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The Sacklers helped cause the opioid epidemic. They’re still making excuses for it.

David Sackler wants you to know that he and his family, which owns the company behind the blockbuster opioid OxyContin, are human — that’s one reason he gave for talking to Bethany McLean at Vanity Fair.

But they’re not human enough, apparently, to make serious mistakes. Throughout the interview with Vanity Fair, Sackler repeatedly insisted that his family and its company, Purdue Pharma, are not at all to blame for the opioid epidemic, and he reportedly got upset at suggestions that they’re culpable.

In the interview, Sackler told a story of his 4-year-old coming home and asking, “Why are my friends telling me that our family’s work is killing people?”

It sounds sad for a child who genuinely has nothing to do with the opioid crisis, but it’s apparently especially sad to Sackler because, in his view, his whole family had nothing to do with the epidemic. “Facts will show we didn’t cause the crisis,” he claimed, “but we want to help.”

This defies the widely accepted understanding of the opioid epidemic. In the 1990s, Purdue unveiled and heavily marketed OxyContin as a new, safe, effective kind of opioid. The company encouraged doctors, with a variety of marketing schemes, to prescribe far more of the drugs, with the promise that misuse, addiction, and overdose would be rare.

During this time, Sackler’s father, Richard, had a major marketing role in the company. David Sackler himself later served on Purdue’s board of directors from 2012 to 2018, after working for the company for a couple summers but otherwise working at different places and a family investment firm.

OxyContin uses an extended-release formula that releases a lot of the drug over time instead of all at once — which Purdue, with the approval of the Food and Drug Administration (FDA), argued made it less prone to misuse. In reality, it was more prone to misuse; the extended-release formula let Purdue include more opioids in each pill, and people found they could bypass the extended-release formula and absorb the opioids all at once by crushing and snorting or injecting the pills.

The result was the beginning of today’s opioid epidemic. Prescriptions skyrocketed, and the US continues leading the world — by far — in opioid prescriptions to this day. Between 1999 and 2017, nearly 200,000 overdose deaths were linked to painkillers, excluding synthetic opioids like fentanyl. Hundreds of thousands more have been linked to heroin, fentanyl, and other opioids. Much of that can be connected back to OxyContin and other legal opioid painkillers, with people who use even illicit opioids like heroin often tracing their initial opioid use — the thing that got them hooked — to the painkillers and, yes, Purdue and the Sacklers.

Sackler gave several reasons for why the opioid crisis is not his family’s fault

Sackler told Vanity Fair that it’s not his family’s or Purdue’s fault that things worked out this way. In his telling, Purdue was working with the best science it had at the time, even if that science turned out to be wrong.

For instance, Purdue relied on a five-sentence letter published in The New England Journal of Medicine in 1980 that seemed to suggest less than 1 percent of people who use opioids in a medical setting become addicted. Purdue interpreted that letter to claim that less than 1 percent of people who use OxyContin would become addicted.

In reality, the letter wasn’t intended to support such sweeping claims. And the letter’s author later told the Associated Press that he was “mortified that that letter to the editor was used as an excuse to do what these drug companies did.”

It doesn’t take an expert to devise that a five-sentence letter to the editor is not solid ground for sweeping claims about science or medicine. And while Sackler argued evidence other than the letter supported Purdue’s claims at the time, Vanity Fair noted that many of the other materials he pointed to are “sourced to the original letter from The New England Journal of Medicine.”

Beyond that, though, the fact of the matter is the addictive and otherwise dangerous traits of opioids have been well known for a long, long time. In fact, opioid epidemics caused by widespread medical use aren’t even new to the US — with a previous opioid crisis taking off after the Civil War when soldiers became addicted to morphine given to them to relieve pain from battlefield wounds. America had personally known about these risks for well over a century before OxyContin arrived.

Yet Sackler continues to insist that OxyContin isn’t that addictive, telling Vanity Fair that addiction rates are “between 2 and 3 percent” and only rise to nearly 5 percent when including more typical dependence and misuse. In reality, reviews of the research have estimated addiction rates at 8 percent and misuse rates as high as 26 percent.

Sackler also argued that OxyContin couldn’t be to blame for the opioid crisis, because it only makes up a small share of the opioid market — never more than 4 percent of opioid prescriptions. But as Andrew Kolodny, an opioid policy expert at Brandeis University, told Vanity Fair, this gravely misunderstands Purdue’s role: Since OxyContin is one of the more potent opioids, it was disproportionately prone to misuse and addiction. So it may make up only 4 percent, at most, of the prescription share, but it’s involved in a much higher percentage of all misuse and addiction cases.

Purdue also had a significant role beyond OxyContin. By marketing its new opioid as safe and effective, Purdue helped foster an environment in which opioids in general — not just OxyContin — were far more loosely prescribed. As Kolodny and other experts explained in the Annual Review of Public Health, Purdue’s advocacy through “education” campaigns and astroturfs was about how opioids in general are safe and effective — even helping spread the term “opiophobia,” which suggested that doctors were irrationally scared of prescribing opioids.

Sackler’s last point is that the real fault behind the opioid crisis falls on government agencies, like the FDA, that let opioids run amok: “You say, ‘Okay, first of all, it was known that those patients were going to exist.’ And the FDA approved this medication with that balance in mind. So like any medication that has unintended side effects, you knew that this was one. It was approved as one. Doctors understood it, right?”

There is some truth to this. As I’ve explained before, regulatory agencies could have done far more to prevent the opioid crisis. The FDA itself agrees, telling Vanity Fair that “the scope of the epidemic reflects many past mistakes and many parties who missed opportunities to stem the crisis, including the FDA.”

But the company who sold one of the most misused drugs surely bears more responsibility than the regulators who failed to stop it.

How opioid makers helped cause the opioid epidemic

The reality is opioid makers, including Purdue, played a big role in launching the opioid crisis.

The opioid epidemic can be understood in three waves. In the first wave, starting in the late 1990s and early 2000s, doctors prescribed a lot of opioid painkillers. That caused the drugs to proliferate to widespread misuse and addiction — among not just patients but also friends and family of patients, teens who took the drugs from their parents’ medicine cabinets, and people who bought excess pills from the black market.

A second wave of drug overdoses took off in the 2000s when heroin flooded the illicit market, as drug dealers and traffickers took advantage of a new population of people who used opioids but either lost access to painkillers or simply sought a better, cheaper high. And in recent years, the US has seen a third wave, as fentanyls offer an even more potent, cheaper — and deadlier — alternative to heroin.

It’s the first wave that really kicked off the opioid crisis — and it’s where marketing for opioid painkillers is likely most relevant. Multiple studies have now linked marketing for opioid painkillers to addiction and overdoses, particularly direct marketing to doctors that encouraged them to prescribe more of the drugs. And another study linked an increase in the supply of opioid painkillers to more overdose deaths.

Beyond the research, we’ve also seen more reports over the past few years about opioid companies aggressively marketing their products, even as it became clearer that the drugs weren’t the safe, effective alternative to other painkillers on the market that they claimed the opioids to be.

In the past year, a filing in Massachusetts Attorney General Maura Healey’s lawsuit against Purdue exposed how Richard Sackler, then Purdue’s president, was personally involved in some of those efforts. The filing claims that Richard, who’s also David Sackler’s father, pushed to market OxyContin as a “non-narcotic” in other countries, even though it’s an opioid; Robert Kaiko, who created OxyContin, had to talk him down from the idea.

The company also allegedly overlooked excessive prescribing in the US, even as some of Purdue’s staff warned of pill mills that should have been reported to federal officials, Maia Szalavitz reported for Tonic.

Purdue countered that the filing “is littered with biased and inaccurate characterizations of these documents and individual defendants, often highlighting potential courses of action that were ultimately rejected by the company.”

Other reports, however, suggest opioid companies were widely irresponsible. As Kolodny and other experts explained in the Annual Review of Public Health, opioid companies exaggerated the benefits and safety of their products, supported advocacy groups and “education” campaigns that encouraged widespread use of opioids, and lobbied lawmakers to loosen access to the drugs. Purdue, as the maker of the then-new OxyContin, played a huge role in these efforts, but so did companies like Johnson & Johnson, Endo, Teva, and Abbott Laboratories.

The result: As opioid sales grew, so did addiction and overdoses.

As opioid painkiller sales increased, more people got addicted — and died. Annual Review of Public Health

It’s not just that the drugs were deadly; they also weren’t anywhere as effective as Purdue and others claimed. There’s only very weak scientific evidence that opioid painkillers can effectively treat long-term chronic pain as patients grow tolerant of opioids’ effects — but there’s plenty of evidence that prolonged use can result in very bad complications, including a higher risk of addiction, overdose, and death. In short, the risks and downsides outweigh the benefits for most pain patients.

Yet even as these risks became apparent over the years, drug companies continued marketing the opioids, including for chronic pain. Even after Purdue and several of its executives were fined more than $630 million for misleading marketing in 2007, the company reportedly continued similar practices. (Purdue didn’t stop advertising opioids to doctors until last year.)

Perhaps the legal threats help explain why the Sacklers aren’t taking any culpability. If they admit to some fault, that could make legal challenges against them easier. And after decades of profiting from opioids, David Sackler and his kin don’t seem ready to give it all up.

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