S03E59 The Evil Sackler Family: Ruthless Architects of the Opioid Crisis

The creators of OxyContin, the Sackler family, have blood on their hands. Their pursuit of wealth led to an opioid crisis, resulting in hundreds of thousands of deaths and the addiction of millions. The recent Supreme Court block of their proposed settlement including legal immunity only reinforces the malevolent legacy of a family that created a multi-billion dollar empire by ruthlessly exploiting the vulnerable.

What should we do with the most evil family in America? First of all, we physicians need to realize our role in exacerbating the opioid crisis, a sobering recognition that fuels our commitment to do better. It's a conversation that needs to be had, and it starts here.

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00:00:05 The Sackler Family's Evil Legacy

00:10:26 Opioids in Pain Management

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S03E59 The Sacklers - The Most Evil Family In America

Sam Rhee: [00:00:00] For over a year, I've wanted to talk about the family that I, as well as a lot of other people consider to be the most evil family in the United States. This family has deliberately caused more harm than anyone else in the United States, certainly in recent times, and perhaps in the entire history of the nation.

This family is named the Sacklers, and you may or may not know them, but they are the family who own the company purdue Pharma, notorious for making Oxycontin, which was instrumental in causing the opioid epidemic, which has continued to grip the United States. Over half a million Americans have died from opioid related overdoses since 1999 with 110,000 deaths last year, and millions of people remain addicted to opioids.

The Sackler family are one of the most dreadful drug dealers in history. At its peak in 2017, their company, Purdue Pharma, made $35 billion from Oxycontin. And it's estimated that the Sackler family has taken $13 billion in profits from the company for themselves. Even now, the [00:01:00] family fortune cannot be calculated and may be more than $13 billion because most of their assets have been hidden overseas and cannot be investigated.

Recently the Sacklers were back in the news after the Supreme Court last week blocked a nationwide settlement where the family would've paid up to $6 billion over time the state and local governments in exchange for complete immunity from lawsuits for their family members who would've been shielded from all legal liability.

Now, if you've never heard of the Sackler family, I would not be surprised. I really hadn't known about them either until I got a book almost two years ago which was recommended by a physician friend of mine. The book was called Empire of Pain, the Secret History of the Sackler Dynasty by Patrick Radden Keefe.

That book sat on my bookshelf for almost a year, and I decided to take it on vacation last year and finally read it.

And while reading Empire of Pain, I felt two strong emotions. One, shame and guilt that I myself participated in the opioid epidemic as a physician by prescribing Oxycontin and I [00:02:00] helped make the Sacklers make their horrific fortune. And number two, complete blood boiling anger at the evil perpetrated, knowingly and selfishly by this family who are driven by greed and self-obsessed with elevating their name and status in high society with the blood money that they drained from our country.

The Sackler family saga starts first with their senior elder, Arthur Sackler, who was the first in the family to start working in pharmaceuticals. In the 1940s arthur first developed the modern pharmaceutical marketing technique that became so effective in selling drugs.

These techniques, including medical publications targeting physicians directly became a staple for pharmaceutical companies and drug sales. I remember as a resident and young attending, getting paid by the Sackler Company IMS Health to report to them, how many and what kind of prescriptions I was writing weekly.

It seemed like free money to provide information which appeared harmless, but they were using in order to target direct advertising to physicians and keep track of what was being prescribed.

As Fortune magazine reported. Arthur [00:03:00] also pioneered lavishing doctors with fancy junkets, expensive dinners, and lucrative speaking fees, which became the norm for many decades and still is in the medical world. Arthur Sackler use these marketing techniques to sell Valium, popularly known back in the 1960s as Mother's Little Helper, making this addictive tranquilizer the bestselling drug for 14 years straight, starting in 1968 until 1982. 2 billion tablets were sold by Roche Pharmaceuticals in 1978 alone.

It was Arthur's Valium marketing playbook that his brothers Mortimer and Raymond Sackler and their family members used to then market their own drug, Oxycontin, which their company, Purdue Pharma first started selling in 1996.

Oxycontin is an opioid drug made of oxycodone, which is in the same drug class as morphine and heroin. It is highly addictive, but the company, Purdue Pharma, claimed that Oxycontin, which was a controlled release preparation, would give [00:04:00] supposedly long lasting 12 hours of pain relief. And the company began marketing the drug for routine pain indications.

After people quickly realized that crushing the pills would allow them to snort or inject the drug, thereby bypassing the controlled release effect, abuse of Oxycontin skyrocketed, resulting in the first wave of deaths linked to use of legal prescription opioids.

Nevertheless, the Sackler family continued to fraudulently advertise the drug as less addictive than other opioids and ordered sales reps to push the highest dosage pills possible and to target the highest volume prescribers for maximum profitability, even if these prescribers were suspicious in nature.

The company pushed that Oxycontin was appropriate for any type of pain, acute or even chronic conditions, such as long-term back pain. Purdue trained its sales representatives to carry the message that the risk of addiction was less than 1%.

Oxycontin sales grew from $48 million in 1996 to $1.1 billion in 2000, and [00:05:00] Purdue Pharma spent $200 million in 2001 alone to market Oxycontin. 5,000 healthcare providers attended all expenses paid trips to training conferences in resorts in Florida, Arizona, and California. A sales rep salary back in 2001 was $55,000, but the average bonus for selling Oxycontin was over $70,000 that year. Some reps made over $240,000 as a bonus.

And by 2004, Oxycontin was a number one abused drug in the United States. I personally remember as a resident at the University of Michigan Medical Center back in 2001, when I worked in the trauma burn unit. The Oxycontin rep was everywhere telling us the very same message, telling us the very same messages.

Safe, low risk of addiction, easy prescription schedule. One pill in the morning, one pill at night. Oxycontin was good for any kind of pain indication, and unfortunately many of us residents listened and prescribed Oxycontin. I don't remember exactly how much I [00:06:00] prescribed, but I know some of us prescribed a lot.

It's now painful to acknowledge, but I know I contributed to the opioid crisis we have now due to my ignorance and lack of due diligence. Abdicating my responsibility and duty as a physician to research and choose medications appropriately, and instead, listening to non-medical sales personnel who were carefully trained to push volume and numbers was a hard lesson that took me a while to learn, and I apologize for whatever part I played in harming my patients back then.

After the start of the opioid addiction wave by Oxycontin and the Sackler family, the second wave of deaths began occurring after restrictions tightened on Oxycontin, and those already addicted began turning to an expanding heroin market.

And most recently, the third wave of deaths has arisen, after illegal cheap, synthetic opioids such as fentanyl have begun flooding the market. Over this time, millions have become homeless, jobless, and have lost families due to the effects of the opioid crisis.

The Sacklers have consistently refused to [00:07:00] take responsibility for their actions. Despite tons of evidence, they claim they knew nothing about the abusive and deceptive marketing practices. They have continually maintained that their opioids are not addictive and that the few people abusing their drugs were addicts to begin with.

And Dr. Richard Sackler, a former president and co-chairman of the board, testified that neither he, his family, the company nor its product, bore any responsibility for the opioid epidemic.

And this family has used corporate bankruptcy laws to shield themselves from financial and legal liabilities. The Sacklers drained the company of assets and transferred their massive wealth to offshore accounts.

They have never acknowledged their role in the crushing wave of opioid destruction across our country. Not a single Sackler has been able to be prosecuted for any crime to date, or even paid a dollar of their money in recompense at this time.

The only thing that society has been able to take away from the Sacklers is their attempts to glorify themselves. Many of the charitable donations, which were an attempt to [00:08:00] elevate their status in high society, to NYU Langone Medical Center, Tufts University, American Museum of Natural History, Metropolitan Museum of Art, the British Museum, the Louvre have all removed the Sackler name from their institution, and I certainly hope the Sackler name at the very least, lives an infamy from many generations to come and that their truly horrific actions are remembered.

Now in regards to the current legal settlement, I do understand that there are a lot of local and state governments that could use the money right now to combat the opioid crisis, and there is a lot of pressure from families affected by the tragedy to accept the agreement, putting aside concerns about the blanket immunity.

But aside from a desire for retribution and justice, I do believe that there are more practical reasons to deny the Sacklers legal immunity in a settlement agreement. Number one, allowing the agreement will now give other criminals a playbook on how to avoid prosecution. And number two, the money that the Sacklers offer keeps increasing as a settlement continues to get [00:09:00] delayed.

A previous initial offer of $4.5 billion is now $6 billion and it must increase a great deal more. We must hold firm and exact both increased financial justice as well as deal an appropriate legal reckoning to the Sacklers. To allow this family an escape hatch with billions of dollars and no punishment would be the ultimate of injustices for all involved.

If you have seen the television series Dope Sick, you know how emotionally impactful the telling of America's struggle with opioid addiction can be. And the book I read, Empire of Pain was an intellectually deep and comprehensive epic that detailed, so much of the appalling family saga soaked in their selfish and arrogant actions over the years both to each other as well as to others.

The book made me shake my head so many times, and it especially resonated with me as a physician who was repeatedly duped by the greed of the Sacklers. Starting with their medical marketing efforts all the [00:10:00] way to their marketing masterpiece, Oxycontin, which has led to the catastrophe that we are all currently fighting.

Ironically, my weekly thankful is oxycodone, the short acting, regular pain medication that Oxycontin is based off of. I do prescribe a version of this called Percocet, where it is combined with Tylenol. Opioids definitely have an important place in our society. Yes, they can be highly addictive, but they are also powerful pain relievers, and many of my surgical patients will go home with one or two Percocet just in case they need it.

Now in the old days, based on drug company recommendations, we'd prescribed 60 or 90 pills at a time, or start them off on high dose Oxycontin.

But as the crisis continued to escalate, we realized that managing pain was not as simple as the Sacklers and the Purdue Pharmas of the world made it out to be. We now keep track and regulate our patient's use of opioids carefully. We also use a combination of non-opioid pain medications and other pain management techniques, and when [00:11:00] necessary, offer opioid pain medications as well, but for the shortest serration necessary.

Opioids can be very helpful, allowing patients to feel comfortable during surgical recovery. And it is unfortunate that a family like a Sacklers have caused our society so much harm by abusing it.

And it is always a reminder that we as physicians have a responsibility to our patients and we should never abdicate it to others like them. Thank you.

Please share your own thoughts with me. DM me @BotoxAndBurpeesPodcast on Instagram. Or leave a comment at youtube.com/@botoxandburpees.

Thank you very much.