Book portrays the rise and fall of families linked to the opioid epidemic in the US – 06/04/2023 – Market

Aggressive pharmaceutical marketing strategies, overprescribing by physicians, regulatory failures by government agencies, and societal pressures for widespread use of painkillers have fueled the opioid epidemic that has killed more than 500,000 people in the United States.

In the book “Empire of Pain”, journalist Patrick Radden Keefe digs into the roots of this serious public health crisis by investigating the rise and fall of the powerful Sackler family, owner of Purdue Pharma, manufacturer of the painkiller with action similar to morphine, the OxyContin, named as one of those responsible for the epidemic.

Although several books and articles have already been written on the subject, the strength of Keefe’s work lies in the revelation of several documents, such as emails and internal company memos, which were kept confidential and only recently became public. He interviewed more than 200 people during five years of research.

The first part of the book is dedicated to Arthur Sackler, the eldest of three brothers born in the early 1900s to Jewish immigrant parents. A psychiatrist, he made the family’s first fortune marketing the sedatives Librium and Valium to doctors, omitting the risk of addiction to the drugs. Launched in 1960, Valium would only become a controlled substance in 1973.

Arthur, who owned a third of the pharmaceutical company until his death in 1987, had little or no connection to the modern Purdue Pharma, but Keefe justifies the space given to him (a third of the work) by arguing that the doctor was the “inventor” of the promotion manual used in OxyContin marketing.

Among the tactics used were payments to doctors and health professionals to promote the drug, conflicted relationships with public regulatory bodies, and downplaying the risk of addiction to the drug.

Beneficiary of prestigious American museums and institutes, Artur may well have crossed the lines between medicine and commerce, but his sins seem minor compared to those of his nephew Richard Sackler, president of Purdue Pharma between 1999 and 2003, and who continued for years to exert a strong influence on business.

It was Richard, for example, who pushed for the development of OxyContin in the 1990s and who spearheaded the drive to market it for routine pain when the FDA approved it in 1995. At a company event, he he even called on Purdue sales representatives to unleash a “prescription blizzard.”

At that time, it was already known that more effective painkillers tended to be addictive. But the pitch adopted by salespeople was that OxyContin, a hard-shell pill, released its medication slowly and steadily, thus avoiding the peaks and valleys of pain relief that can lead to addiction.

Many users, however, quickly discovered how to extract the opioid substance by crushing the pill shell. Then they ingested it or snorted it, getting high quickly.

One of the book’s most revealing episodes occurred in 1999, when the first stories of OxyContin addiction were spreading. Keefe reports that a Purdue executive asked a paralegal to go into online chat rooms under a pseudonym and find out how people could be abusing the drug.

She learned then about the pill-crushing and sniffing stories. She put it all in a memo that Purdue later denied having. But an investigation by the US Department of Justice ended up confirming the existence of the document.

At the time, the company followed through with false advertising. It claimed that less than 1% of patients became addicted. OxyContin generated revenue of about $35 billion and placed Purdue Pharma among the most profitable pharmaceutical companies in the world.

Keefe shows that the Sackler family and Purdue Pharma were aware of the potential for regulatory scrutiny and legal action. But instead of adjusting corporate behavior, it has adopted a range of tactics, such as lobbying to weaken regulations, out-of-court settlements, and even illegal activities like bribery and fraud.

This allowed Purdue Pharma to continue selling OxyContin for years despite mounting evidence of its harmful effects. The company created theories of “pseudoaddiction” (for which the cure would be more opioids) and claimed that doctors who pointed out the risk of the substance suffered from “opiophobia”.

Regulators have also endorsed the drugmaker’s claims about the drug’s safety. Behind this, there was the commitment of lawyers and lobbyists funded by the company. Lawsuits were filed.

When OxyContin was reformulated in 2010 to make it more difficult to abuse, many Americans who were already addicted turned to other alternatives, such as heroin and fentanyl, a synthetic opioid about 100 times more potent than morphine.

Purdue is now the subject of many lawsuits by state and local governments. The company eventually pleaded guilty to multiple federal charges in November 2020, but no Sackler or executive was required to plead guilty. “It’s as if the corporation had acted autonomously, like a car without a driver,” notes Keefe in an excerpt from the book.

Today, the Sackler name has fallen out of favor. Museums and universities that, in the past, received large donations from the family, now refuse the money. Purdue is bankrupt. There are legal efforts to recover some of the fortune taken from the company by the owners, but, in Keefe’s opinion, they seem unlikely to succeed.

Addiction is a complex, multifactorial phenomenon. OxyContin, which is still prescribed and considered effective when prescribed correctly, was not the only drug to become responsible for the epidemic. But, according to the numerous investigations and testimonies brought in the work, it played a unique role in the plague that is still ongoing.

“EMPIRE OF PAIN”

Price: BRL 99.90

Author: Patrick Radden Keefe

Publishing company: intrinsic

Pages: 544