OxyContin’s Sackler Family: What Do You Think The Penalty Should Be for Selling Drugs That Have Killed 200,000 People?
By: Amy Sterling Casil
Tags: Drugs, Murder, Sackler, Opioids, Opioid Epidemic

Why are the Sacklers Under Fire Now?

The Sackler family contend that as board members, not paid employees, not only do they have no responsibility for the illegal prescription opioid sales tactics that made them billionaires, OxyContin is not the cause of the opioid epidemic. They state that OxyContin represents only a small portion of total opioid sales. Their corporate structure includes Rhodes Pharma; between Rhodes and Purdue, the companies sell over 6 percent of the opioids prescribed in the U.S. annually. OxyContin is also a special type of opioid. It is long-lasting and time released and has a high potential for addiction.

Hard evidence has finally come forward documenting the family’s direct statements and actions before and after 2007’s $630 million federal judgment. Connecticut and Massachusetts have filed the first lawsuits in the new battle to stop the OxyContin-fueled opioid epidemic. These lawsuits individually name the Sackler family as the originators and creators of the opioid crisis which has officially taken over 200,000 lives and cost the U.S. an estimated $1 trillion since inception in 1999. After months of legal requests, a Massachusetts’ judge ordered the Commonwealth’s complaint to be unredacted and made available for public view in January.

Why did the Sackler family fight to keep Massachusetts’ lawsuit secret?

Massachusetts’ complaint documents the Sackler family’s roles as leaders and decision-makers for Purdue Pharma throughout the company’s history. The complaint provides evidence of Sackler orders and actions taken after the July, 2007 agreement which settled the previous federal and state cases.

Massachusetts contends, with ample direct, documentary evidence, that the Sacklers were not only personally responsible for ordering their employees to execute unscrupulous plans to sell as many OxyContin prescriptions for the highest possible doses, they personally circumvented or ordered employees to ignore every agreement the company had made to stop these practices in 2007.

The Commonwealth’s complaint is beautifully written and includes mountains of evidence, much like the 2012 Grand Jury report which led to the 2013 murder convictions of Philadelphia “House of Horrors” doctor Kermit Gosnell. What many may have forgotten is: Gosnell’s abortion-fueled murders might have continued undiscovered if he hadn’t been identified by the DEA as an excessive opioid prescriber.

Philadelphia “House of Horrors” Doctor Kermit Gosnell was a Star Prescriber for the Sackler OxyContin Empire

Memories are short, a human tendency the Sacklers have benefited from time and again. Convicted Philadelphia pill mill purveyor Kermit Gosnell wrote over 600,000 prescriptions for oxycodone (OxyContin) between 2007 and 2010. He only stopped when the DEA raided his office and shuttered his practice.

This places Gosnell’s OxyContin prescription pill sales value to Purdue well above that of Massachusetts doctor Walter Jacobs, featured in Massachusetts’ complaint. Jacobs was Purdue’s #1 prescriber in Massachusetts from 2008 to 2012, when he lost his medical license.

According to the Commonwealth’s complaint, Jacobs wasn’t just a high-volume OxyContin prescriber, he was Purdue’s top paid consultant in Massachusetts over the four years prior to losing his medical license. Jacobs received over $80,000 in consulting fees from Purdue Pharma and frequently gave speeches extolling the virtues of OxyContin to other physicians. Before the state stopped him, Jacobs prescribed more than 347,000 OxyContin pills in five years for an estimated value to Purdue of $3 million.

In a disturbing side note, Jacobs, now 70, appears to have obtained a license to practice law in Massachusetts in 2008. Jacobs’ law practice looks to have been as ethical as his medical practice — he received a reprimand in March, 2018 for unethical practices related to wrongful legal representation of a personal friend and former patient who in 2013, was indicted on 15 counts of sexual assault of a minor (step-daughter) in New Hampshire. Both Jacobs and his daughter, also an attorney, are named by New Hampshire in the separate legal malpractice case.

Sacklers Heard Many Reports About Illegal “Region Zero” Prescribers

So, Kermit Gosnell in Philadelphia, writing Oxy scripts for street drug dealers and addicts from his crumbling building in one of the city’s worst neighborhoods, seems to have been qualified for membership in Purdue Pharma’s secret coded Region Zero list. The Region Zero list, frequently named in Massachusetts’ complaint, was a confidential list of prescribing physicians who the company had reason to believe were involved in wrongful prescribing. In 2007, the company had agreed to document reports of suspicious prescribing and report them to authorities in the state of occurrence. But we must be joking! That was Purdue FREDERICK that made the agreement! They’re no longer in business.

At their board meetings, the Sacklers received regular reports about the Region Zero list doctors. This list was closely held by Purdue execs and unknown to the majority of Purdue employees. It was the ultimate resting place for staff reports of suspected bad prescribing behavior. In July 2010, meeting in Bermuda, board members including Beverly, Ilene, Jonathan, Kathe, Mortimer, Richard, and Theresa Sackler heard a report about hundreds of prescriptions written by Massachusetts doctors Michael Taylor and Alvin Chua.

Taylor’s New Bedford, Mass. office had already been raided in December, 2009. He was convicted of illegal prescribing in 2013 and surrendered his license to practice medicine. Chua’s license to practice medicine in Massachusetts was suspended in June, 2011.

Did the Sacklers and other board members express shock about these unscrupulous doctors? Aww, heck no.

According to board meeting records obtained by Massachusetts’ prosecutors, Purdue Pharma’s board, including non-Sackler family members Peter Boer, Judith Lewent, and Cecil Pickett, asked staff to document how much money the company was earning from these two and other Region Zero prescribers but took no other action.

The Region Zero list stayed secret.

Sacklers Ordered Sales Staff to Target Top 10% of Prescribers

By June 2008, OxyContin’s potential for addiction and dependency had become well-known enough that Purdue’s competitors were growing their market share just by saying “We’re not OxyContin.” Perhaps Heath Ledger’s death in January of that year had made a small impression.

Reading the bad news in trade publications, Richard Sackler wrote sales staff:

That’s all it took for Richard Sackler to order staff to ramp up Purdue’s sales force and launch a new initiative, the Options campaign. The Options campaign focused on doctors who already prescribed a lot of OxyContin. The goal of the campaign was calling on these physicians repeatedly, encouraging them to titrate the dosage of OxyContin prescriptions up as rapidly as possible.

Before I began researching prescription painkillers, I didn’t know what “titrate” meant. Titrate is a pharmaceutical term that means tying a dose of medication to symptoms and patient response. According to Purdue’s Options campaign, the best OxyContin doses were the highest doses: 60 and 80 mg per pill. At one point Purdue was marketing a massive 160 mg time-release pill. The high-value prescribers were giving out prescriptions to patients who were taking more than 24 pills a day. Purdue’s marketing materials said the time-release formula had advantages over other pain relievers because it provided pain relief with two pills a day.

By October 2009, Purdue Pharma had increased its sales force to 475 representatives, all focused on the Options campaign.

Illustration from Commonwealth of Massachusetts’ January 2019 complaint

In October, 2009, Richard Sackler ordered sales staff to send him weekly reports on OxyContin sales progress.

Also that month, the Sackler family discussed Federal Sunshine Regulations which would force the company to disclose direct payments to physicians. All 50 states have their own disclosure rules. The database finally got off the ground in 2013.

In case you were wondering, “do these companies pay doctors to write prescriptions for their medications?” Like, the top 10% of prescribers? Aw heck yeah.

How much do they pay?

See for yourself.

Direct payments to physicians were only one way that Purdue Pharma continued profits for Sackler family members.

Other methods included blanketing physicians and patients with thousands of copies of deceptive marketing materials, promotional websites encouraging OxyContin for all types of chronic pain, prescription drug savings cards (a rebate program proven to lengthen prescription use, Purdue profits, and addiction potential), and frequent sales visits to “top decile prescribers” — the top 10% issuing the most prescriptions to the greatest number of patients in the highest dosage.

How frequent?

This calendar is for just one sales rep and one physician from 2015.

Image credit: Commonwealth of Massachusetts January 2019 complaint

In addition to the visits and social opportunities with Purdue’s sales rep, the Fall River doctor eventually received a $48,000 consulting contract. He prescribed more than $1.5 million worth of Purdue Pharma products to his patients.

The Sackler family billions came directly from the company’s sales tactics that never ceased for even a day since OxyContin’s launch party in 1996 when Richard Sackler asked the audience to imagine a series of natural disasters. including a volcanic eruption, a hurricane, and a blizzard.

“the launch of OxyContin Tablets will be followed by a blizzard of prescriptions that will bury the competition,” Sackler said. “The prescription blizzard will be so deep, dense, and white…”

This article was originally envisioned as a stand-alone piece but the OxyContin story is so deep, of such long-standing, and so shocking, and the need for justice is so great that this article is the first in a series. Coming next: Sackler Sales Schemes Targeted the Most Vulnerable Patients. Also, check out Health Care Renewal, a gonzo blog by ethical medical professionals with vocabularies that would strike Ambrose Bierce pale with envy. Sign photographer Nan Goldin’s PAIN Sackler Change.org petition to hold the Sackler family accountable. I have previously written about fentanyl and Narcan /naloxone.