We ended our last newsletter with a few questions about how the hell we ended up here. I told you the opioid crisis that has now claimed the lives of over one million Americans was intentional, and it was. The prevalence of Oxycontin that myself and many others experienced was no mere accident: it was a marketing campaign by a multi-billion dollar company: Purdue Pharma, and one book takes a deep dive into understanding the root causes of the crisis.
The full title of the book is Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. Macy does a great job telling this story in an incredibly well-research book, a true feat of investigative journalism. She tells the tale of the Sackler’s, the family behind Purdue Pharma — and the masterminds behind the opioid crisis.
The Sackler’s were behind the creation of a new wave of powerful opioids. Up until then, most painkillers, like Percocet and Vicodin had very little opioid content actually in the pills. Most of the pills contained 500 mg acetaminophen, Tylenol, and only had about 5-10mg of oxycodone or hydrocodone per pill. The Sackler’s had an idea though: what if the pills eliminated the added acetaminophen and instead had large quantities of the opioid ingredient? This lead to the birth of Oxycontin and several other very powerful pain drugs, including Opana. In the beginning, Oxycontin came in sizes up to 160 mg, or roughly the strength of 32 Percocets.
But it wasn’t enough just to create the pills, now the Sackler’s had to sell them. They had a plan for their new drug that went above and beyond anything that had been done in the pharmaceutical industry at that time. You know those little pain charts with the different faces on them that are in every doctors office and emergency room? That was Purdue’s idea. Their plan was this: to market pain as the 6th “unseen” vital sign, behind temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation.
They coupled this with intentionally misleading people about how addictive the drug was. Purdue paid for one study about the addictiveness of their new drugs, and found that less than 1% of people prescribed them had any problem stopping use afterward their prescription ended, and that this 1% were likely already struggling from substance abuse issues. As long as it was prescribed by a doctor and taken at the same intervals, according to Purdue, there was little to no risk of addiction.
They then effectively wined and dined medical students and doctors, specifically targeting doctors in areas that already had high opioid prescription rates like areas of rural West Virginia that now have some of the highest overdose rates in the country. They essentially targeted people they thought would be more likely prescribe. They hired a massive sales team to target these doctors, and took them to all expenses paid resorts for their pain management seminars. And it worked. They made billions of dollars over the next few years, with some estimates showing profits of over $30 billion from Oxycontin and similar medications.
All the while the death toll skyrocketed, eventually leading to the explosion of heroin and later fentanyl use and over one million deaths in the United States alone, making it the biggest iatrogenic drug crisis in human history – even larger than the morphine epidemic after the Civil War.
The lawsuits began a few years later. Purdue was found guilty of intentionally marketing and lying about the abusability of the drugs, and for it’s role in the overdose crisis. In 2019, the company was dissolved and forced to pay some $5 billion in fines. The Sackler family is still worth over $10 billion and faced no criminal charges.
The opioid crisis rages on, the overdose rate has skyrocketed as fentanyl and even more dangerous opioids come into the scene, since they’re easier to make and more potent, making them easier to smuggle into the country.
The epidemic is so extreme that it has even impacted the overall life expectancy in the United States – the first decline recorded in over a century.
If you want a more-detailed account of this story, be sure to give Dopesick a read.
Sources:
https://www.cdc.gov/drugoverdose/deaths/index.html
https://alcoholstudies.rutgers.edu/the-four-sentence-letter-behind-the-rise-of-oxycontin/
https://www.nytimes.com/2021/09/01/health/purdue-sacklers-opioids-settlement.html