Sell To The Weakest: Sackler OxyContin Marketing Targeted Patients At Highest Risk Of Addiction
We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals. — Richard Sackler
Note: 23 January 2021 — this is the second article in a series about the family-owned businesses, Purdue Pharma and Rhodes Pharma which sell opioids including OxyContin and MSContin, and which are being sued by the majority of states, local governments, and tribal governments in the U.S. (along with other opioid manufacturers). The business model is not unique to the pharma industry. It is also present in mass food and beverage industries, including soda, prepared foods, “junk” foods, and fast foods. Here is a link to the first article.
After the opioid prescribing landscape changed and Purdue Pharma paid its federal fines and penalties in 2007, the company’s prime OxyContin marketing targets became veterans, the elderly, osteoarthritis (OA), and “opioid naïve” patients.
In order to understand how demonic Purdue Pharma’s selection of these four sales targets is — far worse than just targeting vulnerable patients— it’s important to understand how opioids, especially the time-release pill OxyContin, affect the brain and body. The Sackler OxyContin business scheme is very similar to big tobacco’s multi-year conspiracy to market cigarettes to children and teens in full knowledge of nicotine’s massive potential for addiction.
Marlboro never promised gas station owners that their safe, non-addictive cigarettes would relieve chronic, severe pain with no side effects, did it?
Who am I kidding? Everybody knows doctors smoke Camels.
How can pain patients who take opioids long-term help us to understand opioid dependency and greater health risk?
Dr. Andrew Kolodny, Co-Director of the Opioid Policy Research Collaborative at Brandeis University, has been one of the leading advocates for responsible opioid prescribing since the 1990s. Dr. Kolodny has encountered stiff opposition from pain patients and pro-opioid physicians for his rigorous research and public policy stances. His critics are members of organizations that benefit U.S. chronic pain patients, many of whom have been taking prescription opioids for long periods of time. Some long-term pain patients passionately assert that the only help for their chronic, severe pain is their opioid prescription. They believe that Dr. Kolodny wants to take their medication away because he has been a successful driving force behind legislation and public health policy that has reduced opioid prescribing in recent years.
I reviewed several of the pain organization advocates’ publications. It’s easy to find information about how the government is violating patient rights to have pain medication with increasingly strict prescribing guidelines. The pain patients make it clear they are dependent and must continue opioids to maintain their daily lives. They’re absolutely right. They must continue to take the medication to continue their daily lives. The reason is the way opioids work. Opioids, including OxyContin, produce:
- Tolerance and Lower Pain Threshold: People taking opioids develop tolerance, an ever-increasing need for stronger doses to maintain the same pain relief. Opioids also decrease the body’s natural pain threshold. As time goes on, opioid medication becomes less effective in relieving pain — but the patient feels more, and more severe, pain than ever.
- Long-Term Changes in Brain Architecture and Chemistry: Opioid medications like OxyContin bind to our body’s endogenous opioid receptors: nerve cells located in the central and peripheral nervous systems. This is the primary way they relieve pain. With each use, opioids also stimulate our brains to release dopamine, the natural “feel good” neurotransmitter that produces feelings of reward, happiness, and pleasure. Continued, long-term use of opioids produces long-term changes in neurons and brain chemistry. This process is called the “brain disease model of addiction”. The Betty Ford Center along with the overwhelming majority of other addiction and recovery centers now use the brain disease model of addiction to help guide medication-assisted therapy (MAT) and combined MAT/counseling/therapy recovery programs. In plain English: opioids change our body’s central and peripheral nervous systems. They reduce our body’s ability to make and use neurochemicals like dopamine. They reduce the number of opioid receptors that accept dopamine whether natural or induced by the opioid itself. They simultaneously support addiction through the artificial release of dopamine (“reward”) and increase depression and anxiety through the reduction of dopamine receptors. They chemically train the brain and nervous system to need opioids.
- Opioid Dependence: According to the NIH, everyone who takes opioid medication for “an extended period” will become dependent. Opioid dependency means that the person will experience physical withdrawal symptoms upon ceasing the medication. Dependent pain patients called for Dr. Andrew Kolodny’s resignation from Brandeis University because he has proposed that some long-term opioid patients should be forcibly tapered off their medication. Symptoms of opioid withdrawal include nausea, vomiting, chills, depression and anxiety, diarrhea, and muscle cramps. According to Tracey Duncan, who detoxed off tramadol, withdrawal symptoms were intolerable
It feels like the worst flu you ever had, the sickest you’ve ever been, times suicidal thoughts and complete and total confidence that you are never, ever, ever going to feel better. It feels like the day your wife left and your kitten died and there were no more rainbows anywhere and never will be again.
The opioid Tracey was taking, tramadol, has been sold for years as a “safe” medication. As OxyContin has become less-prescribed, tramadol has become the vanguard of the next opioid overdose epidemic.
Why did Richard Sackler target veterans, the elderly, and other vulnerable target market patients?
The Sacklers targeted veterans, the elderly, people with osteoarthritis (OA) and “opioid-naive” injury patients because these groups were most at-risk of dependency and addiction.
Veterans have a high risk of opioid use disorder and opioid overdose. They also have Tricare and VA benefits so profits from sales of prescription OxyContin were and are guaranteed.
Purdue Pharma partially funded the publication of Exit Wounds (2009) by wounded veteran Derek McGinnis. According to Massachusetts’ 2019 complaint, Exit Wounds said, “Long experience with opioids shows that people who are not predisposed to addiction are unlikely to become addicted to opioid pain medications.”
The head of the University of California, Davis’ Center for Pain Medicine Dr. Scott Fishman, is pictured elsewhere in the newsletter accepting an award for the Center’s “National Award of Excellence in Pain Management.” Fishman and other high-profile physicians have said their financial ties to the pharmaceutical industry did not influence their medical advice.
Along with three other nationally-recognized physicians, Fishman is named in over 400 of the state and local-level lawsuits against Purdue Pharma and other opioid manufacturers. He is a KOL — a “key opinion leader” —who received hundreds of thousands of dollars personally or for the UC Davis Center for Pain Medicine from Purdue and other opioid manufacturers. He is the author of Responsible Opioid Prescribing, which Purdue Pharma sales reps gave to doctors. The book asserted, “a small minority of people seeking treatment may not be reliable or trustworthy” and not suitable for addictive opioid drugs.”
Fishman was instrumental in one of Purdue Pharma’s most devastating marketing initiatives: introducing the idea of “pseudoaddiction” to family medicine doctors and encouraging them to prescribe OxyContin to “trustworthy” patients.
Before we go further, I’m going to emphasize again — even at the time Fishman was writing these books and Purdue Pharma was telling ordinary doctors that OxyContin was safe and non-addictive, the mechanism of opioids in the body was understood. Research had shown that opioid dependency reduced the medications’ effect on pain over time. Research would soon show that opioids decreased pain tolerance, making pain feel worse than it did before patients started taking the medication. It would also soon show that the medications reduced the body’s number of opioid receptors, reducing our own natural ability to cope with pain. Finally, research had shown that opioids’ artificial enhancement of the brain’s production of dopamine led to a cycle of nearly-guaranteed addiction and enormous challenges in recovery. Oh yeah: increased depression. As you can see, this makes OxyContin “ideal” for injured veterans in chronic pain.
Ideal to become dependent, requiring more and more OxyContin over time, with Tricare to pay for any and all prescribed medications.
Did the Sacklers know patients would require higher doses of OxyContin and more doses over time?
Back to OxyContin and the Sacklers. Every older Sackler male was or is a medical doctor. The Sacklers often demanded that colleges, universities, and museums formally recognize their status as MDs to receive their multi-million-dollar gifts. The Sacklers sold OxyContin, Butrans, and Hysingla through Purdue Pharma and they sold MS Contin (time-release morphine), oxycodone, and opioid side-effect treatments such as stool softeners through Rhodes Pharma. The family specialty is opioids and prescriptions to treat their side effects.
In January 2018, Purdue Pharma’s former CEO Richard Sackler appeared as one of six patent-holders on a Rhodes Pharma patent for a buprenorphine wafer for medication-assisted therapy (MAT) for opioid addiction. The first application for the patent was made in June, 2015. The patent application cited references dating back to the original 1973 patent application for naloxone. Naloxone, popularly known as Narcan, is the primary opioid antagonist/overdose reversal drug. Buprenorphine (Suboxone) is a partial agonist. It doesn’t produce a “high” sensation but does displace opioids from the body’s receptors. It helps to reduce or eliminate opioid withdrawal symptoms.
Richard Sackler is probably more of an expert in opioid dependency than Brandeis’ Dr. Andrew Kolodny or Dr. Scott Fishman, UC Davis’ key opinion leader. Purdue Pharma’s goal was to make as much money as possible for the Sacklers through OxyContin. Sackler consistently directed his sales staff to target doctors treating patients at the highest risk for long-term opioid use, dependency, and potential addiction.
How concerned was Richard Sackler about deaths resulting from OxyContin?
In January 2001, Richard received a plea for assistance from Purdue sales rep Joseph Coggins. Coggins had attended a community meeting at a local high school for parents of children who had fatally overdosed on OxyContin. “Statements were made that OxyContin sales were at the expense of dead children and the only difference between heroin and OxyContin is that you can get OxyContin from a doctor,” Coggins wrote to Sackler.
Then Mortimer Sackler wrote Richard Sackler about a federal prosecutor’s report of 59 OxyContin-related deaths in a single state. Richard responded, “This isn’t too bad. It could have been far worse.”
On February 14, 2001, Richard Sackler received a “Valentine” from a grieving mother.
My son was only 28 years old when he died from Oxycontin on New Year’s Day. We all miss him very much, his wife especially on Valentines’ Day. Why would a company make a product that strong (80 and 160 mg) when they know they will kill young people? My son had a bad back and could have taken Motrin but his Dr. started him on Vicodin, then Oxycontin then Oxycontin SR. Now he is dead!
Without knowing, the grieving mother had listed the exact profit-generating series of ever-stronger prescriptions that Purdue Pharma desired physicians to prescribe and which formed the basis of its sales campaigns. The 28-year-old’s death resulted from him receiving opioid pain medication in the exact way Richard Sackler had instructed sales and marketing execs to promote in order to meet quarterly sales targets.
Shortly after these contacts, Richard Sackler wrote in a confidential email,
We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.
This directive to Purdue Pharma sales staff is one of the main reasons the Sacklers fought with all of their paid legal might to stop the Massachusetts’ Attorney General’s filing from being released to the public in January.
Richard Sackler demonized people who overdosed on OxyContin even though he knew that the death risk for patients increases with every succeeding month on an opioid prescription — it apparently wasn’t a concern because the longer patients took OxyContin, the higher Purdue Pharma’s profits went. Richard Sackler’s concern was extracting every possible cent from injured veterans, elderly pain patients with arthritis, and workers hurt on the job who’d never taken an opioid — all the while understanding the brain theory of addiction well enough to file a patent on a medication used to help people recover from opioid addiction.
Another lawsuit may contain even more damning evidence of reckless disregard for human life
The Sackler legal team continues to fight to keep 17 million records out of public view gathered as part of a Kentucky lawsuit that was settled in 2015. More than 1,600 additional lawsuits are underway and would certainly benefit from the extensive record trove, including Oklahoma’s lawsuit which is set to be televised; Purdue lawyers are fighting this, calling it a “media circus.”
STAT, the Boston Globe’s life sciences reporting site, requested the Kentucky records and received a favorable judgment in December 2018 but are still awaiting the release of the massive trove. The records reportedly include a long deposition provided by Richard Sackler.
As Profits Lagged, Purdue Pharma Targeted Increasingly Vulnerable Populations
It might seem impossible to believe that a pharmaceutical company that says it wants to alleviate pain could build its business plan on addicting customers to a potentially deadly medication that in the long run, reduces pain tolerance. OxyContin by its nature, guaranteed that every patient who took the drug longer than a few days would begin to develop tolerance. Those taking the drug longer than a few days would build dependence.
Longer use and higher dosages of OxyContin are the twin pillars of the business plan that paid the Sacklers over $4 billion after the 2007 Federal judgment to which the company pled guilty, agreeing to stop selling its pain medication in a way that encouraged long-term use of higher and higher doses.
According to the National Institute on Drug Abuse, in 2017, 1.7 million people in the U.S. had a prescription opioid drug use disorder. NIDA reports that anywhere from 21 to 29 percent of people who receive opioids for chronic pain misuse the medication. Between 8 and 12 percent of these individuals develop a substance use disorder. Another 4 to 6 percent transition from prescription drugs to heroin. About 80 percent of people who use street heroin first used prescription opioids.
OxyContin savings cards: discounted addiction and overdose risk
In 2009, Purdue Pharma introduced prescription drug savings cards. The cards are still available on the Purdue website. The Massachusetts’ indictment documents Purdue’s marketing strategy for the cards.
Legal maneuverings to evade responsibility
The Sacklers deny responsibility for Purdue’s actions in the current group of 1,600+ lawsuits. They say Richard Sackler vacated his paid employee role at Purdue back in 2003. Other family members also vacated their paid employee positions before the 2007 judgment. They allege they have no involvement in the company’s operations. In light of these statements, it’s hard to say whether the family ought to have accepted the more than $4 billion in profits they paid themselves since 2007 since they allege they were not involved in the company’s operations at all. Massachusetts obtained complete records of Purdue Pharma’s board meetings between 2007 and 2018; the attendance and minutes are exhaustively cited in the Commonwealth’s complaint.
Purdue Pharma is also considering bankruptcy because of the 1,600+ impending state and local lawsuits. Individuals cannot discharge criminal fines or government-ordered restitution through bankruptcy.
Many of the articles I’ve written have dealt with what is — to me — shocking disregard for any ethical concern or law on the part of wealthy, powerful US-based companies and politicians. Most people are not aware that the last successful prosecutions of large companies for fraud and reckless wrongdoing date to the Enron and Worldcom scandals in the early 2000s.
In 2006, Enron’s former chief Jeffrey Skilling was sentenced to 24 years in prison for his role in the $multi-billion fraud which destroyed retirement funds for thousands and defrauded countless investor. Enron’s other executive, Ken Lay, died while awaiting sentencing. Skilling’s sentence was reduced, and he was released from prison in 2018.
Worldcom’s former CEO Bernard Ebbers was convicted of multiple counts of fraud in 2005 and continues to serve his 25-year sentence at the Oakdale Federal Correctional Institution in Louisiana.
We already know that not one of the top 25 executives originally named as responsible for the 2008 subprime mortgage crisis served one second of jail time or received any criminal penalty. An individual whose company was implicated in the fraudulent foreclosure of thousands of homeowners is currently the U.S. Treasury Secretary.
Just so we are on the same page. The question really is: what is the penalty for taking over 200,000 lives? The cost to taxpayers is staggering: over $1 trillion.
This would easily pay for #MedicareForAll. Opioid deaths are the primary leading cause for U.S. decline in life expectancy each year since 2015. If our country can issue no penalty of any type to the Sacklers, it’s reasonable to ask: do we even have a country or any laws — or are we merely a group of 325 million organisms that live only to be preyed upon by the wealthy, evil, and unscrupulous.
Some #MAGA become outraged over the wrongful murder of one person whose life is taken by an undocumented immigrant. Yet the same people apparently believe it is unimportant when one family builds a whole company around a medicine with guaranteed sales (dependency/addiction), deceiving doctors and patients to make themselves billionaires, ultimately costing 200,000 lives and a major part of your taxpayer dollars. If you believe in this country’s laws like you say you do: enforce them. What the Sacklers “allegedly” (these people have at least $12.999 billion more than I do so it’s “allegedly”) did is completely illegal and they kept doing it and increased it after they agreed to stop in 2007. Stopping them would save a lot more lives than building a wall.
Make American Great Again?
Maybe we should go back to how great America was in 1924 when heroin’s sale was banned in the U.S. because it had addicted an estimated 200,000 people including children. America first! Most other countries had banned Bayer’s sale of heroin years earlier. Bayer, the friendly German aspirin and Zyklon B company, invented heroin (“heroisch”) and promoted it as a safe, non-addictive medicine starting in 1898. This is after an estimated 400,000 Americans became addicted to morphine, dying of overdose or dependency-related causes following the U.S. Civil War.
America is the world leader in opioid medication. The U.S. consumes 80% of prescription opioids in the world. Canada and Europe combined consume another 15%. The rest of the world uses the remaining 5% of prescription opioid medications.
If you’re sitting at home concerned about fentanyl coming across the Mexican border to kill Americans, I documented that one famous criminal oversprescribing doctor, convicted mass infant murderer Kermit Gosnell, prescribed over 600,000 OxyContin pills. He had a system of cash payment for street dealers who entered his Philadelphia abortion clinic, paid $30, received a prescription, filled it, then sold the OxyContin pills on the street. This one guy did this for years and Purdue Pharma targeted similar overprescribers in every state. Massachusetts’ lawsuit documents more than a dozen similar overprescribing “pill mill” physicians in the Commonwealth.
I’m only saying this because if people want to stay alive and live well, they’ve got to wake up. Your first step to protect yourself is to refuse opioids outside of a hospital/surgical environment. I do not care how bad you think your pain is or if your doctor tells you it’s safe. They are getting money to say that and to prescribe: over $5.5 million in 2017 from Purdue Pharma alone. Seek other, less-addictive or non-addictive treatment. If you take opioids for longer than 3 days your risk of addiction and overdose rises dramatically. This information is based on the outcomes of millions of patients prescribed opioids in the U.S. over the past 20 years. The data proving the risk is the reason that the CDC has issued new prescribing guidelines. If you are a long-term pain patient on a fentanyl patch or take more than 2 OxyContin or stronger pills a day, seek aid to receive medication-assisted treatment (MAT) and work with ethical medical professionals to save your own life and reduce your pain with medications that do not produce dependency, reduce your pain threshold, and carry such a high risk of overdose and death.
If you don’t believe the CDC’s reports, maybe you’ll believe Purdue Pharma’s profits. The longer a patient took OxyContin and the higher dose their doctor prescribed, the more profits Purdue Pharma made: $4 billion to the Sackler family after the Purdue Frederick Company pled guilty to its federal charges and paid over $600 million in fines in 2007.
This is the second in a series of articles about Purdue Pharma and the Sackler family’s pursuit of profits from OxyContin and related medications. The first article served as an introduction to the reasons why the family and company have been named in over 1,600 state and local lawsuits over their practices in promoting OxyContin. The next article will discuss Richard Sackler’s promotion of “trustworthiness” in physician prescribing of opioids and the unbelievably reckless and destructive promotion of “pseudoaddiction” which Sackler and other “key opinion leaders” like Dr. Scott Fishman promoted in speeches, books, and sales/promotional materials to explain why patients demanded more opioids and became angry when they were not prescribed them. The solution to “pseudoaddiction”? Higher doses of OxyContin — of course.
