According to the cynical old saw, apocryphally attributed to Joseph Stalin, a single death is a tragedy but a million deaths is a statistic.
I’ve been pondering that line lately, apropos the 183,000 deaths related to prescription opioid overdoses between 1999 and 2015- a figure sure to rise when 2016 data come out. A study published last week by economists Anne Case and Angus Deaton argues opioid overdoses help explain rising death rates for whites without a college education in the 21st century, when death rates for other demographic groups continue to fall.
Prescription opioid overdose deaths were rare before the 1990s, suggesting the current wave could have been avoided, and that one or more persons or institutions can and should be held accountable.
Who, exactly? I don’t know, but I know whose opinion on the subject I most want to hear: Dr. Richard Sackler’s.
Sackler is the scion of one of the wealthiest families in the world, whose collective assets, shared among 20 people, total $13 billion, according to Forbes magazine. Art museums and medical research institutions around the world bear the Sackler name in recognition of the family’s philanthropy.
Relevant to the opioid crisis, however, the source of the Sacklers’ fortune is their privately held firm, Purdue Pharma, maker of OxyContin, a potentially addictive painkiller that has earned an estimated $35 billion in revenue since it came on the market in 1995 – an event many consider the trigger of the opioid epidemic.
Purdue’s aggressive marketing tactics, akin to those pioneered for other drugs by Richard Sackler’s uncle, Arthur Sackler (who died in 1987), spurred OxyContin’s phenomenal sales growth around the turn of the 21st century.
They also got the company prosecuted by the Justice Department. In 2007, Purdue pleaded guilty, as a corporation, to a felony related to false marketing of the pills, and paid $635 million. Three top executives also accepted guilt and paid fines.
Neither Richard Sackler (nor any other family member) faced charges; evidence did not tie them to the misconduct, according to the Virginia U.S. attorney in the case, John Brownlee.
Sackler was, and apparently still is, a key figure at Purdue, however. He went into the family business in 1971 and over the next 33 years rose to “a series of positions of increasing responsibility, including direct management of both the Research and Development and the Sales and Marketing functions,” according to his published résumé. Sackler became president of Purdue in 1999, then co-chairman of the board in 2003.
Today, Purdue’s corporate website announces it’s “learning from the past while focusing on the future.”
In 2010, Purdue reformulated OxyContin so it is much more difficult for those seeking a high to convert the pills into inhalable or injectable forms. Perhaps not just coincidentally, OxyContin sales, though substantial, are declining. The company is at work on new products (such as a remedy for constipation caused by prolonged opioid use) and recently provided a $3 million grant to Virginia’s prescription drug-monitoring program.
Still, it’s hard to move on without some sort of public accounting, unmediated by lawyers or corporate executives, from the people who made so much money off these drugs.
The Sacklers, though, are publicity-shy, aside from putting their names on buildings and endowed chairs. A Purdue spokesman declined my request for an interview with Richard Sackler or any member of the company’s board, which includes his close relatives.
The closest thing to an accounting Sackler has given may be his 2015 sealed deposition in a lawsuit against Purdue by the opioid-ravaged state of Kentucky. Purdue settled out of court shortly after this sworn testimony, for $24 million, with no admission of wrongdoing. Now Purdue’s lawyers are fighting a state judge’s subsequent order to release Sackler’s deposition, and other internal Purdue records, at the request of StatNews, which covers health care.
A Kentucky appeals court could decide the matter soon. Perhaps Sen. Claire McCaskill, D-Mo., will have better luck producing documents. She has announced a wide-ranging investigation into the top five opioid manufacturers and their marketing practices.
To be sure, continuing opioid-related litigation against Purdue and other pharmaceutical companies would discourage individual owners and executives from addressing the crisis candidly outside of court, even if they wanted to. This may be a drawback of how the American system holds businesses, and others, accountable.
Also, no investigation of the crisis would be complete without examining the role of all the gatekeepers – the Food and Drug Administration, the Drug Enforcement Administration, state regulators and prescribing physicians – that were supposed to protect the public.
Which brings us back to the cynical old saw. If everyone is to blame, is no one to blame? Where does the buck stop for 183,000 lives avoidably lost?
I want Richard Sackler’s take on that – because we know where the bucks stopped.