The opioid crisis that’s played out like a slow-moving horror movie over the past two decades has killed close to half a million Americans and thousands of Massachusetts citizens. It kills about 100 residents in Berkshire County annually. Off the top of my head, I can think of five South County victims. A single mother with a warm smile. Her sister. A budding chef. The brother of one of my former students. A young woman with long blond hair. This is to say nothing of the millions more whose early deaths by suicide or accident were indirectly caused by opioid addictions, or the millions of survivors whose lives have been derailed by them.
For a four-part series I wrote in 2018, I interviewed a recovering heroin addict whose life started to unravel the moment someone offered her an OxyContin pill at a party a decade earlier. “People were selling them [OxyContins] for $80 an 80-milligram pill, and I could do that in one shot! I probably jumped to heroin within that same year. When you have someone saying this will do the same thing for you, but it’s a tenth of the price? Sounds good to me. Oxy and heroin, there’s no difference. They are the same. They are the same. If you can’t find any heroin, an oxy pill’s gonna do the same thing for you.”
The name OxyContin is a combination of the powerful narcotic derivation oxycodone, and contin, as in “continuous.” The Sackler family’s company Purdue Pharma first developed this technology in the blockbuster pill’s precursor, MS Contin, a morphine drug with a coating that was meant to assure that each pill’s punch would be released slowly, over a 12-hour period. But, as my interview subject discovered, all you had to do was remove the coating, crush the pill, and snort or inject it for a quick high.
Four out of five heroin addicts started out misusing prescription opioids, and while OxyContin is not the only prescription opioid, without the medical marketing deceptions its founders developed and road-tested in the 1950s, we’d likely have no opioid crisis. Since the drug’s launch, in 1996, Purdue Pharma has made 30 billion dollars off of OxyContin, which is why nearly every state, as well as hundreds of municipalities and Native American tribes, has sued them. In June 2018, Massachusetts’ own Attorney General Maura Healey was the first to name individual Sackler family members on the suits.
Nearly three years later, the legal journey seems to be nearly over, with the Sacklers having successfully siphoned off most of the company’s assets into myriad shell companies and off-shore accounts, and threatening to declare bankruptcy. Their latest settlement offer includes the idea of turning the company into a public trust, and to let creditors reap the proceeds from future OxyContin sales. Maura Healey and New York’s Letitia James are leading the charge to hold out for more money and a better deal that gets at the family’s personal wealth.
So, through one lens, the war of USA versus The Sackler Family is over, and Sackler won. Looked at another way, they’ve lost big. Patriarch Arthur Sackler spent decades establishing prestige for the Sackler name, a name that’s been wiped from websites and scraped off buildings. That name that is now mud.
It’s getting muddier with the recent publication of “Empire of Pain” by Patrick Radden Keefe, which grew out of his bombshell 2019 New Yorker story, “The Family That Built an Empire of Pain,” where he made the clearest and most public connection to date between the Sacklers and OxyContin.
Arthur Sackler’s side of the family sold their share of the company before OxyContin was invented, so only the descendants of his two younger brothers, Mortimer and Raymond, appear on the lawsuits. These two wings of the family refused to participate in the book, and Raymond’s heirs — who include Richard, the force behind OxyContin, and his son David — dispatched attorney Tom Clare to send dozens of angry letters to Doubleday, the book’s publisher, to try to kill it. The most recent one arrived just a couple of weeks ago.
Until recently, no visitor to the western world’s most elite cultural and educational institutions could avoid encountering the name Sackler. They bought the naming rights to the medical school of my alma mater, Tufts University. There was a Sackler wing at the Louvre, a Sackler gallery at the Smithsonian, the Guggenheim, the Victoria and Albert Museum, the Tate. The Metropolitan’s Museum of Art’s signature antiquity, The Temple of Dendur, is housed in a massive room named Sackler.
It makes sense that Keefe devotes a full third of a book about OxyContin to the brother who died nearly 10 years before the drug came on the market. Arthur led the way for his kid brothers in all things. Trained as a doctor but more interested in the business of medicine, a man of great energy, ambition, and especially secrecy, Arthur served as the role model for the rest of his generation and those to come.
In 1942, he took a job with an advertising firm called WD McAdams, where he helped revolutionize the marketing of pharmaceuticals. Arthur had inherited from his immigrant parents a “reverence for the medical profession,” and staked his career on a belief in the power of the letters “MD” to win over consumers. Over the following decades, his approach to selling drugs — Terramycin, Betadine, the laxative Senocot, and earwax remover Cerumenex — would be essentially the same: convince doctors to convince consumers, and keep the hand of the company out of view. He “devised campaigns that would appeal directly to clinicians, placing eye-catching ads in medical journals and distributing literature to doctors’ offices. He promoted the practice of having drug companies cite doctor-approved studies about how well the drug worked, studies that had often been sponsored by the companies themselves.”
Arthur acquired Purdue Frederick in 1952, and then the family got truly rich. The first big cash cows were the tranquilizers Librium and Valium, introduced in 1960 and 1963 respectively, with the latter quickly becoming the most “widely consumed — and widely abused” prescription drug in the world, https://ryderclinic.com/valium-diazepam/. To the end, however, Arthur refused to believe that Valium was to blame for any negatives. In an early preview of what would become a famous Sackler defense, he blamed addictive personalities. Over the years, he mastered the art of, as Keefe put it in a recent interview, “overplaying the benefits and underplaying the dangers” of the drugs he was selling and, eventually, with the acquisition by Mortimer of Napp Pharmaceuticals in 1966, developing.
Richard joined Purdue Frederick in 1981, taking the title of assistant to the President, his father Raymond. His tenure coincides with their entry into the painkiller business with MS Contin, OxyContin’s precursor, a slow-release morphine in a pill that patients could take at home. But the company needed to come up with a formulation for a similarly controlled-release oxycodone product before the patent ran out in 10 years’ time.
Morphine had an unfortunate death-adjacent connotation, but oxycodone did not, and was wrongly perceived as weaker. If they got their messaging right, Purdue could exploit the misperception and market OxyContin, their new drug, as safer than morphine, though it was actually about twice as strong. Job number one would therefore be to convince the public not to be afraid. They dispatched doctors around the country to tout the benefits of OxyContin, how it was, as its motto said, “The one to start with and the one to stay with.”
Though he’d later deny direct involvement in the day-to-day operations of Purdue Pharma, Richard Sackler was “in the trenches” with the OxyContin rollout, sending emails to employees at three in the morning. “Richard devoted himself … dedicated himself to OxyContin.” Court documents later revealed that, at the 1996 launch party for OxyContin, which coincided with a historic snowstorm in the northeast, he predicted a “blizzard of prescriptions” that would be “deep, dense, and white.”
OxyContin brought in 45 million dollars in its first year, more than 1 billion in 2000, and 3 billion in 2010. The number of sales reps for Purdue Pharma kept pace, were lavished with bonuses, and incentivized to join the “Toppers” list of the Top Ten salespeople. They were pushed to push the highest doses available, because higher doses meant higher profit.
During this time, and as the company came under increasing scrutiny, with overdose deaths raising alarms nationwide, company president Michael Freidman, Medical Director Dr. Paul Goldenheim, and counsel Howard Udell were sent out as the public face, with Goldenheim expressing regret about how drug addicts were abusing their product, as his “medical credentials were useful to the company in projecting an image of Hippocratic virtue.” He wore a white coat in advertisements. In private, the executives spoke of themselves as tigers taking on the world, but “in public they were serious and ashen, projecting an air of sober earnestness.”
The Sacklers had also been road-testing various hassle-avoidance mechanisms over the decades, including the courting of public officials tasked with oversight of their products. Curtis Wright, the FDA official responsible for approving OxyContin, went to work for the company right after leaving public service. The first federal official who attempted to take Purdue to task for the abuse potential of their star product, Jay McCloskey of Maine, stepped down from his prosecutor’s post in 2001, and started work as a consultant for Purdue.
Friends in high places helped, too. The first serious efforts to bring Purdue to court came out of Virginia, and the office of United States Attorney John Brownlee, in 2006. His 100-page memo indicted Purdue Pharma with “an incendiary catalogue of corporate malfeasance.” He intended to charge Friedman, Goldenheim, and Udell with the crimes of money laundering, wire fraud, and mail fraud.
But, when you can spend $50,000,000 fighting off a case, you can also pull the strings necessary to get someone in George W. Bush’s justice department to throw out most of the case. The three plead guilty only to “misbranding,” and the company paid out a $600 million fine, just half a year of OxyContin profits.
Purdue had no intention of tossing out successful practices, and after that slap on the wrist, sales reps were trained to adopt the mantra from the conmen of “Glengarry Glen Ross.” A.B.C. Always. Be. Closing. Profits soared.
The company contracted with McKinsey, the elite consulting firm where huge numbers of Ivy League graduates are annually enticed, to help boost profit margins further. Among other good ideas, the smartest people in that room suggested offering a rebate “each time a patient who had been prescribed OxyContin subsequently overdosed or developed an opioid use disorder.” The payouts of up to $14,000 per sufferer wouldn’t go directly to those afflicted, however, but to the pharmacies and insurance companies who paid for the drug, to encourage them not to let up on prescriptions, “even in the face of such potentially lethal side effects.”
But even McKinsey couldn’t help Purdue avoid a tsunami. Kentucky was the first to depose Richard Sackler in person, and the contents of that deposition have been front and center on subsequent suits. He responded with “I don’t know” to more than 100 questions, a satirical version of which you can watch here delivered most hilariously by actor Richard Kind.
The cars, houses, and cell phone bills of the third generation of Sacklers were paid for with OxyContin money, but they’ve historically dodged questions regarding from where the wealth derived. David Sackler, the son of Richard and his ex-wife Beth Sackler, is the only third generation family member whose name appears on indictments, and in June 2019, he gave an interview to Bethany McLean at Vanity Fair, in which he painted the family as the true victims, the targets of “vitriolic hyperbole.”
He was especially bereaved that so many fabulously wealthy universities and richly endowed cultural institutions no longer wanted their money. The family had, he told McLean, been “giving where our hearts are” and he very much hoped the leadership at Yale, Harvard, and the Victoria and Albert would have a “change of heart.”
In a just world, of course, the Sacklers would have been compelled not to give where their hearts are, but toward the common good. Instead, the Sacklers got to route their billions through offshore entities with strict bank secrecy laws, and so keep for themselves what should have been paid in taxes.
A speech given by one of Stockbridge’s Gilded Age residents, Joseph Choate of Naumkeag, is quoted at the start of Radden Keefe’s New Yorker story. He opened the Metropolitan Museum of Art in 1880 by arguing that the “philanthropy” afforded by great wealth can buy immortality. “Think of it,” he exhorted his fellow donors, “ye millionaires of many markets, what glory may yet be yours, if you only listen to our advice, to convert pork into porcelain, grain and produce into priceless pottery, the rude ores of commerce into sculptured marble.”
But, it seems to me, this story reveals the most consequential thing great wealth can buy. Pure oblivion. A permanent opiate high. A ticket back to the garden, where knowledge of how the rest of the world lives, struggles, and dies need not trouble you.
At the Sacklers’ private family compound on Turks and Caicos, where staff sprayed down the sand so it wasn’t too hot for sensitive feet, it was not unusual for bloated corpses to wash up. Haiti, the poorest country in the Western Hemisphere, was across the water, and desperate migrants fleeing the island on unseaworthy boats sometimes drowned and were swept ashore there. But the Sacklers’ staff had been instructed to look out for these. They’d eliminate all evidence of a dead body, of the no-name soul who’d occupied a world just across the water and several worlds away, before any of the Very Important People were even awake.
