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Should Big Pharma Be Held Accountable for the Opioid Epidemic?

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Medically Reviewed By: Diana Vo, LMFT

May 7, 2024

Table of Contents

In 2017, Donald Trump declared the opioid epidemic crisis a national emergency.

Deaths from opioid overdose have quadrupled since 1999. 81,000 people died between June 2019 and May 2020, the largest overdose death toll in 12 months.

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The US is currently experiencing a clash of two epidemics, the opioid crisis, and COVID-19.

Overdose is the leading cause of death in people under 50 years old. So far, the crisis has killed over half a million people.

Many blame Oxycontin manufacturers Purdue Pharmacy for the origins of the opioid epidemic, which is being exacerbated by COVID-19 and believe it’s time to hold them to account.

Purdue Pharmacy, which is owned by the Sackler family, have been fending off thousands of lawsuits over the years, but still refuse to accept personal responsibility.

We assume that public health is taken seriously and that those in charge of pharmacy and medicine have our best interests at heart. Unfortunately, the opioid epidemic is rooted in the greed and corruption of a family who continue choosing to put profits over people.

What Caused The Opioid Epidemic?

Several factors caused the current crisis but the main factor is the Sackler family and the opioid painkiller Oxycontin. They are accused of aggressively marketing opioid prescription pills and addicting people to get rich.

The Sackler family owns Purdue Pharmaceutical which manufactures Oxycontin.

In December 2020, two members of the Sackler family faced questioning in a televised hearing. They were the first Sacklers to ever face public questioning. All public relations were conducted under Purdue Pharmacy. Members of the Sackler family have continuously managed to dodge any prosecution by blaming other agencies such as the FDA.

To understand the origins of the opioid epidemic crisis you have to look at the Sackler family.

The Sacklers

The Sackler story started in 1952 when three psychiatrist brothers Raymond, Mortimer, and Arthur Sackler acquired a pharmaceutical company called Purdue.

Together they authored over one hundred papers on the biochemistry of mental illness. They then became advertising pioneers in pharmaceuticals by using their research papers as leverage.

Arthur Sackler made Valium the first drug to pass 100 million sales by inventing the idea of psychic tension in his advertising campaigns. Valium was strictly prescribed for anxiety at first, but Arthur’s marketing campaign promoted it as a treatment for a wide range of complaints. He managed to sell the drug to people who didn’t need it.

In the 1980s, Purdue Pharmaceutical released a morphine-based pill for use in hospice-based end-of-life care called MS Contin. This opioid helped people with end-stage cancer to sleep and relieve pain.

Addiction is not a problem with end-of-life care, but the company later introduced the pill onto the general market for pain relief. Unfortunately, MS Contin was the precursor to the medication that would lead to the opioid epidemic.

MS Contin became the go-to pain relief for advanced stage cancer patients in the US. Some research papers claimed that there was a minimal link between addiction and opioid painkillers and that any previous claims of their addictiveness were overstated.

The New England Journal of Medicine, for instance, stated that the chance of addiction was 1%. This claim was cited in over 600 medical journals.

Arthur’s nephew Richard started work at Purdue as a research scientist. He constantly searched for new ways to use MS Contin as he shared his uncle’s passion for commerce and marketing.

In 1999, Richard Sackler became the President of Purdue. It is reported that Richard Sackler was a micromanager who would send out bulletins with secret passwords which sales reps would have to give to his secretary to get the rest of the bulletin. It seems he was the driver of the company’s aggressive marketing aims.

From MS Contin to Oxycontin

During the 1990s, Purdue realized that the patent for MS Contin was due to expire. As morphine in end-of-life care had stigmatized connotations, they brought out Oxycontin with oxycodone as the active ingredient.

Doctors believed that oxycodone wasn’t as strong as morphine when it is 50% stronger than morphine.

In 1999, Purdue Pharma wrote a paper on oxycodone, which found that it had an addiction of 13% rather than 1% as they previously claimed.

The Federal Drug Administration had already endorsed the drug saying that its delayed absorption meant it was less addictive. Interestingly, when Purdue’s paper came out, the examiner from the FDA took a job from Purdue Pharma.

In 2015, Purdue was granted permission to market Oxycontin to children aged 6 and upwards.

When Purdue released Oxycontin, the numbers of opioid-addicted surged. But, Purdue simply blamed the people taking the drug for being morally bankrupt. The company also fired one of their secretaries for becoming addicted to Oxycontin.

Patients with chronic pain or pain after surgery are often prescribed opioid painkillers. Opioid painkillers work by blocking the pain neurotransmitters. These pills also provide a dopamine response which floods the brain with feel-good chemicals. By the time the opioids wore off, the person starts to feel withdrawals and feels the need to take more.

The Sacklers corrupted the supply chain of Oxycontin in the 1990s. They hired sales reps to convince doctors that the pills weren’t addictive. They even hired doctors to speak at educational conferences to convince pharmacists and doctors that opioid painkillers were not addictive like street opioids.

Purdue’s aggressive marketing campaign didn’t stop there.

Doctors were paid bonuses and sent on luxury holidays. The sales reps would target doctors who prescribed the most, never mind if they were prescribing more than the recommended dosage.

an image of opioids

Purdue’s Aggressive Marketing Strategy

Purdue started its marketing campaign in 1995. At first, the company focused its marketing campaign on cancer patients. The company aimed to get the drug widely accepted with regulatory bodies and to get the drug incorporated into medical programs.

Sales Reps

Sales reps were encouraged to lie about the addiction rates claiming that patients who were prescribed opioids by a doctor had less than a 1% chance of becoming addicted.

Bribery in the Supply Chain

Purdue also paid off every link in the supply chain. They offered doctors who prescribed Oxycontin full rebates, pharmacists, and distributors were offered refunds, and patients received coupons to get their first prescription free.

Academic institutions also received grants from Purdue. Medical journals received money if they advertised Oxycontin. The Sackler family and Purdue also gave money to politicians.

Most importantly was the doctors. Purdue would fly doctors in to attend seminars which were golfing weekends. Thousands of clinicians were paid to speak at seminars on behalf of Purdue to legitimize Oxycontin. Prominent well-respected doctors were paid to play down the addictive potential of Oxycontin.

Political Donations

Between 2006 and 2015, Purdue Pharma and other big pharma companies paid $900 million in political donations and lobbying.

Purdue lobbied to have doctors ask patients about their pain scores on a scale of 1 to 10 to give a quantifiable reason to prescribe Oxycontin. The reason was to make Oxycontin a legitimate drug for reasons other than cancer treatment.

The company even marketed the right of US citizens to have opioid medication if they felt they needed it.

Oxycontin Sales

By 2001, annual sales of Oxycontin passed $1 billion.

Between 1996 and 2001, the company went from 300,000 prescriptions in a year to 6 million. And studies showed a direct correlation between the rates of prescription and the rates of overdose.

Purdue targeted poor work areas where there would be a high rate of workplace injury.

The company also monitored the numbers of prescriptions written by Doctors to give them a better idea of which doctors to target.

The DEA started arresting doctors who prescribed unusually large amounts of Oxycontin to their patients without a legitimate reason. These practices are referred to as ‘pill mills.’

Some sales reps earned as much as six figures for Oxycontin sales. In 2001, Purdue paid out $40 million in bonuses.

By this time, Purdue was receiving considerable criticism. Their public image became worse when they controversially encouraged doctors to increase the dosage after complaints the pills didn’t last as long as advertised. Rather than instruct the doctors to increase frequency, the company encouraged the doctors to prescribe higher doses, making them more addictive.

As patients built up a tolerance to the higher dosage, they became more addicted to Oxycontin. Withdrawing from them produces terrible side-effects such as:
  • Anxiety, fear, depression
  • Restless legs
  • Sweating
  • Hot and cold sweats
  • Diarrhea
  • Stomach cramps
  • Pain
  • Vomiting

You could say this family is the biggest drug pusher in history. They actively marketed Oxycontin to the general public as non-addictive when they knew it was addictive. They knew what they were doing, but didn’t care because of the huge fortune they were making.

As a result, the Sacklers made billions of dollars while the opioid epidemic ravaged the US population.


Purdue has faced many class-action lawsuits. In many cases, the plaintiffs settled out of court for millions of dollars.

Purdue settled one case in 2004 for deceptive marketing for 10 million dollars. The problem with settling the case is it gets sealed for confidentiality, the company admits no wrongdoing, and makes no changes.

The company always manages to evade full prosecution by settling out of court at the last minute. In 200, Purdue was sued by the Federal Government for a criminal felony of purposefully deceiving patients about Oxycontin pills.

Purdue admitted that they knew about the Doctors’ misconceptions when they promoted Oxycontin. This particular settlement cost Purdue $600 million.

Interestingly, no Sackler family member names were included in any of the guilty pleas, but they did have an agreement attached. The family tried to distance themselves from the cases and tried to keep their identities hidden.

In March 2019, Purdue settled another lawsuit and agreed to pay $270 million to the state of Oklahoma. No Sackler family members had signed the agreement, although they did voluntarily offer $75 million to the National Center for Addiction Studies at Oklahoma State University.

Purdue is considering bankruptcy amongst hundreds of lawsuits from class-action lawsuits and local governments to protect their assets. Around 1600 lawsuits are being carried out across the US against Purdue.

Research shows that there is a high correlation between areas with high prescription rates and high overdose rates. 4 out of 5 people who are addicted to drugs start by taking prescription or non-prescription opioid painkillers.

Every year 214 million prescriptions for opioid painkillers are given to patients.

People from all sectors of society are becoming hooked on opioids. Sporty successful people who would never touch drugs recreationally started to become hooked on opioids after taking Oxycontin for pain. As they built up a tolerance, they needed more to satisfy their withdrawal symptoms.

As prescriptions for Oxycontin are hard to access and more expensive, people would turn to cheaper and stronger alternatives such as street heroin or fentanyl.

Art Philanthropy

The Sackler family is well-known for their generous donations to art galleries and museums. They’ve spent a large portion of their $14 billion net worth on universities, museums, and art galleries.

The Louvre Gallery in Paris has a Sackler wing. Westminster Abbey has a window named after them. They’re more than happy to have their name associated with prestigious awards, but they are not prepared to admit their role in the opioid crisis.

Over the past years a number of galleries and museums have begun to distance themselves from the Sackler family in reaction to their lack of responsibility.

Nan Goldin and the Pain Sackler Movement

Nan Goldin is the founder of the Pain Sackler movement which is fighting for justice for the crisis which is rapidly taking over the US population.

Goldin became addicted to opioid pain medication and after overdosing on fentanyl vowed to bring justice to the Sackler family.

Protesters have been calling for the cultural establishments that take donations from the Sacklers to remove their links with the family.

In February 2019, the Guggenheim Museum in New York who is a regular recipient of donations from the Sackler family was taken over by Nan and protestors. The protestors dropped hundreds of prescriptions bearing the Sackler name from the roof which floated down to the ground where protesters were laid down for a ‘die-in.

The Guggenheim Museum, the Louvre, the Tate Gallery, and the National Portrait Gallery have all decided to stop taking donations from the Sackler family in protest at the family’s links to the opioid epidemic crisis.

The Sackler family is partly responsible for the opioid epidemic but has made a multi-billion empire on the opioid painkiller Oxycontin.

By 2010, Purdue realized they needed to confront the issue, and created a new version of Oxycontin that couldn’t be crushed or snorted. A study found that a third of users switched to other drugs when the reformulation was introduced. Also, another 70% of Oxycontin users switched to heroin.

As the patent for Oxycontin was nearing its end, Purdue lobbied that no other manufacturer should be able to produce anything similar due to the widespread abuse. The FDA agreed with Purdue in 2013 and made them the sole manufacturer of this highly addictive medication.

This move only meant that Purdue monopolized the market as no other company can legally produce anything similar to Oxycontin.



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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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