The Daily - How the Opioid Crisis Started

Episode Date: July 5, 2018

Prosecutors, seeking to hold someone accountable for the opioid epidemic, have been targeting doctors, dealers and users themselves. But those who made billions of dollars from sales of OxyContin, a painkiller at the center of the crisis, have gone largely unpunished. Guest: Barry Meier, the author of “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic,” who has reported on Purdue Pharma and the opioid crisis for The New York Times. For more information on today’s episode, visit nytimes.com/thedaily.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today, in seeking accountability for the opioid epidemic, prosecutors have been targeting the bottom rung, users themselves. But the family who made billions off the sales of the painkiller at the center of the epidemic has gone largely unpunished.

It's Thursday, July 5th. There were three Sackler brothers. There was Arthur, Mortimer, and Raymond. They all grew up in New York City. They were from Brooklyn. Their parents were immigrants, and they all eventually went to medical school and were trained as research psychiatrists. Barry Meyer has reported on the origin of the opioid epidemic for The Times. Arthur, the older brother, even while he was in medical training, worked part-time as a copywriter in an advertising company that specialized in advertising prescription drugs.

And right around this time, which was not long after the end of World War II, the pharmaceutical industry itself was exploding. Companies were growing. They were producing more types of drugs, lots of different antibiotics, for example. And Arthur discovered he's got a real knack for this. One of the more infamous ads that he created was an ad for an antibiotic. And it was essentially a testimonial where you had doctors testifying about what a great drug it was. And subsequently, when people started checking on the whereabouts of these

doctors, they found out that these doctors didn't exist. He just made them up. He totally made them up. But it became sort of a hallmark. You know, this is the kind of stuff that Arthur Sackler did. Arthur is making a fortune from the advertising and marketing of drugs. But there's one area where he wants to make another fortune, and that is in the production and sale of drugs themselves. So he brings in his brothers, Mortimer and Raymond, and they purchase a company that becomes known as Purdue Pharma. And what does this company that they buy, Purdue Pharma, what does it actually sell? The first products they sell are basically a laxative. Then they move on to an earwax softener.

It's in the 1980s that they start selling their first real drug. It's a drug that is supposed to treat the most severe types of pain, like cancer pain, called MS-Contin. And essentially what it is, it's pure morphine in a tablet form. Barry, how did the company go from earwax remover to pure morphine? That's a huge leap. Well, the Sacklers were adept at catching moments. And the 1980s was one of them, particularly when it came to the treatment of pain.

For years, there had been resistance to the use of narcotics to treat pain, even for patients who were suffering from cancer or who were at the end of their lives. There was, you know, fears of addiction, that these patients would abuse the drug. A special documentary report on the topic of cancer pain. But by the 1980s, cancer patients sometimes suffer needless pain. They suffered not because pain relief is impossible, but because we are sometimes more focused on that elusive cure than on compassion. People wanted to be compassionate. People wanted to deal with this type of patient pain. And MS-Contin, which was a long-acting form of morphine that Purdue started producing, kind of arrived at this moment, and doctors embraced it as an effective way of treating patients at the

end of life. That compassionate approach to pain treatment soon jumped over the walls of the cancer wards into the mainstream of medicine. As advocates for greater narcotics use, began promoting the use of these drugs for all kinds of common pain, be it back pain, arthritis, dental pain, you name it, basically pointing back to the experience with cancer patients, saying, it was so successful here, why are we preventing patients from getting these kinds of drugs? And it would seem that Purdue Pharma would be well-positioned for that. They were perfectly positioned, because right around the time that this movement was making the transition from the cancer ward into the general breadbasket of medicine, they were developing a drug that would become the flagship drug of the pain management movement,

and that drug was called OxyContin. OxyContin was a nuclear weapon. It contained large amounts of a narcotic called Oxycodone, It contained large amounts of a narcotic called oxycodone, which is part of the opioid family of drugs, which also includes heroin and morphine. So it was a pure, powerful narcotic that was many, many times stronger than any pain reliever that had preceded it on the market.

any pain reliever that had preceded it on the market. It seems like it would be very hard to get such a powerful drug, the nuclear narcotic, as you've described it, past federal regulators. Well, Sackler's came up and Purdue came up with a brilliant strategy based on the nature of OxyContin itself. based on the nature of OxyContin itself. Traditional narcotic painkillers, drugs like Percocet and Vicodin, last for four hours. OxyContin lasts for 12 hours.

The contin in OxyContin stands for continuous. So OxyContin was essentially a long-acting version of a painkiller. And the concept that Purdue presented to the FDA was simply this. Because it was a long-acting narcotic, it would have less appeal to people who like to abuse painkillers because they like to get a quick hit from a drug. So they'd be looking for drugs like Percocet or Vicodin, which acted more quickly, and they could get their hit from it more immediately than they could from OxyContin. And in late 1995, the FDA approves OxyContin. And as part of that approval, they give Purdue a unique marketing claim that the regulators had never given to any pharmaceutical company before. And that is the claim that essentially says that OxyContin,

because it is a long-acting narcotic, is believed to pose less of a risk for abuse and addiction than traditional opioids. So Purdue creates this drug, OxyContin. The FDA approves it. And it gives the company this kind of soft, ambiguous claim that the drug is believed to be less addictive than other narcotics. And then what happens? Essentially, they take what is an equivocal claim and they turn it into an absolute claim.

We doctors were wrong in thinking that opioids can't be used long term. So they train their salespeople to go out to doctors and tell doctors that OxyContin will not cause abuse and addiction. We used to think they'd stop working or the patients would become addicts. That it's a totally unique drug, a safer drug, a better drug. We now find that these medicines are much safer, much more powerful, much more versatile than we used to think,

and we feel that they should be used much more liberally for people with all sorts of chronic pain. for people with all sorts of chronic pain. It goes out and begins holding seminars throughout the country, hundreds of seminars where it flies in doctors for essentially all-expense-paid junkets at resorts. I thought it would be nice to let you know what's going on in my specialty. As you know, I work in pain management. Where they're proselytized about the undertreatment of pain and the need to treat pain

more aggressively. We usually undertreat pain. We undertreat pain catastrophically. Very often, we don't even recognize it. Very often, we don't even acknowledge it. We refuse to acknowledge that the patient's hurting. Essentially, what Purdue is doing is taking what have become standard marketing techniques for everyday common drugs. You know, cholesterol-lowering drugs, diabetes drugs, erectile dysfunction drugs. And it is using these same techniques to promote a high-powered, addictive, narcotic painkiller. That had never been done in the history of the pharmaceutical industry before. So does this marketing blitz work? It works incredibly well.

Tiny Purdue has turned into a powerhouse. And sales of OxyContin are skyrocketing. By the late 1990s, it's bringing in over a billion dollars a year in sales. This one drug? This one drug. And this one drug is accounting virtually all of Purdue Pharma's revenues. And Barry, how do you become drawn into this story? At this time in 2001,

I had done a few stories about the drug industry, but I knew nothing about narcotic painkillers, drug addiction, and had never heard of Purdue Pharma or the Sacklers ever before. But on one day in 2001, an editor comes over to me and says that he's received a call from a source of his, a person who's working for a pharmacy board. And the story he relates is that there's this hot new drug on the street, this pharmaceutical that's being abused, that people are seeking, that's getting top dollar on the street.

And what makes the situation particularly extraordinary is that Purdue Pharma is going around promoting this drug, OxyContin, as less prone to abuse and addiction. So the editor says to me, well, why don't you start making phone calls and try to figure out what's going on here? And what did you hear when you started to make those calls? What I start finding out is that... It's known as Oxycontin, Oxy, or hillbilly heroin. All that was needed was to basically pop this drug in your mouth and the entire narcotic payload that was contained within OxyContin

would be available for your immediate use. Thefts of a drug some say can cause a high like heroin. And OxyContin is becoming the core and the leading edge of a crime wave. Prescription holders have been assaulted. Addicts have fake pain to get prescriptions. And around the country, there have been more than 700 pharmacy robberies like this one. According to police, he gives a note to the pharmacist telling them to hand over all their OxyContin. People are breaking into drugstores to steal OxyContin.

They're breaking into people's homes to steal OxyContin. They're breaking into people's homes to steal OxyContin. They're shoplifting things to get the money to buy OxyContin. It was being sold for, you know, $20, $40, $80 on the street for a tablet of OxyContin. For one pill. For one pill that you could get by prescription

for like a dollar or two. It becomes clear to me fairly soon, maybe after a few months of reporting, that the basic claims that are being made by Purdue are not accurate, that the science behind those claims doesn't exist, The science behind those claims doesn't exist. And what I'm starting to observe is the coming together of a huge public health crisis. We have a young lady that will not wake up. Is she breathing, sir?

No, sir. By the time emergency workers brought Shauna to the hospital, she was dead of an OxyContin overdose. About a hundred of the cases that we see every year now are Oxycodone deaths, and about half of those are OxyContin related deaths. But federal drug authorities are increasingly concerned about the dangerous, unsuspecting kids who take the pills as a party drug, having no idea what they're in for. We'll be right back. The next panel will be Dr. Paul Goldenheim, Executive Vice President for Research and Development of Regulatory and Medical Affairs, Purdue Pharma. In 2001, executives of Purdue Pharma are called before Congress for a series of hearings.

Thank you, Mr. Chairman. The article in yesterday's New York Times, now, there are papers and there are newspapers. This one has a pretty decent repetition for its analysis of issues. Are they wrong? Because they weren't exactly nice to your company at all. Which statement in particular were you referring to, sir? It's clear to everyone by now that the abuse of OxyContin is widespread. And one of the questions that lawmakers have is... The fact that your salesmen have been approached by pharmacists, for instance, and told that there was a problem. People understood it was all about making money and not necessarily about what the results were.

When did the company learn about the drugs abuse and what did it do about it when it learned that information? And what does the company say in response to that question? They draw a line in the sand. in response to that question? They draw a line in the sand. We launched OxyContin in 1996, and for the first four years on the market, we did not hear of any particular problem. And that is that they only became aware

of OxyContin's growing abuse in early 2000. In February of 2000, that was the first time we had any inclination that something different was going on that required special attention. And it's a line that they would stick to before Congress, in other public settings, in interviews with the news media. And does anything come of these congressional hearings? On the surface, it appears that that produced weather storm. Nothing has really happened to them. But in fact, in this tiny town called Abington, which is in very western Virginia, something has started to happen. Abington is the type of town, much like many towns in the Appalachian region, that's been hard hit by OxyContin.

The prosecutors in this town, every case that they're working on, has become involved with OxyContin. They're prosecuting doctors, they're prosecuting druggists, they're prosecuting drug abusers. And eventually, it strikes them that they ought to be looking at the drugs manufacturer. So they launch an investigation of Purdue. And what do these federal investigators, Barry, find as they're digging into Purdue?

Simply put, they find two things. The first thing that they find is that Purdue has engaged in systemic deception of doctors. They've trained their sales representatives to go out and tell aware of OxyContin's abuse in 1998, three years prior to their testimony, and that effectively they covered up their knowledge. So what do these investigators do with these very damning findings? They prepare a report, and within that report are their recommendations for indictments, you know, criminal charges that are going to be brought. And those recommendations include felony indictments against Purdue Pharma for defrauding

the United States government, and felony charges against the company's three top operating executives for their roles in that conspiracy to defraud the government and other charges, including making false statements, lying to Congress, etc. So very, very serious charges for which these executives could be sent to prison for any number of years. And these recommendations for charges are now forwarded to the Justice Department. And it appears that it's all set to go until the 11th hour. What happened in the 11th hour? So there's an 11th hour meeting between top political appointees within the Justice Department and an all-star defense team that Purdue has assembled.

And that defense team itself is being advised by Rudy Giuliani. meeting is over and the door opens up, it becomes clear to the people who had hoped to bring this indictment that they're not going to be able to do it. So whatever happened in this meeting resulted in the Department of Justice telling the investigators that these charges were not going to be brought against Purdue and its executives. Yes, the message from the Justice Department was you're going to have to plea bargain and see if you can bring a misdemeanor case or bring lower charges against them because we're not going to support a felony charge. Essentially, the message was back off.

Essentially, yeah, the message was, back off. Essentially, yeah. The message was, this is not going to happen. We're not going down this road. And so a plea bargain is struck. The company itself pled guilty to a charge that it had misrepresented what the FDA had allowed it to say about OxyContin's potential for abuse and addiction and paid a $600 million fine. The executives were allowed to plead guilty to misdemeanor charges. And the executives would claim both before they pled guilty to these misdemeanors

that they did nothing wrong and essentially afterwards would continue to claim that they had done nothing wrong and that effectively the government had not accused them of doing anything wrong. And perhaps the most remarkable part about the resolution of the case in 2007 was the fact that because the indictments never went forward, all the work that prosecutors had put into compiling their report, all the evidence that they had gathered from Purdue's files, all the testimony that they had gotten from former company execs during grand jury proceedings, got buried. Buried how?

Well, essentially, it was protected because it was grand jury information. The report itself was effectively sealed and buried in Justice Department files, never publicly released. Someone who was upset that this information had been buried, that the Justice Department had not gone forward with the prosecution, provided me with a copy very recently. Hmm. provided me with a copy very recently. Hmm.

I sat down and I read it, and I was both stunned and heart-sickened by it. So what I found was emails of conversations between top Purdue officials discussing the abuse of OxyContin. What was in the report were recitations of documents that were shared between Purdue executives and members of the Sackler family about the abuse of OxyContin. For example, they were monitoring websites, you know, internet chat rooms that were frequented by drug abusers where they were discussing, hey, this is this great new drug. You can crush it. You can snort it. Reports about that were being sent to Richard Sackler, the son of Raymond Sackler, founder of Purdue Pharma. There was this wealth of evidence suggesting that Purdue executives had in fact known about the drug's abuse.

And I found it just startling. And not only the Sacklers knew and not only the executives knew from this evidence, it seems, but we know the Justice Department knew for more than a decade because it had been in possession of this report. And yet, the Justice Department decided, essentially, to do nothing. The Justice Department had an opportunity to sound an alarm bell. And all that would have been required was to have gone forward with these recommendations. And what prosecutors believe is that had they told the truth, this entire marketing campaign, the foundation of OxyContin's marketing campaign would have crumbled.

OxyContin would have been just a niche drug. It would have been a nothing drug. It would have been just another narcotic painkiller. But by concealing this information, sales continued to grow and grow and grow, and OxyContin became a blockbuster. So a decade later, at another moment, the crisis is now the biggest public health epidemic that we're facing. And we're lashing out at it in various ways. President Trump recently announced that he favors the execution of drug dealers. Attorney General Sessions is calling for a crackdown on doctors and druggists. Some local prosecutors are arresting people found in the same room with people who have overdosed on murder charges, prosecuting them for sharing drugs.

But we have yet to hold corporate executives to account. If we are going to treat street-level drug dealers as criminals, we have to treat corporate executives who knowingly break the law as criminals as well. Barry, thank you very much. Michael, it's been a real pleasure. In June, the Attorney General of Massachusetts filed the first lawsuit against current and former executives of Purdue Pharma, including members of the Sackler family. members of the Sackler family. A week later, Purdue Pharma laid off the sales force responsible for marketing OxyContin.

And this week, two members of Congress demanded the release of the sealed report documenting Purdue's deceptive practices and all communication between the Justice Department and the company related to the last-minute plea deal. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.