It may be difficult to imagine, but a single family may have had a direct effect on the massive epidemic of opioid-related addiction and deaths the U.S. is now experiencing.
The U.S. involvement in the Vietnam War between 1954 and 19751 led to the death of 58,200 military personnel.2 By comparison, in 2017 alone, 70,200 people died from drug overdoses, 68% of which involved an opioid.3
The number of overdose deaths involving opioids was six times higher in 2017 than in 1999. In the 18 years from 1999 to 2017, almost 400,000 people died from overdosing on an opioid drug, including illicit opioids such as fentanyl and prescription drugs.4
These monumental mortality statistics are a recent phenomenon, as are the skyrocketing prescriptions for pain medications, since the understanding of pain pathophysiology is still in its infancy. In 1986, the World Health Organization published its Cancer Pain Monograph,5 which addressed the perceived undertreatment of post-operative and cancer pain.
This prompted several publications questioning the undertreatment of pain,6 including an article in 1990 in Scientific American,7,8 which questioned why opioids were reserved solely for cancer patients and avoided by those suffering chronic pain.
In 2000, The Joint Commission published standards for pain management,9,10 while the Federation of State Medical Boards and Drug Enforcement Agency promised less regulatory scrutiny.11
These events provided the foundation for pharmaceutical companies to introduce new extended-release opioid formulations, such as OxyContin, which were presumed to have a lower likelihood of abuse but were in fact extremely addictive. From 1997 to 2002, prescriptions for OxyContin rose from 670,000 in 1997 to 6.2 million in 200212 as physicians were urged to prescribe opioids for the treatment of chronic noncancer pain.
Opioid Epidemic Driven by Aggressive Sales Strategies
A recent Massachusetts lawsuit13 alleges that even though Purdue Pharmaceuticals, maker of Oxycontin, was aware of the drug's addictive potential, the company reassured physicians that the risk of addiction was low.14 By 1999, the National Capital Poison Center15 found 86% of patients who were prescribed opioids were using it for noncancer pain.
Early efforts to reduce opioid prescriptions created a demand for heroin, which was cheap and widely available. Deaths related to heroin overdose increased by 286% from 2002 to 2013.16 Synthetic opioids, like fentanyl, became available in 2013. By 2016, 20,000 deaths could be attributed to fentanyl and other synthetic opioid overdoses, in addition to overdoses from heroin and prescription opioids.17
The Massachusetts lawsuit alleges that in February 2015,18 Purdue Pharmaceutical's Project Tango was presented to the board as a plan for a joint venture to sell the addiction medication suboxone (Naloxone). The team mapped out how patients could first get addicted to opioids through prescription drugs or heroin, and then become consumers of the company's new drug.
They noted that even after patients were finished with the first round of suboxone, up to 60% would relapse and need it again, nullifying the company's original assurances the drugs were not addictive.19 The Sackler family are the owners of Purdue Pharma and in 2016 were said to have a combined fortune estimated at $13 billion.20
The family received nearly $4 billion in profits over the past decade, in large part due to sales of Oxycontin.21 Kathe Sackler is accused of devising Project Tango to increase the company's profits from a growing epidemic that is killing tens of thousands each year.22
Despite warning signs OxyContin was addictive, sales reps were promoting opioids to specific prescribers to increase prescription rates. Purdue Pharma hired global consulting firm McKinsey & Company to raise sales and control their image.
The effort is said to have been initiated to counterbalance emotional messages from mothers whose children had died from an opioid overdose.23 McKinsey & Company allegedly urged Purdue to direct its sales reps to the most prolific prescribers, classified as "Super Core" prescribers.24
Harvard Announces They Will Keep Sackler Name on Museum
The Sackler family play a strong role in Purdue Pharma and have historically been known for their philanthropic efforts. The family donated a wing at the Metropolitan Museum of Art, a wing at the Louvre, a courtyard at Victoria and Albert Museum, a Center for Feminist art at the Brooklyn Museum and an arts education center at the Guggenheim Museum.25
Their profits have funded educational programs, medical research and professorships at Cornell, Stanford and Columbia universities.26 However, litigation against the Sacklers stemming from their role in the opioid crisis has placed pressure on these same institutions to return the gifts and remove the family name.
On this list of prestigious academic and art institutions is the Arthur M. Sackler Museum27 on the campus of Harvard University.28 As other institutions contemplate whether removing the Sackler name from their buildings and returning money might be appropriate, The Harvard Crimson29 reported university president Lawrence Bacow found this "inappropriate."
He stated Harvard would not remove the Sackler family name from campus buildings and would not return past monetary donations,30 as it was Dr. Arthur Sackler who donated funds to Harvard to name the school's museum after him.
Arthur Sackler — who The New York Times described as a research psychiatrist "who made his fortune in medical advertising, medical trade publications and the manufacture of over-the-counter drugs," passed away in May 1987,31 nine years before Oxycontin was launched in the U.S.32 Bacow believes there are "legal and contractual considerations," commenting:33
"Dr. Arthur Sackler died before the drug was developed. His family sold their interest in the company before the drug was developed. And I think it would be inappropriate for the university to either return the gift or take Dr. Sackler's name off the building that his gift supported given that he had absolutely no relationship to it."
New York Metropolitan Museum of Art Ends Relationship With Sackler Family
In a move the New York Metropolitan Museum of Art said is "in consideration of the ongoing litigation," they suspended any donations from the Sackler family and decided to end their relationship with the family. In a statement the museum attributed the move to the34 "production of opioids and the ensuing health crisis surrounding the abuse of these medications."
While they will no longer accept donations, they announced no plans to rename the Sackler Wing of the museum. The family quickly denied any allegations they are linked to the crisis in a statement to the New York Times,35 saying they believe the allegations are "false and unfair," but understand accepting gifts would place the museum in a difficult position at this time.
This ends a period of multiple gifts over generations that have been given by the Sackler family to the museum. Daniel Weiss, president and CEO of the New York Metropolitan Museum of Art, made a statement on the importance of private philanthropy to the museum as it has literally been the foundation and reason for growth of the buildings and collections. Weiss said:36
"What distinguishes our Museum from its global peers, such as the Prado, the Hermitage, and the Louvre, is the fact that we did not begin with a royal or imperial collection. Every object and much of the building itself came from individuals driven by a love for art and the spirit of philanthropy.
For this reason, it is our responsibility to ensure that the public is aware of the diligence that we take to generate philanthropic support. Our donors deserve this, and the public should expect it."
Similar announcements were made earlier this year from the National Portrait Gallery, Tate Modern and the Guggenheim Museum.37 In March, an arts organization — the Sackler Foundation — made a statement it would "pause" donations to institutions across the U.K.38
Arthur Sackler Designed Aggressive Tactics Responsible for Profits
Brooklyn-born brothers Arthur, Mortimer and Raymond Sackler were all physicians, and together founded Purdue Pharmaceuticals in 1952 after taking over a small struggling drug manufacturer. The company remained below the radar until the mid-1990s when Oxycontin came on the market.39
Over the years, the family was known for donating lavishly to a large range of institutions, many of which bear the family name. The loophole through which Harvard University40 and Arthur's wife Jillian41 would like to step begins when Arthur's brothers, Raymond and Mortimer, bought out his shares of Purdue Pharma from the estate before the introduction of Oxycontin.42
However, this overlooks Arthur's contribution to the sales of Oxycontin, as the drug's success is largely based on the aggressive advertising tactics he pioneered before his death. Arthur's daughter Elizabeth has since divested herself from any work with Purdue Pharma.
Raymond's sons Richard and Jonathan, and Mortimer's daughters Marissa and Kathe continue to work with the company.43 Kathe Sackler was at the heart of the marketing campaign dubbed Project Tango.44
She may have been sitting at the knee of Arthur Sackler, who was posthumously inducted into the Medical Advertising Hall of Fame in 1997. Sackler thought of doctors as unimpeachable stewards of public health, and devised his advertising campaigns to appeal to medical professionals.
Understanding doctors were greatly influenced by their own peers, he enlisted prominent physicians to endorse his products and cited scientific studies underwritten by pharmaceutical companies. John Kallir, who worked under Sackler for 10 years, was quoted in The New Yorker45 saying, "Sackler's ads had a very serious, clinical look — a physician talking to a physician. But it was advertising."
Allen Frances, former chair of psychiatry at Duke University School of Medicine, put it differently:46 "Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler."
'The Sackler Family Lied and Our Kids Died'
The parents of children who fatally overdosed on opioids are unconcerned by claims that returning Sackler donations and taking his name off buildings are unrelated to the intricate relationship between Arthur Sackler and the opioid crisis. They are demanding Harvard University remove the family name from buildings that house one of its art museums.47
Tony LaGreca, age 71, told AP News48 the story of how his son Matthew became addicted after a football injury in college. He was prescribed 100 Oxycodone pills and told to take three or four a day.
According to LaGreca, his son rapidly became addicted and lived through hell for the next 15 years until he died. "The Sackler family lied and our kids died," LaGreca said.49 Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, commented:50
"If you look at the prescribing trends for all the different opioids, it's in 1996 that prescribing really takes off. It's not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks."
Tufts University is another institution struggling with the decision of what to do with its Sackler donations. The scrutiny at Tufts was triggered by the Massachusetts lawsuit raised by the attorney general against Purdue Pharma.
Although a Tufts spokesman issued a statement saying the university remains deeply committed to the highest ethical and scientific standards, the allegations go deep into practices at the university.
According to the redacted lawsuit,51 in 1999 the family made a targeted gift, establishing Tufts' masters of science in pain research, education and policy, essentially purchasing goodwill, name recognition and access to physicians. To get ahead of the game, Tufts has ordered its own investigation and tapped former U.S. Attorney General Donald Stern to review the program.52,53
However, while Purdue Pharma pleaded guilty to misleading regulators in 2007, this action did not compel universities and museums to return or refuse cash. A scathing editorial in the Tufts Daily explained:54
"The opioid crisis was engineered in our own backyard… Purdue staff lectured Sackler students at courses on opioid policy, hosted events to encourage their widespread use, and developed research protocols and publications on pain management for the school.
Tufts even promoted a Purdue employee to be an adjunct professor in 2011, four years after Purdue pleaded guilty to intentionally misleading doctors and patients about OxyContin."
Number of Opioid Lawsuits Growing as Purdue Publicly Discusses Bankruptcy
The mounting number of lawsuits promises to be expensive for Purdue Pharma. One court filing in Connecticut revealed a 20-year-old internal company email saying "abusers aren't victims." The emails, which came from Richard Sackler, were revealed in a public complaint brought by the Connecticut attorney general as one of 2,000 lawsuits filed across the country.
In a statement, Attorney General William Tong said,55 "Purdue and defendant members of the Sackler family knew people were dying, but they continued to push their opioids in blind pursuit of profit."
At the party to launch Oxycontin, Richard Sackler, senior vice president of sales, announced,56 "[T]he launch of OxyContin Tablets will be followed by a blizzard of prescriptions that will bury the competition. The prescription blizzard will be so deep, dense and white …"
About 1,500 of the 2,000 lawsuits filed in the U.S. are being overseen by a federal judge in Cleveland who is pushing the parties to settle. However, the Connecticut lawsuit is filed with the state government in a state court.
Purdue Pharma's CEO has said the company is considering bankruptcy in the face of lawsuits alleging their role in the opioid epidemic. While they have not yet decided whether to file bankruptcy, the CEO told The Washington Post57 it is something they are considering.
Jails Were Not Designed as Detoxification Centers
The number of overdoses from heroin use has led to an overpopulation in county jails now struggling with a new role as a center for opioid detoxification. More county jails are adding a form of medicated assisted treatment to help inmates detoxify safely in the hope they will stay clean behind bars and after their release.58
However, jail programs were not designed or built for effective detoxification treatments. This has led to a critical situation in which jails are scrambling to catch up. The National Sheriffs Association estimates up to two-thirds of the jail population has a dependence or drug abuse problem.59
One of the states hardest hit has been Middlesex County, Massachusetts, where the sheriff believes they are in a critical situation as they must physically and medically detoxify up to 40% of their population. Jails that have been hardest hit by the opioid epidemic include those in Ohio, Kentucky, West Virginia, Rhode Island and Massachusetts.
Carlos Morales, the director of Correctional Health Services for California, San Mateo County, is optimistic about their potential to impact the community. He states60 statistics in their area show that, as an opiate user, once you detoxify in the jail system you have a 40% chance of overdosing. He believes they have the potential to reduce those odds.
The offering of treatment programs is new for many correctional systems across the country. Morales believes the jail needs to build a momentum of treatment. But treatment inside the jail is only half the problem, as once the inmates leave the facility they need access to health insurance, medications, counseling and treatment services to help them get through and stay drug-free.
Struggling With Opioid Addiction? Please Seek Help
Regardless of the brand of opioid, it's vitally important to realize they are extremely addictive drugs and not meant for long-term use for nonfatal conditions. Chemically, opioids are similar to heroin. If you wouldn't consider shooting up heroin for a toothache or backache, seriously reconsider taking an opioid to relieve this type of pain.
The misconception that opioids are harmless pain relievers has killed hundreds of thousands and destroyed the lives of countless more. In many cases you'll be able to control pain without the use of medications. In my previous article, "Treating Pain Without Drugs," I discuss several approaches to consider that may be used separately or in combination.
If you've been on an opioid for more than two months, or if you find yourself taking a higher dosage, or taking the drug more often, you may already be addicted. Resources where you can find help include:
- Your workplace employee assistance program
- Contact the Substance Abuse Mental Health Service Administration61 24 hours a day at 1-800-622-HELP