The opioid epidemic: Is it only about the USA? (Part II)

The opioid crisis in the United States has killed more than 200,000 people. Behind this, the fingers point to the pharmaceutical giant Purdue Pharma

The Sacklers, a family that built an economic empire over pain

The opioid crisis in the United States has killed more than 200,000 people. Behind this, the fingers point to the pharmaceutical giant Purdue Pharma. The company has been involved in the marketing and distribution of opiates since the beginning of the crisis and has been accused, through various lawsuits, of deceptive practices.

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If you are an art lover and love to travel, you may have come across the name of the Sackler family on many occasions. The Smithsonian Museum in Washington houses the Arthur M. Sackler Gallery, while the Metropolitan Museum of Art in New York has a Sackler Wing. Even the Louvre,  showcases the Sackler Wing of Eastern Antiquities. There is a Sackler Museum at Harvard and a Sackler Center for Arts Education in the Guggenheim. These museums have recently been disassociating themselves from the Sackler family. It all started in March 2019, when the British National Portrait Gallery announced it would not accept a $1.3 million donation from the Sackler Trust. The Guggenheim Museum in New York and the Tate Museum in London have announced that they will not accept further Sackler donations.

According to Forbes, the Sacklers are now one of the richest families in America, with a collective net worth of US$ 13 billion. Most of the Sacklers' fortune has only been accumulated in recent decades, yet the source of their wealth is unknown to most people. Sacklers are interviewed regularly for their philanthropic actions, but they hardly ever talk about the family business, Purdue Pharma, a private company that developed the painkiller OxyContin. When it was released in 1995, OxyContin was presented as a sensational medical discovery that could help patients with chronic pain. The drug generated about $35 billion in revenue for Purdue.

But OxyContin is a controversial drug. Its active ingredient, oxycodone, is a close relative of heroine. Doctors have always been reluctant to prescribe strong opioids, except for cancer pain and end-of-life palliative care. Doctors have always feared the ability of these drugs to create addiction. Purdue launched OxyContin with a marketing campaign that sought to counter this attitude and change doctors' prescription habits. 

The company funded research and paid doctors to show that concerns about opioid addiction were excessive and that OxyContin could safely treat an ever-widening range of diseases. For millions of patients, the drug was the real solution to their pain. But many began to depend on it and, unable to afford prescription painkillers or unable to get them prescribed, began to seek heroin.

Purdue is being accused today of conducting dishonest marketing practices that saw patients prescribed with OxyContin, even if their ailment did not require the medication; even more astounding, it seems the company encouraged wrong dosage models to induce addiction in patients. 

In the United States, Purdue and three executives were fined over $600 million after pleading guilty in 2007 to mislabelling OxyContin and minimizing the drug’s addiction risk. Purdue and the Sacklers agreed this year to pay an additional $270 million to the state of Oklahoma to close a misleading marketing lawsuit that held the company responsible for triggering the US addiction epidemic.

The company has always vehemently defended itself, noting that the U.S. Food and Drug Administration had regularly approved OxyContin for chronic pain. Hundreds of cases are still pending against Purdue and other companies.

It would appear that the Sackler family has not limited its actions to the United States. According to the accusers, in fact, through Mundipharma they facilitated the use of opioids in other countries as well. Mundipharma, like Purdue, is owned by a network of trusts that include assets from the Sacklers. Mundipharma's network currently operates in more than 120 countries, including a few emerging markets. Their operations have expanded to Asia, Africa, and Latin America, selling an assortment of drugs that includes opioids. A 2016 article in the Los Angeles Times reported that Mundipharma was repeating some of Purdue's controversial marketing tactics abroad, prompting U.S. representative Katherine Clark and eleven other members of the US Congress to urge the World Health Organization to take action before other nations face an opiate outbreak.

In the United States, opioid recommendations for chronic pain are decreasing. In 2016, the Centers for Disease Control published guidelines that find no evidence that opiates are effective in the long term and that the risks far outweigh the benefits. In the same year, Mundipharma in Italy published the results of a study according to which almost half of Italians suffer from chronic pain.

The press release also offered a solution: opiate painkillers.

1. Galofaro C, D'Emilio F. Purdue foreign arm caught up in opioid probe in Europe. AP News. May 29 2019
2. Kelsey P. The Sackler family made their fortune in opioids - and museums are rejecting their donations. Vox. May 15 2019
3. Radden Keefe P. The family that built an empire of pain. The New Yorker. October 23 2017