Arthur, he was heavily interested in the commercial and marketing side of the business. Purdue’s former executive director of product management recalled that Richard didn’t always wait for the research results. Richard would later become president of the company in 1999 and co-chairman in 2003, as his uncle and father became co-CEOs. He was an avid micromanager, sending out sales bulletins which halfway through read “if you’re reading this, call my secretary” and he would leave secret passwords in the text. Based on which sales reps called the secretary and delivered the password, Richard would know exactly who was reading the bulletins and who wasn’t. During the 90s, the company realised they needed to do something about MS Contin. The patent was set to expire by the end of the decade, and the use of morphine as an end of life medication stigmatized the drug from being more widely available. The company moved to make a new drug called OxyContin with the active ingredient oxycodone replacing morphine. Many doctors falsely believed that oxycodone was weaker than morphine as it was one of the substances used in a weaker drug called Percocet. OxyContin pills ranged from 10mg to 80mg doses, for a period of time it was even available in 160mg. For reference, Percocet contained between 2.5 to 10 mg of oxycodone. The active ingredient in OxyContin, Oxycodone was in fact 50% stronger than morphine. Later, in an unpublished study by Purdue in 1999, the company found that the addiction rate was 13% not less than 1%. Often people also mistook oxycodone with oxy-codeine, again a comparatively weaker drug. Purdue was well aware of the misconceptions about Oxycodone in both doctors and the general public. If you’re getting confused between MS Contin, OxyContin, Codeine and Oxycodone, that’s exactly what the company wanted to do. Instead of correcting these misconceptions, the company actively tried to exploit them to make the drug more widely prescribed. The FDA even approved a claim that Oxycontin’s delayed absorption reduced the probability of abuse of the drug. In simpler terms, they were stating that addicts would prefer an instant fast release hit, rather than their slow releasing tablet. Meaning that the drugs abuse rate potential was less than other opioids. Addicts soon discovered that snorting crushed pills was an easy way to bypass the slow-release mechanism of the drug. And this was simple to figure out, as Purdue’s packaging even stated that the drug’s slow release could be circumvented by crushing the pills. The FDA examiner who was involved with the approval of this claim left the FDA shortly after and within 2 years had accepted a role at Purdue. In 2001, the FDA removed the claim from OxyContin and would never approve the same claim for any opioid since. In 2015, Purdue was granted F.D.A. approval to market the drug to children as young as eleven. Almost immediately after OxyContin was released, the cases of addiction became apparent. But rather than admit their drug was addictive, the company simply blamed people who were not taking the drug as directed. Even the Purdue had to fire one of their secretaries after she became addicted to OxyContin. Why was the use and abuse of OxyContin so widely spread, well it wasn’t by accident, the company knew what it was doing. Purdue’s strategy for its new drug OxyContin began in 1995 where the company focused the drug on the same market as MS Contin. Cancer patients. This move was made to win regulatory acceptance and the integration of the drug into medical programs. The company began its targeted advertisements on health professionals with sales reps encouraged to lie about the addictive nature of the drug. Purdue then began paying off the links of the supply chain. Distributors were granted rebates, pharmacists were given refunds and patients were given coupons for “starter suppliers”. Academia also got their share in grants; medical journals were making money from advertising the drug. Politicians were given campaign donations from both Purdue and the Sackler family. But the most important link in the whole chain was doctors, after all, they were the ones who used their discretion on what to prescribe their patients. Purdue had a speaking bureau where doctors would be flown to so-called seminars which were essentially golfing trips. Thousands of clinicians were paid to speak at conferences on the company’s behalf. Prominent doctors on the Purdue payroll, played down the effects of opioids, calling them a “gift from nature” and stating that the notion that opioids caused addiction was a “medical myth”. The chronic-pain movement in the nineties concerned itself with improving the treatments and therapy for chronic pain, which was previously poor. Purdue, along with a host of other pharmaceutical companies formed advocacy groups as an attempt to capitalize on the already growing movement. During a 9 year stretch between 2006 and 2015, Purdue and other drug manufacturers in the industry had spent almost 900 million dollars on political payments and lobbying. Purdue launched its group called Partners Against Pain, who along with the rest of the industry had lobbied regulators into making pain a “fifth vital sign”. Often doctors to ask patients to rate their pain on a scale of 1 to 10, giving a more quantifiable and tangible reason to prescribe opioids. The company was trying to make OxyContin a viable treatment for noncancer patients. An excerpt from Esquire’s story reads “The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American. By 2001, annual OxyContin sales had surged past $1 billion”. Business was booming. In the 5-year period between 1996 and 2001, in the United States, OxyContin grew from three hundred thousand prescriptions to almost six million. It is possible to find regions of the country where the amount of prescriptions is more than the actual population of that region. Opioid abuse cases began rising to the surface and studies would show direct correlations between the location of the cases and the volume of opioid prescriptions in that area. Purdue even targeted poor areas with high labour work. The higher incidences of workplace injury leading to high uses of OxyContin. The company also recorded information about the prescriptions quantities individual doctors were writing. Sadly, this was so the sales reps would then have a better idea of which doctors to target, like casinos targeting the clients that spend the most, Purdue targeted doctors that prescribed the most. Doctors would be arrested in the hundreds for running clinics which prescribed pills to patients without a legitimate reason, often called pill mills. Purdue even had a list of doctors they considered suspicions in operating these schemes but did not divulge the list to law enforcement until years later. The company memos between sales reps read “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!”. Some of the better sales reps were earning 6 figure commissions with the company paying out 40 million dollars in bonuses in 2001. With mounting criticism of the OxyContin, but Purdue still managed to make things even worse. took artificial measures to help the reputation of the drug and the company name. They would give doctors tamper-resistant prescription pads and offered to replace stolen drugs from pharmacies. Of course, these measures didn’t reduce the rates of prescription and it certainly didn’t change the addictive properties of the drug. The effects of OxyContin were supposed to last 12 hours, enough for a good night’s rest, however often the effects were only present for about 8 hours. Sales reps were strictly instructed to inform doctors to increase dose amounts instead of frequency. This created a perfect cycle for addiction, with the patient feeling physical effects related to withdrawal for a short period before another dose would make them at ease again. This led patients down the slope of being prescribed more than they needed and as their tolerances grew, falling deeper into addiction. Purdue would go on to face many class-action law-suits in regard to their practices and the drug. Often the company settled, awarding the plaintiffs millions. In 2004, Purdue was sued for deceptive marketing as the drugs which were meant to last 12 hours, lasted much less. The company settled the suit for 10 million dollars, sealing the case under confidentiality and admitting no wrongdoing or changing any practices. Purdue always avoided any Sacklers testifying under oath, reaching settlements just as they were called upon. In 2007, the company faced a suit from the federal government in which Purdue was charged for a criminal felony of purposefully pushing misconceptions of OxyContin. In the suit, Purdue acknowledged that they knew about the misconceptions doctors had about their drug, and actively exploited it for profits. Even though a lot of the Sackler family were on the board and Richard Sackler had a direct hand in operations, This settlement cost Purdue 600 million dollars. With the top three executives pleading misdemeanour charges paying 34.5 million dollars from their own pocket. However, the top executive during most of the period when Purdue made their shady dealings was Richard Sackler, with the other members of the family holding various board positions. The Sackler name appeared nowhere on the 89-page guilty plea, however, they did appear on the non-prosecution agreement attached to the plea which would mean the government wouldn’t go after any of those listed entities related to the Sackler family. The company’s eagerness to settle was in order to avoid anything going on the public record, especially anything from the Sackler’s themselves. The family’s only testimony on the topic came from Richard in 2015. Sealed from public view for 4 years and only released in 2019, the testimony showed that Richard Sackler may have to know about the dangers of OxyContin earlier than it was originally thought. In 2001, after it was reported that 59 people died from OxyContin overdoses, his email to executives read “This is not too bad. It could have been far worse”. By 2010, Purdue had realised they needed to address the issue facing them. So, they created a new formula for their pill which was harder to snort and inject. After the reformulation, a study was conducted on 240 people from an OxyContin abuse treatment group. From this group, it that found, that a third had switched to other drugs, and of those, a further 70% began using heroin. Economists argued that the reformulation simply increased the rate that people turned to cheaper and harder opioids, as there was a significant increase in cases post-2010. Purdue’s actions went a step further. As the oxyContin’s patent was also nearing its end, so Purdue with an apparent change of heart stunningly lobbied that the drug was prone to abuse and that no companies should be allowed to re-make it. In 2013, the FDA agreed, no generic copies of OxyContin were to be made on the day that parts of the OxyContin patent were set to expire, the FDA ruled that no generic copies of OxyContin could be created. But OxyContin remained on the market, this simply meant that no competitors could make their own versions of the drug. What looked to be a noble act by Purdue, was simply a cunning move to secure a few more years of competition-free selling of their billion dollar baby, OxyContin. With its trail of destruction ruining large sections of the American population, Purdue appears to be moving its intention to other markets. Moving to markets with fewer regulations would be a simple way for the Sacklers to keep milking their cash cow. In 2016, an L.A. Times investigation into Purdue’s child company Mundipharma, which seeks out new markets, suggested that it is gearing up to take on international markets with their drug. In response, US lawmakers wrote a letter to the World Health Organisation warning the intentions of the company owned by the Sackler family. In 2018, the Sackler’s obtained a patent for a drug which is used to treat opioid addiction, ironically, they might make even more money from the crisis they helped create. In March 2019, Purdue settled yet another lawsuit. This time the company agreed to pay 270 million dollars to the state of Oklahoma for its part in the opioid epidemic. The Sackler family was not called by name as a defendant. However, perhaps in order to not be called to testify, the Sackler family has voluntarily pledged 75 million to the National Centre for Addiction Studies at Oklahoma State University. The company is currently said to be considering bankruptcy in the midst of thousands of lawsuits in order to protect their assets. In total, a separate collection of about 1,600 lawsuits are being carried out from various levels of government. The Sackler name was kept as far away as possible from their products. Purdue wasn’t called Sackler Pharma and OxyContin wasn’t called OxySackler on purpose. Protesters have begun assembling and organising against the Sacklers. In February 2019, the Guggenheim Museum in New York, a common recipient of Sackler money, was taken over by masses of protesters. Prescription papers fell from the balconies as carelessly as the doctors on the Sackler payroll once wrote them. "Shame on Sackler" echoed throughout the streets of New York as the groups chanted. It seems that the Sacklers favourite domain, the art and museum world, has been overtaken by people who had finally had enough. In 2019, one by one art galleries around the world have begun to reject their work, Publicly listed companies have to release a lot of information about their workings to appease shareholders. Purdue, being privately owned by the Sackler’s, was under no such requirement. The museum and art world either had little knowledge of their source of wealth or lacked to understand the connection. Recently, they have started to wake up amongst public outcry and protest against the family. The National Portrait Gallery in the UK announced it would be rejecting a 1.3-million-dollar donation for the Sackler trust. London’s Tate Museum and New York’s Guggenheim Museum both announced that any further donations from the Sackers will not be accepted. As far as the outrage against the Sackler’s goes, the deeper story is more nuanced, most of the decedents are involved in philanthropic work organising various charities and well-meaning causes. Some have never even owned any shares in Purdue, but bare the family name. Should the decedents, some of whom have no interaction with Purdue apart from collecting their checks, which Forbes estimates at around 700 million per year, be held accountable? The New Yorker puts forward a good argument that money received from ill gains should be used to counter whatever impact it had. The Nobel Peace Prize was created by Alfred Nobel who was said to have felt tremendous responsibility for his destructive invention, dynamite. For example, John D. Rockefeller, who founded Standard Oil which was later broken up into oil companies such as Chevron, ExxonMobil and BP. The descendants of Rockefeller have used some of their fortunes to fund resources involved with climate change and to audit, the companies harm due to their “enormous moral responsibility”. Should the Sackler’s do the same? The last of the three original Sackler brothers, who started the company back in the 1950s died in 2017. However, Richard, who ran the company, and other Sackler family members who served on the board are still alive and being sued. These settlements seem like pennies on the dollar for a company which reportedly earned 35 billion dollars in revenue from OxyContin and further fuelled an epidemic which has killed over 200,000 people since 1997. One senator even calling them an “expensive licence for criminal misconduct”. Sure, the Sacklers are not singularly responsible for the opioid epidemic, a range of other drugs was available both pharmaceutical and, on the street. And factors such as improper methods of dealing with addiction, mental health issues and homelessness within the national system are also factors. Perhaps there’s a silver lining, The US government has taken the first steps to address the issue on a national level. Emergency response tools such as Narcan nasal spray have saved countless lives in emergency overdose situations. Understanding addiction and creating medical reforms that make it harder for companies to lie about their drugs will be key in future change. Credit must be given to there are countless people who are trying to help those affected by this crisis. Hospital staff, charity workers, local police, fire departments, in their own way they help to save lives every day. But it is evident now, more than ever the affect the Sacklers had on the world. Depending on how long the opioid crisis continues we still may not know the true extent of the Sacklers efforts. Ironically, Arthur had told his children, “leave the world a better place than it was when you came in”. I wonder if he was serious. The Sacklers that were involved in creating the opioid epidemic cared more about profits than they did about their patients, the people they were meant to help. It may be too late to bring those responsible to justice or completely heal the impact that their actions had on the world. But it is not too late to stop these kinds of things happening in the future. For the last 30 years, the Sackler’s had a secret, not anymore.