The Men Behind the Opioid Crisis

Mike Carberry

UPDATE (11/2020): Purdue Pharma has pled guilty, and the Sackler family has been separated from the company. Fines and further litigation against the company will almost certainly cost billions.The Sacklers themselves may still face criminal liability.

Who Created the Opioid Crisis?

Man is a pain magnet. There are many varieties and sources of pain to him. Some are much more sensitive to it and pay anything to reduce or stop it. Thus, the creation of pain relievers, and the creation of a type of man who profits from it.

He created opioids, a class of drugs that include the illicit drug heroin as well as the prescription pain relievers oxycodone, hydrocodone, codeine, morphine, fentanyl and others. Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. (American Society of Addiction Medicine)

The terms “opioid” and “opiate” are often used interchangeably, but they have distinct meaning and usages. At one point in time, the word “opioid” was used to describe only the synthetic substance used to mimic opium. Today, it’s used to define the entire class of substances either derived from or used to simulate opium. “Opiate,” on the other hand, refers to a natural drug derived from the opium poppy. Whether the drug is in its natural or synthetic form, it can cause serious side effects and be dangerously addictive.

How Does it Cause Addiction?

The drug enters the brain through the bloodstream, creating a flood of artificial endorphins and dopamine — neurotransmitters responsible for feelings of reward, pleasure and satisfaction. This creates a rush of happiness and euphoria. This high is so unlike any naturally-occurring rush of dopamine or endorphins that the only way a person can experience it again is by using the drug again.

After repeated use, however, the brain will stop creating dopamine and endorphins, limiting a person’s ability to experience these feelings again to only when they use opiates. Because of the strong and desirable feelings that flood the brain, and because they cannot feel pleasure naturally any longer, it is easy to crave an opiate high. People choose to abuse opiates in order to lessen their pain and continue experiencing these euphoric feelings on demand. (The Recovery Village, Personalized Addiction Treatment)

Of the 20.5 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin. It is estimated that 23% of individuals who use heroin develop opioid addiction. National Opioid Overdose Epidemic Drug overdose is the leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015. American Society of Addiction Medicine.

4.5 Million Americans on Non Medical Opioids

According to the 2013 National Survey on Drug Use and Health, 4.5 million individuals in the United States were current non-medical users of prescription opioids and 289,000 were current users of heroin. The leading causes of death in people using opioids for non-medical purposes are overdose and trauma. The injection route use (intravenous or even intramuscular) of opioids or other drugs increases the risk of being addicted.

Purdue Pharma

How did it become a crisis? Going to the source, we learn that Purdue Pharma is a privately held corporation based in Stamford, Connecticut, that developed OxyContin, a prescription painkiller. It was hailed as a breakthrough that helped patients suffering from intractable pain, and generated thirty five-billion dollars in revenue for Purdue.  OxyContin’s active ingredient is oxycodone, a chemical cousin of heroin that is more than twice as powerful as morphine. Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids.  CDC

Many addicts starting on OxyContin turned to heroin because they couldn’t afford the prescription variety. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers.  Now, the centers for Disease Control and Prevention suggest that a hundred forty-five Americans now die every day from opioid overdoses. Patrick Keefe, The New Yorker, A Family that Built an Empire of Pain.

The crisis was initially precipitated by a shift in the culture of prescribing—a shift carefully engineered by Purdue. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off, it’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, said, when asked how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.” Keefe,

Sackler Brothers

Who owns Purdue? The Sackler brothers represent America’s wildest dream: three Brooklyn-born sons of immigrants who became physicians and went on to found a pharmaceutical dynasty that is today worth more than $13 billion.The three Sackler Brothers, growing up in Brooklyn, all became psychiatrists. The Sacklers were especially interested in the biological aspects of psychiatric disorders, and in pharmaceutical alternatives to mid-century methods such as electroshock therapy and psychoanalysis. Arthur studied under a European psychiatrist and had a genius for marketing.

As a doctor himself, Arthur knew that opinions of doctors were unimpeachable. Using this as his base he devised campaigns that appealed directly to clinicians, putting colorful ads in medical journals and delivering authority laden literature into doctor’s offices. He knew that doctors listened to other doctors, their own peers, so he enlisted prominent ones to endorse the drug and he actually had “scientific” studies made and paid for by the drug companies themselves, which ads were serious clinical in appearance. Such as one doctor talking to another about the benefit of the products.  Remember this was in the days when doctors were pictured smoking Camels or Lucky Strike Cigarettes. Keefe

Sackler and Valium

He got rich marketing Librium and Valium. These drugs had never been examined for their addictive properties. Valium was positioned as an elixir for a problem Arthur christened “psychic tension.” According to his ads, psychic tension, the forebear of today’s “stress,” was the secret culprit behind a host of somatic conditions, including heartburn, gastrointestinal issues, insomnia, and restless-leg syndrome. The campaign was such a success that for a time Valium became America’s most widely prescribed medication—the first to reach more than $100 million in sales. Arthur, whose compensation depended on the volume of pills sold, was richly rewarded, and he later became one of the first inductees into the Medical Advertising Hall of Fame. – Esquire

He became a publisher starting a biweekly newspaper, the Medical Tribune, which eventually reached six hundred thousand physicians. In 1959 became public that a company he owned, MD Publications, had paid the chief of the antibiotics division of the FDA, Henry Welch, nearly three hundred thousand dollars in exchange for Welch’s help in promoting certain drugs. 

The Sackler brothers bought Purdue, a small pharmaceutical company, and then began producing drugs.  Estes Kefauver investigated them and learned they had a totally integrated enterprise from creating a drug, a marketing company, with ties into the FDA, the AMA that, altogether was a small empire unto its own to assure any drug they created would be a home run financially.

They created OxyContin.

The brothers created focus groups with doctors promoting OxyContin as a “gift of nature,” and that it could be used long term without any addictive problems. It had never been tested for addictiveness.

The FDA approved OxyContin in 1995 in spite of the fact that Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. But Dr. Curtis Wright, the FDA examiner who approved the drug package insert for OxyContin which announced that the drug was safer than rival painkillers, because the patented delayed-absorption mechanism “is believed to reduce the abuse liability.” Wright left the agency shortly afterward.  He later went to work at Purdue.

Huge conventions were held, presented by well paid doctors, attended by hundreds of doctors who were told it was virtually non addictive, and then there were awards and payments made to doctors who prescribed it. Well meaning doctors took the word of other respected physicians that it could help their patients in pain without side effects, and so they began prescribing it in masses.

The Sacklers were unrelenting in making OxyContin a blockbuster, saying that people do not need to be in pain.

Reports rolled in that people in rural areas like Maine and Appalachia were grinding up the pills and snorting or injecting them. Doing this overrides the time-release mechanism and delivers a huge narcotic payload all at once. The warning label actually advised users of how to do this: “Taking broken, chewed, or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose.”

Soon there developed a huge black market, with patients selling the pills with a street price of a dollar a milligram. Many doctors who were easily manipulated by their patients — or corrupted by the money in play— set up so-called pill mills, pain clinics that thrived on a wholesale business of issuing OxyContin prescriptions.

Lawsuits were resisted by Purdue, defending by saying addiction was the problem of the abuser not the drug. The Sacklers had kept a low profile to stay out of sight and were legally beyond liability personally, though they were reaping billions.  The lawsuits were settled for sums that were pittances compared to the huge money reaped by the damage done. Just the cost of doing business. Purdue relented and reformulated OxyContin so it could not be ground up snorted or shot up, but maintained the original formula. It was shown that it was addictive even if taken according to directions.

Heroin dealers from Mexico fanned out across the US to supply a major market of people of now addicts who had started it all by pill addiction. Such an irony that the original formulation created a generation addicted to pills; the reformulation, by forcing users off the drug, helped create a generation addicted to heroin.

The original formulation is still being sold in Canada, and in spite of irrefutable proof of its addictive nature, the Sacklers continue to relentlessly market it, now just adjusting their sights on other countries with less regulatory control. They continue the original program they used to addict America in Mexico, and has only increased its efforts abroad, and is now pushing the drug, through a Purdue-related company called Mundipharma, into Asia, Latin America, and the Middle East. Part of Purdue’s strategy from the beginning has been to create a market for OxyContin—to instill a perceived need by making bold claims about the existence of large numbers of people suffering from untreated chronic pain.

Using the Same Propaganda

As Purdue moves into countries like China and Brazil, where opioids may still retain the kind of stigma that the company so thoroughly overcame in the United States, its marketing approach has not changed. In Mexico, Mundipharma has asserted that twenty-eight million people—a quarter of the population—suffer from chronic pain. In China, the company has distributed cartoon videos about using opioids for pain relief; other promotional literature cites the erroneous claim that rates of addiction are negligible. In a 2014 interview, Raman Singh, a Mundipharma executive, said, “Every single patient that is in emerging markets should have access to our medicines.” – the New Yorker.

It’s a parallel to what the tobacco industry did, they got caught in America, they saw their market share decline, so they export it to places with even fewer regulations than we have. You know what’s going to happen. You’re going to see lots and lots of death.  This may be the Armageddon we fear of having planet wide drugged population, along with its reduction in production and increase of human misery, illness and apathetic lifestyle of a drugged society.

What makes one ill is how the secretive Sackler family has remained hidden and yet has become the poster child of benevolence, and Mortimer Sackler, who gave up his American Citizenship has been awarded a Knighthood by Queen Elizabeth for all of the sumptuous beneficence he bestowed in Britain. The family became philanthropists on a huge scale, particularly in the fields of the arts and medical research, their names appended to buildings around the world. Sackler, who had a house in London and an English wife, Theresa, gave millions of pounds to numerous educational, scientific and cultural institutions. – TheTelegraph, 27 April 2010

The newly installed Sackler Courtyard at London’s Victoria and Albert Museum is one of the most glittering places in the developed world. Eleven thousand white porcelain tiles, inlaid like a shattered backgammon board, cover a surface the size of six tennis courts. According to the V&A’s director, the regal setting is intended to serve as a “living room for London,” by which he presumably means a living room for Kensington, the museum’s neighborhood, which is among the world’s wealthiest. In late June, Kate Middleton, the Duchess of Cambridge, was summoned to consecrate the courtyard, said to be the earth’s first outdoor space made of porcelain; stepping onto the ceramic expanse, the silently mouthed, “Wow.”

-Raymond

The Sackler Courtyard is the latest addition to an impressive portfolio. There’s the Sackler Wing at New York’s Metropolitan Museum of Art, which houses the majestic Temple of Dendur, a sandstone shrine from ancient Egypt; additional Sackler wings at the Louvre and the Royal Academy; stand-alone Sackler museums at Harvard and Peking Universities; and named Sackler galleries at the Smithsonian, the Serpentine, and Oxford’s Ashmolean. The Guggenheim in New York has a Sackler Center, and the American Museum of Natural History has a Sackler Educational Lab. Members of the family, legendary in museum circles for their pursuit of naming rights, have also underwritten projects of a more modest caliber—a Sackler Staircase at Berlin’s Jewish Museum; a Sackler Escalator at the Tate Modern; a Sackler Crossing in Kew Gardens. A popular species of pink rose is named after a Sackler. So is an asteroid.

Other Legacies and Sackler Heritages

Nearly two million Americans abused prescription painkillers in 2013, and 28,648 people died in the nation from opioids in 2014. Deaths caused by heroin, according to the CDC, nearly quadrupled between 2002 and 2013. According to the National Survey on Drug Use and Health, 467,000 Americans are addicted to heroin. Freedom Magazine.

Opioids kill roughly 142 Americans each day, a tally vividly described as “September 11th every three weeks.” The epidemic has also exacted a crushing financial toll: According to a study published by the American Public Health Association, using data from 2013—before the epidemic entered its current, more virulent phase—the total economic burden from opioid use stood at about $80 billion, adding together health costs, criminal-justice costs, and GDP loss from drug-dependent Americans leaving the workforce. Esquire

How many of these deaths, these suffering Americans, would be alive and well today were it not for the insufferable greed and arrogance of this irresponsible family? Regardless of what Arthur Sackler and his brothers say about how this devil drug is helping people in pain, there is no justification on continuing its production once it became known how dangerous it was.  The Food and Drug Administration has approved the powerful narcotic painkiller OxyContin for children as young as 11. While doctors who treat young cancer patients hailed the approval, others expressed concern that prescribing OxyContin to children could put them at risk for addiction. USA Today. August 13, 2015.    

Huge Settlement Foreseen

A recent article in the Guardian, by Joanna Walters, in an article Meet the Sacklers, a Family Feuding over Blame for the Opioid Crisis, says “There are signs that a giant court settlement may be around the corner between Big Pharma and city, county and state authorities from across the US that are all suing. Mississippi lawyer Mike Moore is confident there will be a deal to help pay for a catastrophe that the US Centers for Disease Control and Prevention estimate is costing the US over $78 billion a year.

Moore helped secure the historic $246 billion so-called Big Tobacco settlement against cigarette companies in 1997 and the $20 billion settlement against British Petroleum (BP) for the 2010 Deepwater Horizon oil spill.

 He declined to name the law firms or discuss which family members might be targeted in any expansion of the pharmaceutical cases. And the OxyContin heirs don’t want to talk about any of it. It is known that seven members of the Sackler family are on the board of Purdue, but the company will not disclose who owns shares or how much individuals are worth.”

According to Forbes, the “Sacklers continue to reap hundreds of millions of dollars in profits from the businesses in 2016– some $700 million last year, by Forbes’ calculations – from an estimated $3 billion in Purdue Pharma revenues plus at least $1.5 billion in sales from their foreign companies”.

How can any of this phantom family which has remained hidden for two decades while it made billions off of human suffering, now say that they haven’t feasted on the blood of the victims of Oxycontin—their golden goose. None of them knew?  They knew.  But blame will do little to help those who have suffered and are still suffering from the horrors of addiction.

It is not all Dark – There is a Shining Solution Just Ahead

On the horizon is a new healthcare standard: a world without the misery inflicted by drugs and the disease managing system that now holds sway in the US. It is a world where any and all ills are given the proper treatment to reduce pain as well as to correct any condition without the use of drugs or surgery. Therefore, there would never be such a crisis as we now are experiencing, for the goal and the policy would be to never give a drug when any other solution would resolve the problem.

What kind of world would that be? There is a sea change in the administration and care in the arts of healing moving throughout the country as this is written.  People are realizing that “conventional”, or “modern” medicine of disease management through drugs and surgery is no longer the answer. Through the internet and word of mouth, as well as personal experience, the failure of the current system is reaching a meltdown, and people are seeking sane, workable and inexpensive answers to their health. There is an answer, and it is becoming increasingly available, and soon will be the way to handle your health without waiting for it to get so bad that you need drugs for pain.

Suppose you could go to a clinic that has, under one roof, all of the caregivers that could handle your problem, and it would not cost you an arm and a leg, and would probably be covered by your insurance.  You could walk in and be given a diagnosis as to the proper therapy, and be sent to the appropriate person for initial handling. Under that roof would be a Medical Doctor, surgeon, Chiropractor, nutritionist, acupuncturist, trainer, and any other healthcare specialist needed in house or on call. If referral to a specialist would be required, then there would be affiliated specialists available unless you have one you prefer.

The overriding policy is to avoid drugs of any kind at all costs, unless absolutely necessary to control pain, and then only as long as immediately needed. Surgery is to be avoided as well unless there is no other choice.  Totally integrated systems as conceived here are being created on a daily basis throughout the country. 

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If you are a doctor, you owe it to yourself and your patients to find out more. CLICK HERE or follow us on YouTube and find out how our approach is helping to bring natural medicine into the mainstream and fight against the opioid crisis. Open up new opportunities for your patients and your practice – call us at 1-888-777-0815 today.

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