Tessa Dunlop with Edna, 102. Photograph: Laura Pannack for the Guardian
Edna lives just off the M4 in a tiny brick bungalow with a wheelchair ramp. I crawled to her front door. I didn’t knock; I went straight in and put my head on her knee, pushing the Zimmer frame out of the way. And I cried, and she was still and kind and said: “I think you will always miss him. You lost your son, dear.”
On the way to Edna’s I’d had to pull the car over so the animal in me could thrash the air and grope for my dead baby – a primal scream against the loss, the regret and the pain of it all. The burden shifted marginally, briefly almost felt manageable, when I arrived at her house.
Edna is a 102-year-old widowed former servant. She is one of six centenarian women I got to know while working on a book. Now extremely old, most sit back on life, observing and listening, a wealth of female experience folded up inside their frail bodies. As a 42-year-old writer and (occasional) TV presenter, with a nine-year-old daughter and a husband, I had presumed I would be the one looking after them. But they ended up looking after me.
Loyal Edna had been watching me on Coast. “I saw you the other night,” she said. “I wondered if that was the one you were pregnant in.”
There I was, on cloud nine (a pretty trippy place, as it happens), beaming at the camera and talking about a special bit of British coastline before vomiting over the side of an inflatable dinghy. Me, the girl (woman, rather) who at 41 had won the lottery of life and got a longed-for bun in the oven thanks to IVF.
Edna knew all this. She knew everything, because the first time we were due to meet, eight months earlier (on New Year’s Eve 2015) in the Wiltshire village of Wroughton, I had to stand her up. I was having an 11-week miscarriage (also following IVF).
“Well, dear, that is sad news,” she told me back then. “You must take good care of yourself. I shall look forward to seeing you when you feel better.”
I was grateful for Edna’s reassurance and sympathy. I meant it when I told her I was sorry not to be there.
It was two more months before we could meet in person. I sat on her faded carpet for the first time and heard about life as a live-in servant at the age of 14 (there was little hope of anything better after her dad died when Edna was four). “You see, I didn’t like being in service. I was owned, really.”
I thought of my own childhood in the 70s and 80s. My mother, arms akimbo, standing on the landing, staring down at her defiant daughter and telling me: “Darling, the world is your oyster. You can do whatever you like!” I grew up energised by the rash of possibilities that were finally available to young women. Edna shook her head: such bravado and self-belief were unimaginable.
“No, I never had any children. I wasn’t married in time and you couldn’t have children if you weren’t married.” She leaned over and touched my knee. “Are you feeling better? I’ve been crossing all my fingers and toes ever since your sad news.” So I told her that I did feel better after the miscarriage and that I was ready to try again. To my surprise, Edna nodded. She grew up without choice, but she did not begrudge me mine. “Well, I shall keep praying for you.”
Whether it was the power of Edna’s prayers or a sheer fluke (I suspect the latter), the second round of IVF worked. The 12-week scan was surely one of the best days of my life.
“Oooh, how lovely, dear. I am pleased.” I could tell she really was.
Now, two months later, my head was on Edna’s knee and I was crying. My baby had died of listeriosis, a rare infection caused by bacteria called listeria. I had eaten something I shouldn’t have. Grief was leaking out of me.
Edna sat and listened, her calm buffering my pain. Then she told me about one of her few living relatives, a niece. “Oh, I love Carolyn. She was an only child, you know. My brother and his wife had a terrible time trying for another.” I tried to imagine having a late miscarriage 70 years ago. If things go wrong, mother nature gets ugly. “Oh, back then people died at any age. Yes, there was a lot of death.”
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I visited Edna a lot after the baby died (and 101-year-old Helena, in Brecon, who told me: “I was one of eight. My mother had at least one miscarriage and lost a child. It’s very hard to lose a child at any age”).
When they told me in the hospital that they couldn’t find a heartbeat, I heard myself say, “But I have a book to write.” I knew the small dead person in my stomach would be hard to come back from. For months it felt impossible.
I rang Ann, 103, in Richmond upon Thames to explain I was in hospital and not in her house, as I should have been. We met while I was still pudgy and sad. Ann, a discreet woman, proved harder to reach than Edna and Helena, but it was worth the wait. A talented art publisher, she married late. I wondered if it was difficult being single in the baby-boomer 50s.
“Yes, it could be painful. But that was my private concern.”
She has been a widow for over 30 years, coping daily with a giant loss of her own, but Ann didn’t dismiss my pain; instead she addressed it head-on. “I know no rational discussion helps,” she wrote to me in her handsome hand. “Rationality just doesn’t apply.” She then gently nudged me in the right direction. “I had a friend; we found when life gave us knocks or when disappointment hit us, she restored and sustained herself by learning something new, and I by making something new. Worth a try?” I kept the letter in my bag for weeks, smoothing it out and marvelling at its perfect pitch. How different from so many jarring “consolation” comments. “You’re lucky to have your daughter.” “It just wasn’t meant to be.” “Why did you leave it so long?”
Olive, 102, came from British Guiana in 1952; by 1953 she had miscarried twins alone in a London boarding house. When she heard my news, she called me and wailed. She relived her pain and in doing so relieved mine.
Mid-war, Phyllis, then 23, gave birth to a baby who died after a few days. She was miles from her Indian home, living with unforgiving new Presbyterian in-laws in Edinburgh. “Ach, you had to thole it. It’s an old Scottish word. I had to be tough, tough.” She still is. I made a mental note that I wanted to be more like 100-year-old Phyllis.
A classicist and honorary fellow of Newnham College Cambridge, 99-year-old Joyce never had a husband. “In those days if you got married you had to give up your job, and I didn’t want to do that.” She grew up in a world where girls knew they couldn’t have everything. But, having worked with students most of her life, she is not naive about the challenges that women face today. Like Ann, Joyce is a letter writer. “I am so sorry,” she wrote to me, “and can only say when I have had troubles (nothing like yours, though), I have always found that it helped to get back to work – starting with an hour a day and building up to eight or, eventually, 10.”
Throughout 2017 I rolled the dice a few more times, hoping for fertility’s equivalent of a double six. I visited all of the women frequently during that year, sometimes on IVF drugs, sometimes masking my disappointment. Occasionally, I cried. The visits were high points in my calendar. Two years after that first call to Edna, I was back where I began, sitting on her floor in Wroughton, reading extracts from the book I’d written about these women. During a chapter featuring babies I looked up and told Edna that I wouldn’t be doing any more IVF. I was OK now – the sadness had tucked itself up; at last it felt smaller and more manageable. And I thanked her for being a friend and for never saying the wrong thing. “That’s right, dear,” she said. “You’ll always miss him a little bit, but you can’t worry about what you don’t have in life.”
The Century Girls by Tessa Dunlop is published by Simon & Schuster on 22 February, £20.
Articles from boingboing.net, AlterNet, Esquire, the New Yorker and the Guardian
'As far back as the early 1960’s, staffers for Tennessee Senator Estes Kefauver prepared a memo for a subcommittee he chaired that was looking into the rapidly growing pharmaceutical industry. “The Sackler empire is a completely integrated operation in that it can devise a new drug in its drug development enterprise, have the drug clinically tested and secure favorable reports on the drug from various hospitals with which they have connections, conceive the advertising approach and prepare the actual advertising copy with which to promote the drug, have the clinical articles as well as advertising copy published in their own medical journals, [and] prepare and plant articles in newspapers and magazines.”' https://www.alternet.org/education/notorious-family-contributing-opioid-crisis-and-funding-charter-schools
The Super Wealthy Oxycontin Family Supports School Privatization With Tactics Similar to Those That Fueled the Opioid Epidemic
A fortune derived from the relentless marketing of painkillers is now being used to expand charter schools.
Figuring out who is funding the latest charter school-promoting front group often feels like a game of whack-a-mole. That's why reading Patrick Radden Keefe’s recent New Yorker piece, “The Family That Built an Empire of Pain,” made so much fall into place. Keefe writes, “Purdue and other pharmaceutical companies have long funded ostensibly neutral nonprofit groups that advocate for pain patients.”
The same influence techniques Purdue used to promote painkillers are now being used by Jonathan Sackler to expand charter schools.
Promotional power
The late Arthur Sackler, the eldest of three brothers who bought the company in 1952, was posthumously inducted into the Medical Advertising Hall of Fame, and cited for his achievement in “bringing the full power of advertising and promotion to pharmaceutical marketing.” Yet Allen Frances, former chair of psychiatry at Duke University School of Medicine, quoted in theNew Yorkerpiece, highlighted the darker side of that power: “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.” As a copywriter at a medical advertising agency, Arthur Sackler devised strategies to promote drugs like Librium and Valium. Now, some of those same strategies are now being used with the aim of promoting charter schools.
Jonathan Sackler, Arthur’s nephew, is a well-known name in the education reform movement. He founded the charter school advocacy group ConnCan, progenitor of the nationwide group 50CAN, of which he is a director. He is on the Board of Directors of the Achievement First charter school network. Until recently, Sackler served on the board of the New Schools Venture Fund, which invests in charter schools and advocates for their expansion. He was also on the board of the pro-charter advocacy group Students for Education Reform.
Through his personal charity, the Bouncer Foundation, Sackler donates to the abovementioned organizations, and an ecosystem of other charter school promoting entities, such as Families for Excellent Schools ($1,083,333 in 2014, $300,000 in 2015 according to the Foundation’s Form 990s) Northeast Charter School Network ($150,000 per year in 2013, 2014 and 2015) and $275,000 to Education Reform Now (2015) and $200,000 (2015) to the Partnership for Educational Justice, the group founded by Campbell Brown which uses “impact litigation” to go after teacher tenure laws. Earlier this year, the Partnership for Educational Justice joined 50CAN, which Sackler also funds ($300,000 in 2014 and 2015), giving him a leadership role in the controversial—and so far failing cause—of weakening worker protections for teachers via the courts.
Just as Arthur Sackler founded the weekly Medical Tribune, to promote Purdue products to the medical professional who would prescribe them, Jon Sackler helps to fund the74million.org, the “nonpartisan” education news website founded by Campbell Brown. The site, which received startup funding from Betsy DeVos, decries the fact that “the education debate is dominated by misinformation and political spin,” yet is uniformly upbeat about charter schools while remarkably devoid of anything positive to say about district schools or teachers unions.
Vertical integration
The Sackler “special sauce” is vertical integration. As far back as the early 1960’s, staffers for Tennessee Senator Estes Kefauver prepared a memo for a subcommittee he chaired that was looking into the rapidly growing pharmaceutical industry.
“The Sackler empire is a completely integrated operation in that it can devise a new drug in its drug development enterprise, have the drug clinically tested and secure favorable reports on the drug from various hospitals with which they have connections, conceive the advertising approach and prepare the actual advertising copy with which to promote the drug, have the clinical articles as well as advertising copy published in their own medical journals, [and] prepare and plant articles in newspapers and magazines.”
This was used to great effect in promoting OxyContin. Art Van Zee MD looked at the Marketing and Promotion of OxyContin and found that in 2001 alone, the company spent over $200 million to market and promote the drug through a variety of methods. In the settlement in the US District Court of Western Virginia, the company admitted to misbranding the drug with the intent to defraud and mislead the public.
The company was lavish with branded swag for health care practitioners. According to a GAO report, these included, “OxyContin fishing hats, stuffed plush toys, coffee mugs with heat-activated messages, music compact discs, luggage tags, and pens containing a pullout conversion chart showing physicians how to calculate the dosage to convert a patient to OxyContin from other opioid pain relievers.”
The GAO report went on to quote the DEA as saying the Purdue’s use of branded promotional items in the marketing of OxyContin was “was unprecedented among schedule II opioids, and was an indicator of Purdue's aggressive and inappropriate marketing of OxyContin.”
The description of “lavish swag” will sound familiar to anyone who has witnessed one of the no-expenses-spared charter school rallies that are a specialty of Sackler-funded organizations like Families for Excellent schools. Then there is the dizzying array of astroturf front groups all created for the purpose of demanding more charter schools. Just in Connecticut, we’ve had the Coalition for Every Child, A Better Connecticut, Fight for Fairness CT, Excel Bridgeport, and the Real Reform Now Network. All of these groups ostensibly claim to be fighting for better public schools for all children. In reality, they have been lobbying to promote charter schools, often running afoul of ethics laws in the process.
Take Families for Excellent Schools, a “grassroots” group that claims to be about parent engagement, yet was founded by major Wall Street players. In Connecticut, the group failed to register its Coalition for Every Child as a lobbying entity and report a multimillion-dollar ad buy expenditure and the costs of a rally in New Haven.
In Massachusetts, Families for Excellent Schools-Advocacy (FESA) recently had to cough up more than $425,000 to the Massachusetts general fund as part of a legal settlement with the Office of Campaign and Political Finance, the largest civil forfeiture in the agency’s 44-year history. Massachusetts officials concluded that FESA violated the campaign finance law by receiving contributions from individuals and then contributing those funds to the Great Schools Massachusetts Ballot Question Committee, which sought to lift the cap on the number of charter schools in the state, in a manner intended to disguise the true source of the money. As part of the settlement, the group was ordered to reveal the names of its secret donors. Jonathan Sackler was one of them.
Patrick Riccards, a former CEO of ConnCan, the pro-charter group that Sackler founded in 2005, told me, “Jon went to Berkeley and in many ways fits into that idealistic mold. But at the same time it was he who made it clear to me that one of the reasons ConnCan existed was to leverage the investment in the charter community, in Achievement First, which is still the dominant charter school network in the state. [CT] The venture capital community ... has put tons of money into seeing Achievement First grow, first in Connecticut, then in New York, then in Rhode Island.”
It’s all part of the model, concluded Riccards. “While you have a public vision of great public schools for all, ConnCan’s focus was: how does the charter industry continue to grow? Every year, ConnCan’s fight was how do we increase the number of seats, and how do we increase the per pupil expenditure?”
Staggering toll
OxyContin was approved for use in treating moderate to severe pain in 1995. Purdue was determined to make the drug a hit, and funded doctors like Russell Portenoy, who said in a 1993 interview with the New York Times: "There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem.”
Except that the literature was based on short-term usage, not on long-acting opioids taken over extended periods of time. By 2003, Portenoy admitted to the Times that he had misgivings about how he and other pain specialists had used the research. Although he had not intended to mischaracterize it or to mislead fellow doctors, he had tried to counter claims that overplayed the risk of addiction. But if not for such mischaracterizations, the Sacklers wouldn’t be as wealthy, and America might not be suffering from a public health crisis that is costing the country an estimated $78.5 billion a year.
Even as the scope and scale of the opioid epidemic unfolds, the fortune OxyContin built continues to grow. In the case of OxyContin heir Jonathan Sackler, part of that fortune is being devoted to expanding charter schools and weakening protections for teachers in traditional public schools. Patrick Keefe’s New Yorker feature ends with a stunning statistic: “An addicted baby is now born every half hour.” He asks whether such devastation should give pause to organizations that benefit from the Sacklers' extensive philanthropy. In the case of the charter schools and education reform advocacy groups that Jonathan Sackler funds, the answer to that question should be obvious.
Sarah Darer Littman is the author of middle-grade and young adult novels, and has previously written for Hearst Newspapers and CTNewsJunkie.com. She teaches writing in the MFA program at Western CT State University and at the Yale Summer Writers’ Workshop. Follow her on Twitter @realsamerica.
The Sackler Family: best known for philanthropy, they made billions promoting Oxycontin
Purdue cynically created the American opiod epidemic through a combination of bribing medical professionals to overprescribe Oxycontin, publishing junk science, and aggressively lobbying regulators at every level to turn a blind eye to the destruction of the lives of millions of patient; while the company settled a record-setting criminal case, the name of the secretive family of billionaires who run Purdue and profited from the Oxy epidemic is best known for philanthropy, not profiteering: the Sackler family.
The Sacklers directly managed and oversaw the development and sale of Oxycontin, including an aggressive campaign to expand the kinds of pathologies that would be treated with the powerfully addictive painkillers. The company admitted that it knew that doctors harbored incorrect beliefs about the strength and addictiveness of its products and that they traded on this because it was making them billions.
Princeton economist Alan Krueger believes that one in five Americans who no longer participates in the labor force does so because of addiction to Oxtcontin.
The Sackler family are prominent philanthropists whose donations have bought them naming rights at some of the world's great museums, galleries and universities. But for all that name recognition, the source of their fortune is largely unknown -- according to the director of Yale's Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, "neither students nor faculty have ever brought up the OxyContin connection."
The deliberate strategy of profiting through abuse of OxyContin is not behind the Sacklers. Today, Mundipharma -- also owned and controlled by the Sacklers -- is pursuing overseas markets for Oxycontin using the same playbook that devastated America. Campaigns in overseas territories seek to convince doctors and patients that many conditions should be treated with the long-term use of powerful, addictive opiods, despite the clinical evidence that this is both ineffective and dangerous.
Both the World Health Organization and a bipartisan Congressional coalition have issued warnings about Mundipharma's plans, warning other countries' governments that they face grave problems if the Sacklers are allowed to re-run their American addiction project in other nations.
In May, a dozen lawmakers in Congress, inspired by the L.A. Times investigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.
THE SECRETIVE FAMILY MAKING BILLIONS FROM THE OPIOID CRISIS
You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?
BY CHRISTOPHER GLAZEK
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, she silently mouthed, “Wow.”
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.
The Sackler name is no less prominent among the emerald quads of higher education, where it’s possible to receive degrees from Sackler schools, participate in Sackler colloquiums, take courses from professors with endowed Sackler chairs, and attend annual Sackler lectures on topics such as theoretical astrophysics and human rights. The Sackler Institute for Nutrition Science supports research on obesity and micronutrient deficiencies. Meanwhile, the Sackler institutes at Cornell, Columbia, McGill, Edinburgh, Glasgow, Sussex, and King’s College London tackle psychobiology, with an emphasis on early childhood development.
The Sacklers’ philanthropy differs from that of civic populists like Andrew Carnegie, who built hundreds of libraries in small towns, and Bill Gates, whose foundation ministers to global masses. Instead, the family has donated its fortune to blue-chip brands, braiding the family name into the patronage network of the world’s most prestigious, well-endowed institutions. The Sackler name is everywhere, evoking automatic reverence; the Sacklers themselves, however, are rarely seen.
In 1974, when the Sackler brothers made a large gift to the Met—$3.5 million, to erect the Temple of Dendur—they stipulated that all museum signage, catalog entries, and bulletins referring to objects in the newly opened Sackler Wing had to include the names of all three brothers, each followed by “M.D.”
The descendants of Mortimer and Raymond Sackler, a pair of psychiatrist brothers from Brooklyn, are members of a billionaire clan with homes scattered across Connecticut, London, Utah, Gstaad, the Hamptons, and, especially, New York City. It was not until 2015 that they were noticed by Forbes, which added them to the list of America’s richest families. The magazine pegged their wealth, shared among twenty heirs, at a conservative $14 billion. (Descendants of Arthur Sackler, Mortimer and Raymond’s older brother, split off decades ago and are mere multi-millionaires.) To a remarkable degree, those who share in the billions appear to have abided by an oath of omertà : Never comment publicly on the source of the family’s wealth.
That may be because the greatest part of that $14 billion fortune tallied by Forbes came from OxyContin, the narcotic painkiller regarded by many public-health experts as among the most dangerous products ever sold on a mass scale. Since 1996, when the drug was brought to market by Purdue Pharma, the American branch of the Sacklers’ pharmaceutical empire, more than two hundred thousand people in the United States have died from overdoses of OxyContin and other prescription painkillers. Thousands more have died after starting on a prescription opioid and then switching to a drug with a cheaper street price, such as heroin. Not all of these deaths are related to OxyContin—dozens of other painkillers, including generics, have flooded the market in the past thirty years. Nevertheless, Purdue Pharma was the first to achieve a dominant share of the market for long-acting opioids, accounting for more than half of prescriptions by 2001.
According to the Centers for Disease Control, fifty-three thousand Americans died from opioid overdoses in 2016, more than the thirty-six thousand who died in car crashes in 2015 or the thirty-five thousand who died from gun violence that year. This past July, Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, led by New Jersey governor Chris Christie, declared that opioids were killing 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. Tobacco remains, by a significant multiple, the country’s most lethal product, responsible for some 480,000 deaths per year. But although billions have been made from tobacco, cars, and firearms, it’s not clear that any of those enterprises has generated a family fortune from a single product that approaches the Sacklers’ haul from OxyContin.
Even so, hardly anyone associates the Sackler name with their company’s lone blockbuster drug. “The Fords, Hewletts, Packards, Johnsons—all those families put their name on their product because they were proud,” said Keith Humphreys, a professor of psychiatry at Stanford University School of Medicine who has written extensively about the opioid crisis. “The Sacklers have hidden their connection to their product. They don’t call it ‘Sackler Pharma.’ They don’t call their pills ‘Sackler pills.’ And when they’re questioned, they say, ‘Well, it’s a privately held firm, we’re a family, we like to keep our privacy, you understand.’
THE FAMILY’S LEADERS HAVE PULLED OFF THREE OF THE GREAT MARKETING TRIUMPHS OF THE MODERN ERA: THE FIRST IS SELLING OXYCONTIN; THE SECOND IS PROMOTING THE SACKLER NAME; AND THE THIRD IS ENSURING THAT, AS FAR AS THE PUBLIC IS AWARE, THE FIRST AND THE SECOND HAVE NOTHING TO DO WITH ONE ANOTHER.
To the extent that the Sacklers have cultivated a reputation, it’s for being earnest healers, judicious stewards of scientific progress, and connoisseurs of old and beautiful things. Few are aware that during the crucial period of OxyContin’s development and promotion, Sackler family members actively led Purdue’s day-to-day affairs, filling the majority of its board slots and supplying top executives. By any assessment, the family’s leaders have pulled off three of the great marketing triumphs of the modern era: The first is selling OxyContin; the second is promoting the Sackler name; and the third is ensuring that, as far as the public is aware, the first and the second have nothing to do with one another.
If you head north on I-95 through Stamford, Connecticut, you will spot, on the left, a giant misshapen glass cube. Along the building’s top edge, white lettering spells out ONE STAMFORD FORUM. No markings visible from the highway indicate the presence of the building’s owner and chief occupant, Purdue Pharma.
Originally known as Purdue Frederick, the first iteration of the company was founded in 1892 on New York’s Lower East Side as a peddler of patent medicines. For decades, it sustained itself with sales of Gray’s Glycerine Tonic, a sherry-based liquid of “broad application” marketed as a remedy for everything from anemia to tuberculosis. The company was purchased in 1952 by Arthur Sackler, thirty-nine, and was run by his brothers, Mortimer, thirty- six, and Raymond, thirty-two. The Sackler brothers came from a family of Jewish immigrants in Flatbush, Brooklyn. Arthur was a headstrong and ambitious provider, setting the tone—and often choosing the path—for his younger brothers. After attending medical school on Arthur’s dime, Mortimer and Raymond followed him to jobs at the Creedmoor psychiatric hospital in Queens. There, they coauthored more than one hundred studies on the biochemical roots of mental illness. The brothers’ research was promising—they were among the first to identify a link between psychosis and the hormone cortisone—but their findings were mostly ignored by their professional peers, who, in keeping with the era, favored a Freudian model of mental illness.
Concurrent with his psychiatric work, Arthur Sackler made his name in pharmaceutical advertising, which at the time consisted almost exclusively of pitches from so-called “detail men” who sold drugs to doctors door-to-door. Arthur intuited that print ads in medical journals could have a revolutionary effect on pharmaceutical sales, especially given the excitement surrounding the “miracle drugs” of the 1950s—steroids, antibiotics, antihistamines, and psychotropics. In 1952, the same year that he and his brothers acquired Purdue, Arthur became the first adman to convince The Journal of the American Medical Association, one of the profession’s most august publications, to include a color advertorial brochure.
In the 1960s, Arthur was contracted by Roche to develop an advertising strategy for a new antianxiety medication called Valium. This posed a challenge, because the effects of the medication were nearly indistinguishable from those of Librium, another Roche tranquilizer that was already on the market. Arthur differentiated Valium by audaciously inflating its range of indications. Whereas Librium was sold as a treatment for garden- variety anxiety, 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.
As Arthur’s fortune grew, he turned his acquisitive instincts to the art market, quickly amassing the world’s largest private collection of ancient Chinese artifacts. According to a memoir by Marietta Lutze, his second wife, collecting, exhibiting, owning, and donating art fed Arthur’s “driving necessity for prestige and recognition.” Rewarding at first, collecting soon became a mania that took over his life. “Boxes of artifacts of tremendous value piled up in numerous storage locations,” she wrote, “there was too much to open, too much to appreciate; some objects known only by a packing list.” Under an avalanche of “ritual bronzes and weapons, mirrors and ceramics, inscribed bones and archaic jades,” their lives were “often in chaos.” “Addiction is a curse,” Lutze noted, “be it drugs, women, or collecting.”
When Arthur donated his art and money to museums, he often imposed onerous terms. According to a memoir written by Thomas Hoving, the Met director from 1967 to 1977, when Arthur established the Sackler Gallery at the Metropolitan Museum of Art to house Chinese antiquities, in 1963, he required the museum to collaborate on a byzantine tax-avoidance maneuver. In accordance with the scheme, the museum first sold Arthur a large quantity of ancient artifacts at the deflated 1920s prices for which they had originally been acquired. Arthur then donated back the artifacts at 1960s prices, in the process taking a tax deduction so hefty that it likely exceeded the value of his initial donation. Three years later, in connection with another donation, Arthur negotiated an even more unusual arrangement. This time, the Met opened a secret chamber above the museum’s auditorium to provide Arthur with free storage for some five thousand objects from his private collection, relieving him of the substantial burden of fire protection and other insurance costs. (In an email exchange, Jillian Sackler, Arthur’s third wife, called Hoving’s tax-deduction story “fake news.” She also noted that New York’s attorney general conducted an investigation into Arthur’s dealings with the Met and cleared him of wrongdoing.)
In 1974, when Arthur and his brothers made a large gift to the Met—$3.5 million, to erect the Temple of Dendur—they stipulated that all museum signage, catalog entries, and bulletins referring to objects in the newly opened Sackler Wing had to include the names of all three brothers, each followed by “M.D.” (One museum official quipped, “All that was missing was a note of their office hours.”)
Hoving said that the Met hoped that Arthur would eventually donate his collection to the museum, but over time Arthur grew disgruntled over a series of rankling slights. For one, the Temple of Dendur was being rented out for parties, including a dinner for the designer Valentino, which Arthur called “disgusting.” According to Met chronicler Michael Gross, he was also denied that coveted ticket of arrival, a board seat. (Jillian Sackler said it was Arthur who rejected the board seat, after repeated offers by the museum.) In 1982, in a bad breakup with the Met, Arthur donated the best parts of his collection, plus $4 million, to the Smithsonian in Washington, D. C.
Arthur's younger brothers, Mortimer and Raymond, looked so much alike that when they worked together at Creedmoor, they fooled the staff by pretending to be one another. Their physical similarities did not extend to their personalities, however. Tage Honore, Purdue’s vice-president of discovery of research from 2000 to 2005, described them as “like day and night.” Mortimer, said Honore, was “extroverted—a ‘world man,’ I would call it.” He acquired a reputation as a big-spending, transatlantic playboy, living most of the year in opulent homes in England, Switzerland, and France. (In 1974, he renounced his U. S. citizenship to become a citizen of Austria, which infuriated his patriotic older brother.) Like Arthur, Mortimer became a major museum donor and married three wives over the course of his life.
Mortimer had his own feuds with the Met. On his seventieth birthday, in 1986, the museum agreed to make the Temple of Dendur available to him for a party but refused to allow him to redecorate the ancient shrine: Together with other improvements, Mortimer and his interior designer, flown in from Europe, had hoped to spiff up the temple by adding extra pillars. Also galling to Mortimer was the sale of naming rights for one of the Sackler Wing’s balconies to a donor from Japan. “They sold it twice,” Mortimer fumed to a reporter from New York magazine. Raymond, the youngest brother, cut a different figure—“a family man,” said Honore. Kind and mild-mannered, he stayed with the same woman his entire life. Lutze concluded that Raymond owed his comparatively serene nature to having missed the worst years of the Depression. “He had summer vacations in camp, which Arthur never had,” she wrote. “The feeling of the two older brothers about the youngest was, ‘Let the kid enjoy himself.’ ”
Raymond led Purdue Frederick as its top executive for several decades, while Mortimer led Napp Pharmaceuticals, the family’s drug company in the UK. (In practice, a family spokesperson said, “the brothers worked closely together leading both companies.”) Arthur, the adman, had no official role in the family’s pharmaceutical operations. According to Barry Meier’s Pain Killer, a prescient account of the rise of OxyContin published in 2003, Raymond and Mortimer bought Arthur’s share in Purdue from his estate for $22.4 million after he died in 1987. In an email exchange, Arthur’s daughter Elizabeth Sackler, a historian of feminist art who sits on the board of the Brooklyn Museum and supports a variety of progressive causes, emphatically distanced her branch of the family from her cousins’ businesses. “Neither I, nor my siblings, nor my children have ever had ownership in or any benefit whatsoever from Purdue Pharma or OxyContin,” she wrote, while also praising “the breadth of my father’s brilliance and important works.” Jillian, Arthur’s widow, said her husband had died too soon: “His enemies have gotten the last word.”
The Sacklers have been millionaires for decades, but their real money—the painkiller money—is of comparatively recent vintage. The vehicle of that fortune was OxyContin, but its engine, the driving power that made them so many billions, was not so much the drug itself as it was Arthur’s original marketing insight, rehabbed for the era of chronic-pain management. That simple but profitable idea was to take a substance with addictive properties—in Arthur’s case, a benzo; in Raymond and Mortimer’s case, an opioid—and market it as a salve for a vast range of indications.
In the years before it swooped into the pain-management business, Purdue had been a small industry player, specializing in over-the-counter remedies like ear-wax remover and laxatives. Its most successful product, acquired in 1966, was Betadine, a powerful antiseptic purchased in industrial quantities by the U. S. government to prevent infection among wounded soldiers in Vietnam. The turning point, according to company lore, came in 1972, when a London doctor working for Cicely Saunders, the Florence Nightingale of the modern hospice movement, approached Napp with the idea of creating a timed-release morphine pill. A long-acting morphine pill, the doctor reasoned, would allow dying cancer patients to sleep through the night without an IV. At the time, treatment with opioids was stigmatized in the United States, owing in part to a heroin epidemic fueled by returning Vietnam veterans. “Opiophobia,” as it came to be called, prevented skittish doctors from treating most patients, including nearly all infants, with strong pain medication of any kind. In hospice care, though, addiction was not a concern: It didn’t matter whether terminal patients became hooked in their final days. Over the course of the seventies, building on a slow-release technology the company had already developed for an asthma medication, Napp created what came to be known as the “Contin” system. In 1981, Napp introduced a timed-release morphine pill in the UK; six years later, Purdue brought the same drug to market in the U. S. as MS Contin.
MS Contin quickly became the gold standard for pain relief in cancer care. At the same time, a number of clinicians associated with the burgeoning chronic-pain movement started advocating the use of powerful opioids for noncancer conditions like back pain and neuropathic pain, afflictions that at their worst could be debilitating. In 1986, two doctors from Memorial Sloan Kettering hospital in New York published a fateful article in a medical journal that purported to show, based on a study of thirty-eight patients, that long-term opioid treatment was safe and effective so long as patients had no history of drug abuse. Soon enough, opioid advocates dredged up a letter to the editor published in The New England Journal of Medicine in 1980 that suggested, based on a highly unrepresentative cohort, that the risk of addiction from long-term opioid use was less than 1 percent. Though ultimately disavowed by its author, the letter ended up getting cited in medical journals more than six hundred times.
As the country was reexamining pain, Raymond’s eldest son, Richard Sackler, was searching for new applications for Purdue’s timed-release Contin system. “At all the meetings, that was a constant source of discussion—‘What else can we use the Contin system for?’ ” said Peter Lacouture, a senior director of clinical research at Purdue from 1991 to 2001. “And that’s where Richard would fire some ideas—maybe antibiotics, maybe chemotherapy—he was always out there digging.” Richard’s spitballing wasn’t idle blather. A trained physician, he treasured his role as a research scientist and appeared as an inventor on dozens of the company’s patents (though not on the patents for OxyContin). In the tradition of his uncle Arthur, Richard was also fascinated by sales messaging. “He was very interested in the commercial side and also very interested in marketing approaches,” said Sally Allen Riddle, Purdue’s former executive director for product management. “He didn’t always wait for the research results.” (A Purdue spokesperson said that Richard “always considered relevant scientific information when making decisions.”)
Perhaps the most private member of a generally secretive family, Richard appears nowhere on Purdue’s website. From public records and conversations with former employees, though, a rough portrait emerges of a testy eccentric with ardent, relentless ambitions. Born in 1945, he holds degrees from Columbia University and NYU Medical School. According to a bio on the website of the Koch Institute for Integrative Cancer Research at MIT, where Richard serves on the advisory board, he started working at Purdue as his father’s assistant at age twenty-six before eventually leading the firm’s R&D division and, separately, its sales and marketing division. In 1999, while Mortimer and Raymond remained Purdue’s co-CEOs, Richard joined them at the top of the company as president, a position he relinquished in 2003 to become cochairman of the board. The few publicly available pictures of him are generic and sphinxlike—a white guy with a receding hairline. He is one of the few Sacklers to consistently smile for the camera. In a photo on what appears to be his Facebook profile, Richard is wearing a tan suit and a pink tie, his right hand casually scrunched into his pocket, projecting a jaunty charm. Divorced in 2013, he lists his relationship status on the profile as “It’s complicated.”
WHEN PURDUE EVENTUALLY PLEADED GUILTY TO FELONY CHARGES IN 2007 FOR CRIMINALLY “MISBRANDING” OXYCONTIN, IT ACKNOWLEDGED EXPLOITING DOCTORS’ MISCONCEPTIONS ABOUT OXYCODONE’S STRENGTH.
Richard’s political contributions have gone mostly to Republicans—including Strom Thurmond and Herman Cain—though at times he has also given to Democrats. (His ex-wife, Beth Sackler, has given almost exclusively to Democrats.) In 2008, he wrote a letter to the editor of The Wall Street Journaldenouncing Muslim support for suicide bombing, a concern that seems to persist: Since 2014, his charitable organization, the Richard and Beth Sackler Foundation, has donated to several anti-Muslim groups, including three organizations classified as hate groups by the Southern Poverty Law Center. (The family spokesperson said, “It was never Richard Sackler’s intention to donate to an anti-Muslim or hate group.”) The foundation has also donated to True the Vote, the “voter-fraud watchdog” that was the original source for Donald Trump’s inaccurate claim that three million illegal immigrants voted in the 2016 election.
Former employees describe Richard as a man with an unnerving intelligence, alternately detached and pouncing. In meetings, his face was often glued to his laptop. “This was pre-smartphone days,” said Riddle. “He’d be typing away and you would think he wasn’t even listening, and then all of the sudden his head would pop up and he’d be asking a very pointed question.” He was notorious for peppering subordinates with unexpected, rapid-fire queries, sometimes in the middle of the night. “Richard had the mind of someone who’s going two hundred miles an hour,” said Lacouture. “He could be a little bit disconnected in the way he would communicate. Whether it was on the weekend or a holiday or a Christmas party, you could always expect the unexpected.”
Richard also had an appetite for micromanagement. “I remember one time he mailed out a rambling sales bulletin,” said Shelby Sherman, a Purdue sales rep from 1974 to 1998. “And right in the middle, he put in, ‘If you’re reading this, then you must call my secretary at this number and give her this secret password.’ He wanted to check and see if the reps were reading this shit. We called it ‘Playin’ Passwords.’ ” According to Sherman, Richard started taking a more prominent role in the company during the early 1980s. “The shift was abrupt,” he said. “Raymond was just so nice and down-to-earth and calm and gentle.” When Richard came, “things got a lot harder. Richard really wanted Purdue to be big—I mean really big.”
To effectively capitalize on the chronic-pain movement, Purdue knew it needed to move beyond MS Contin. “Morphine had a stigma,” said Riddle. “People hear the word and say, ‘Wait a minute, I’m not dying or anything.’ ” Aside from its terminal aura, MS Contin had a further handicap: Its patent was set to expire in the late nineties. In a 1990 memo addressed to Richard and other executives, Purdue’s VP of clinical research, Robert Kaiko, suggested that the company work on a pill containing oxycodone, a chemical similar to morphine that was also derived from the opium poppy. When it came to branding, oxycodone had a key advantage: Although it was 50 percent stronger than morphine, many doctors believed—wrongly—that it was substantially less powerful. They were deceived about its potency in part because oxycodone was widely known as one of the active ingredients in Percocet, a relatively weak opioid- acetaminophen combination that doctors often prescribed for painful injuries. “It really didn’t have the same connotation that morphine did in people’s minds,” said Riddle.
A common malapropism led to further advantage for Purdue. “Some people would call it oxy-codeine” instead of oxycodone, recalled Lacouture. “Codeine is very weak.” When Purdue eventually pleaded guilty to felony charges in 2007 for criminally “misbranding” OxyContin, it acknowledged exploiting doctors’ misconceptions about oxycodone’s strength. In court documents, the company said it was “well aware of the incorrect view held by many physicians that oxycodone was weaker than morphine” and “did not want to do anything ‘to make physicians think that oxycodone was stronger or equal to morphine’ or to ‘take any steps . . . that would affect the unique position that OxyContin’ ” held among physicians.
Purdue did not merely neglect to clear up confusion about the strength of OxyContin. As the company later admitted, it misleadingly promoted OxyContin as less addictive than older opioids on the market. In this deception, Purdue had a big assist from the FDA, which allowed the company to include an astonishing labeling claim in OxyContin’s package insert: “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.”
The theory was that addicts would shy away from timed-released drugs, preferring an immediate rush. In practice, OxyContin, which crammed a huge amount of pure narcotic into a single pill, became a lusted-after target for addicts, who quickly discovered that the timed-release mechanism in OxyContin was easy to circumvent—you could simply crush a pill and snort it to get most of the narcotic payload in a single inhalation. This wasn’t exactly news to the manufacturer: OxyContin’s own packaging warned that consuming broken pills would thwart the timed-release system and subject patients to a potentially fatal overdose. MS Contin had contended with similar vulnerabilities, and as a result commanded a hefty premium on the street. But the “reduced abuse liability” claim that added wings to the sales of OxyContin had not been approved for MS Contin. It was removed from OxyContin in 2001 and would never be approved again for any other opioid.
The year after OxyContin’s release, Curtis Wright, the FDA examiner who approved the pharmaceutical’s original application, quit. After a stint at another pharmaceutical company, he began working for Purdue. In an interview with Esquire, Wright defended his work at the FDA and at Purdue. “At the time, it was believed that extended-release formulations were intrinsically less abusable,” he insisted. “It came as a rather big shock to everybody—the government and Purdue—that people found ways to grind up, chew up, snort, dissolve, and inject the pills.” Preventing abuse, he said, had to be balanced against providing relief to chronic-pain sufferers. “In the mid-nineties,” he recalled, “the very best pain specialists told the medical community they were not prescribing opioids enough. That was not something generated by Purdue—that was not a secret plan, that was not a plot, that was not a clever marketing ploy. Chronic pain is horrible. In the right circumstances, opioid therapy is nothing short of miraculous; you give people their lives back.” In Wright’s account, the Sacklers were not just great employers, they were great people. “No company in the history of pharmaceuticals,” he said, “has worked harder to try to prevent abuse of their product than Purdue.”
Purdue did not invent the chronic-pain movement, but it used that movement to engineer a crucial shift. Wright is correct that in the nineties patients suffering from chronic pain often received inadequate treatment. But the call for clinical reforms also became a flexible alibi for overly aggressive prescribing practices. By the end of the decade, clinical proponents of opioid treatment, supported by millions in funding from Purdue and other pharmaceutical companies, had organized themselves into advocacy groups with names like the American Pain Society and the American Academy of Pain Medicine. (Purdue also launched its own group, called Partners Against Pain.) As the decade wore on, these organizations, which critics have characterized as front groups for the pharmaceutical industry, began pressuring health regulators to make pain “the fifth vital sign”—a number, measured on a subjective ten-point scale, to be asked and recorded at every doctor’s visit. As an internal strategy document put it, Purdue’s ambition was to “attach an emotional aspect to noncancer pain” so that doctors would feel pressure to “treat it more seriously and aggressively.” The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American.
THE COMPANY REBRANDED PAIN RELIEF AS A SACRED RIGHT: A UNIVERSAL NARCOTIC ENTITLEMENT AVAILABLE NOT ONLY TO THE TERMINALLY ILL BUT TO EVERY AMERICAN. BY 2001, ANNUAL OXYCONTIN SALES HAD SURGED PAST $1 BILLION.
OxyContin’s sales started out small in 1996, in part because Purdue first focused on the cancer market to gain formulary acceptance from HMOs and state Medicaid programs. Over the next several years, though, the company doubled its sales force to six hundred—equal to the total number of DEA diversion agents employed to combat the sale of prescription drugs on the black market—and began targeting general practitioners, dentists, OB/GYNs, physician assistants, nurses, and residents. By 2001, annual OxyContin sales had surged past $1 billion. Sales reps were encouraged to downplay addiction risks. “It was sell, sell, sell,” recalled Sherman. “We were directed to lie. Why mince words about it? Greed took hold and overruled everything. They saw that potential for billions of dollars and just went after it.” Flush with cash, Purdue pioneered a high-cost promotion strategy, effectively providing kickbacks—which were legal under American law—to each part of the distribution chain. Wholesalers got rebates in exchange for keeping OxyContin off prior authorization lists. Pharmacists got refunds on their initial orders. Patients got coupons for thirty- day starter supplies. Academics got grants. Medical journals got millions in advertising. Senators and members of Congress on key committees got donations from Purdue and from members of the Sackler family.
It was doctors, though, who received the most attention. “We used to fly doctors to these ‘seminars,’ ” said Sherman, which were, in practice, “just golf trips to Pebble Beach. It was graft.” Though offering perks and freebies to doctors was hardly uncommon in the industry, it was unprecedented in the marketing of a Schedule II narcotic. For some physicians, the junkets to sunny locales weren’t enough to persuade them to prescribe. To entice the holdouts—a group the company referred to internally as “problem doctors”—the reps would dangle the lure of Purdue’s lucrative speakers’ bureau. “Everybody was automatically approved,” said Sherman. “We would set up these little dinners, and they’d make their little fifteen-minute talk, and they’d get $500.”
Between 1996 and 2001, the number of OxyContin prescriptions in the United States surged from about three hundred thousand to nearly six million, and reports of abuse started to bubble up in places like West Virginia, Florida, and Maine. (Research would later show a direct correlation between prescription volume in an area and rates of abuse and overdose.) Hundreds of doctors were eventually arrested for running pill mills. According to an investigation in the Los Angeles Times, even though Purdue kept an internal list of doctors it suspected of criminal diversion, it didn’t volunteer this information to law enforcement until years later.
As criticism of OxyContin mounted through the aughts, Purdue responded with symbolic concessions while retaining its volume-driven business model. To prevent addicts from forging prescriptions, the company gave doctors tamper-resistant prescription pads; to mollify pharmacists worried about robberies, Purdue offered to replace, free of charge, any stolen drugs; to gather data on drug abuse and diversion, the company launched a national monitoring program called RADARS.
Critics were not impressed. In a letter to Richard Sackler in July 2001, Richard Blumenthal, then Connecticut’s attorney general and now a U. S. senator, called the company’s efforts “cosmetic.” As Blumenthal had deduced, the root problem of the prescription-opioid epidemic was the high volume of prescriptions written for powerful opioids. “It is time for Purdue Pharma to change its practices,” Blumenthal warned Richard, “not just its public-relations strategy.”
It wasn’t just that doctors were writing huge numbers of prescriptions; it was also that the prescriptions were often for extraordinarily high doses. A single dose of Percocet contains between 2.5 and 10mg of oxycodone. OxyContin came in 10-, 20-, 30-, 40-, and 80mg formulations and, for a time, even 160mg. Purdue’s greatest competitive advantage in dominating the pain market, it had determined early on, was that OxyContin lasted twelve hours, enough to sleep through the night. But for many patients, the drug lasted only six or eight hours, creating a cycle of crash and euphoria that one academic called “a perfect recipe for addiction.” When confronted with complaints about “breakthrough pain”—meaning that the pills weren’t working as long as advertised—Purdue’s sales reps were given strict instructions to tell doctors to strengthen the dose rather than increase dosing frequency.
SALES REPS WERE ENCOURAGED TO DOWNPLAY ADDICTION RISKS. “IT WAS SELL, SELL, SELL,” RECALLED SHERMAN. “WE WERE DIRECTED TO LIE. WHY MINCE WORDS ABOUT IT?”
Over the next several years, dozens of class-action lawsuits were brought against Purdue. Many were dismissed, but in some cases Purdue wrote big checks to avoid going to trial. Several plaintiffs’ lawyers found that the company was willing to go to great lengths to prevent Richard Sackler from having to testify under oath. “They didn’t want him deposed, I can tell you that much,” recalled Marvin Masters, a lawyer who brought a class-action suit against Purdue in the early 2000s in West Virginia. “They were willing to sit down and settle the case to keep from doing that.” Purdue tried to get Richard removed from the suit, but when that didn’t work, the company settled with the plaintiffs for more than $20 million. Paul Hanly, a New York class-action lawyer who won a large settlement from Purdue in 2007, had a similar recollection. “We were attempting to take Richard Sackler’s deposition,” he said, “around the time that they agreed to a settlement.” (A spokesperson for the company said, “Purdue did not settle any cases to avoid the deposition of Dr. Richard Sackler, or any other individual.”)
When the federal government finally stepped in, in 2007, it extracted historic terms of surrender from the company. Purdue pleaded guilty to felony charges, admitting that it had lied to doctors about OxyContin’s abuse potential. (The technical charge was “misbranding a drug with intent to defraud or mislead.”) Under the agreement, the company paid $600 million in fines and its three top executives at the time—its medical director, general counsel, and Richard’s successor as president—pleaded guilty to misdemeanor charges. The executives paid $34.5 million out of their own pockets and performed four hundred hours of community service. It was one of the harshest penalties ever imposed on a pharmaceutical company. (In a statement to Esquire, Purdue said that it “abides by the highest ethical standards and legal requirements.” The statement went on: “We want physicians to use their professional judgment, and we were not trying to pressure them.”)
FIFTY-THREE THOUSAND AMERICANS DIED FROM OPIOID OVERDOSES IN 2016, MORE THAN THE THIRTY-SIX THOUSAND WHO DIED IN CAR CRASHES IN 2015 OR THE THIRTY-FIVE THOUSAND WHO DIED FROM GUN VIOLENCE THAT YEAR.
No Sacklers were named in the 2007 suit. Indeed, the Sackler name appeared nowhere in the plea agreement, even though Richard had been one of the company’s top executives during most of the period covered by the settlement. He did eventually have to give a deposition in 2015, in a case brought by Kentucky’s attorney general. Richard’s testimony—the only known record of a Sackler speaking about the crisis the family’s company helped create—was promptly sealed. (In 2016, STAT, an online magazine owned by Boston Globe Media that covers health and medicine, asked a court in Kentucky to unseal the deposition, which is said to have lasted several hours. STAT won a lower-court ruling in May 2016. As of press time, the matter was before an appeals court.)
In 2010, Purdue executed a breathtaking pivot: Embracing the arguments critics had been making for years about OxyContin’s susceptibility to abuse, the company released a new formulation of the medication that was harder to snort or inject. Purdue seized the occasion to rebrand itself as an industry leader in abuse-deterrent technology. The change of heart coincided with two developments: First, an increasing number of addicts, unable to afford OxyContin’s high street price, were turning to cheaper alternatives like heroin; second, OxyContin was nearing the end of its patents. Purdue suddenly argued that the drug it had been selling for nearly fifteen years was so prone to abuse that generic manufacturers should not be allowed to copy it.
On April 16, 2013, the day some of the key patents for OxyContin were scheduled to expire, the FDA followed Purdue’s lead, declaring that no generic versions of the original OxyContin formulation could be sold. The company had effectively won several additional years of patent protection for its golden goose.
Opioid withdrawal, which causes aches, vomiting, and restless anxiety, is a gruesome process to experience as an adult. It’s considerably worse for the twenty thousand or so American babies who emerge each year from opioid-soaked wombs. These infants, suddenly cut off from their supply, cry uncontrollably. Their skin is mottled. They cannot fall asleep. Their bodies are shaken by tremors and, in the worst cases, seizures. Bottles of milk leave them distraught, because they cannot maneuver their lips with enough precision to create suction. Treatment comes in the form of drops of morphine pushed from a syringe into the babies’ mouths. Weaning sometimes takes a week but can last as long as twelve. It’s a heartrending, expensive process, typically carried out in the neonatal ICU, where newborns have limited access to their mothers.
But the children of OxyContin, its heirs and legatees, are many and various. The second- and third-generation descendants of Raymond and Mortimer Sackler spend their money in the ways we have come to expect from the not-so-idle rich. Notably, several have made children a focus of their business and philanthropic endeavors. One Sackler heir helped start an iPhone app called RedRover, which generates ideas for child-friendly activities for urban parents; another runs a child- development center near Central Park; another is a donor to charter-school causes, as well as an investor in an education start-up called AltSchool. Yet another is the founder of Beespace, an “incubator for emerging nonprofits,” which provides resources and mentoring for initiatives like the Malala Fund, which invests in education programs for women in the developing world, and Yoga Foster, whose objective is to bring “accessible, sustainable yoga programs into schools across the country.” Other Sackler heirs get to do the fun stuff: One helps finance small, interesting films like The Witch; a second married a famous cricket player; a third is a sound artist; a fourth started a production company with Boyd Holbrook, star of the Netflix series Narcos; a fifth founded a small chain of gastropubs in New York called the Smith.
Holding fast to family tradition, Raymond’s and Mortimer’s heirs declined to be interviewed for this article. Instead, through a spokesperson, they put forward two decorated academics who have been on the receiving end of the family’s largesse: Phillip Sharp, the Nobel-prize-winning MIT geneticist, and Herbert Pardes, formerly the dean of faculty at Columbia University’s medical school and CEO of New York-Presbyterian Hospital. Both men effusively praised the Sacklers’ donations to the arts and sciences, marveling at their loyalty to academic excellence. “Once you were on that exalted list of philanthropic projects,” Pardes told Esquire, “you were there and you were in a position to secure additional philanthropy. It was like a family acquisition.” Pardes called the Sacklers “the nicest, most gentle people you could imagine.” As for the family’s connection to OxyContin, he said that it had never come up as an issue in the faculty lounge or the hospital break room. “I have never heard one inch about that,” he said.
Pardes’s ostrichlike avoidance is not unusual. In 2008, Raymond and his wife donated an undisclosed amount to Yale to start the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences. Lynne Regan, its current director, told me that neither students nor faculty have ever brought up the OxyContin connection. “Most people don’t know about that,” she said. “I think people are mainly oblivious.” A spokesperson for the university added, “Yale does not vet donors for controversies that may or may not arise.”
IN MAY, A DOZEN LAWMAKERS IN CONGRESS SENT A BIPARTISAN LETTER TO THE WORLD HEALTH ORGANIZATION WARNING THAT SACKLER-OWNED COMPANIES WERE PREPARING TO FLOOD FOREIGN COUNTRIES WITH LEGAL NARCOTICS.
The controversy surrounding OxyContin shows little sign of receding. In 2016, the CDC issued a startling warning: There was no good evidence that opioids were an effective treatment for chronic pain beyond six weeks. There was, on the other hand, an abundance of evidence that long-term treatment with opioids had harmful effects. (A recent paper by Princeton economist Alan Krueger suggests that chronic opioid use may account for more than 20 percent of the decline in American labor-force participation from 1999 to 2015.) Millions of opioid prescriptions for chronic pain had been written in the preceding two decades, and the CDC was calling into question whether many of them should have been written at all. At least twenty-five government entities, ranging from states to small cities, have recently filed lawsuits against Purdue to recover damages associated with the opioid epidemic.
The Sacklers, though, will likely emerge untouched: Because of a sweeping non-prosecution agreement negotiated during the 2007 settlement, most new criminal litigation against Purdue can only address activity that occurred after that date. Neither Richard nor any other family members have occupied an executive position at the company since 2003.
The American market for OxyContin is dwindling. According to Purdue, prescriptions fell 33 percent between 2012 and 2016. But while the company’s primary product may be in eclipse in the United States, international markets for pain medications are expanding. According to an investigation last year in the Los Angeles Times, Mundipharma, the Sackler-owned company charged with developing new markets, is employing a suite of familiar tactics in countries like Mexico, Brazil, and China to stoke concern for as-yet-unheralded “silent epidemics” of untreated pain. In Colombia, according to the L.A. Times, the company went so far as to circulate a press release suggesting that 47 percent of the population suffered from chronic pain.
In May, a dozen lawmakers in Congress, inspired by the L.A. Times investigation, sent a bipartisan letter to the World Health Organization warning that Sackler-owned companies were preparing to flood foreign countries with legal narcotics. “Purdue began the opioid crisis that has devastated American communities,” the letter reads. “Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Significantly, the letter calls out the Sackler family by name, leaving no room for the public to wonder about the identities of the people who stood behind Mundipharma.
An addiction specialist said that the Sacklers’ firm, Purdue Pharma, bears the “lion’s share” of the blame for the opioid crisis.
he north wing of the Metropolitan Museum of Art is a vast, airy enclosure featuring a banked wall of glass and the Temple of Dendur, a sandstone monument that was constructed beside the Nile two millennia ago and transported to the Met, brick by brick, as a gift from the Egyptian government. The space, which opened in 1978 and is known as the Sackler Wing, is also itself a monument, to one of America’s great philanthropic dynasties. The Brooklyn-born brothers Arthur, Mortimer, and Raymond Sackler, all physicians, donated lavishly during their lifetimes to an astounding range of institutions, many of which today bear the family name: the Sackler Gallery, in Washington; the Sackler Museum, at Harvard; the Sackler Center for Arts Education, at the Guggenheim; the Sackler Wing at the Louvre; and Sackler institutes and facilities at Columbia, Oxford, and a dozen other universities. The Sacklers have endowed professorships and underwritten medical research. The art scholar Thomas Lawton once likened the eldest brother, Arthur, to “a modern Medici.” Before Arthur’s death, in 1987, he advised his children, “Leave the world a better place than when you entered it.”
Mortimer died in 2010, and Raymond died earlier this year. The brothers bequeathed to their heirs a laudable tradition of benevolence, and an immense fortune with which to indulge it. Arthur’s daughter Elizabeth is on the board of the Brooklyn Museum, where she endowed the Elizabeth A. Sackler Center for Feminist Art. Raymond’s sons, Richard and Jonathan, established a professorship at Yale Cancer Center. “My father raised Jon and me to believe that philanthropy is an important part of how we should fill our lives,” Richard has said. Marissa Sackler, the thirty-six-year-old daughter of Mortimer and his third wife, Theresa Rowling, founded Beespace, a nonprofit “incubator” that supports organizations like the Malala Fund. Sackler recently told W that she finds the word “philanthropy” old-fashioned. She considers herself a “social entrepreneur.”
When the Met was originally built, in 1880, one of its trustees, the lawyer Joseph Choate, gave a speech to Gilded Age industrialists who had gathered to celebrate its dedication, and, in a bid for their support, offered the sly observation that what philanthropy really buys is immortality: “Think of it, ye millionaires of many markets, what glory may yet be yours, if you only listen to our advice, to convert pork into porcelain, grain and produce into priceless pottery, the rude ores of commerce into sculptured marble.”
Through such transubstantiation, many fortunes have passed into enduring civic institutions. Over time, the origins of a clan’s largesse are largely forgotten, and we recall only the philanthropic legacy, prompted by the name on the building. According to Forbes, the Sacklers are now one of America’s richest families, with a collective net worth of thirteen billion dollars—more than the Rockefellers or the Mellons. The bulk of the Sacklers’ fortune has been accumulated only in recent decades, yet the source of their wealth is to most people as obscure as that of the robber barons. While the Sacklers are interviewed regularly on the subject of their generosity, they almost never speak publicly about the family business, Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin. Upon its release, in 1995, OxyContin was hailed as a medical breakthrough, a long-lasting narcotic that could help patients suffering from moderate to severe pain. The drug became a blockbuster, and has reportedly generated some thirty-five billion dollars in revenue for Purdue.
But OxyContin is a controversial drug. Its sole active ingredient is oxycodone, a chemical cousin of heroin which is up to twice as powerful as morphine. In the past, doctors had been reluctant to prescribe strong opioids—as synthetic drugs derived from opium are known—except for acute cancer pain and end-of-life palliative care, because of a long-standing, and well-founded, fear about the addictive properties of these drugs. “Few drugs are as dangerous as the opioids,” David Kessler, the former commissioner of the Food and Drug Administration, told me.
Purdue launched OxyContin with a marketing campaign that attempted to counter this attitude and change the prescribing habits of doctors. The company funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies. Sales representatives marketed OxyContin as a product “to start with and to stay with.” Millions of patients found the drug to be a vital salve for excruciating pain. But many others grew so hooked on it that, between doses, they experienced debilitating withdrawal.
Since 1999, two hundred thousand Americans have died from overdoses related to OxyContin and other prescription opioids. Many addicts, finding prescription painkillers too expensive or too difficult to obtain, have turned to heroin. According to the American Society of Addiction Medicine, four out of five people who try heroin today started with prescription painkillers. The most recent figures from the Centers for Disease Control and Prevention suggest that a hundred and forty-five Americans now die every day from opioid overdoses.
Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, has worked with hundreds of patients addicted to opioids. He told me that, though many fatal overdoses have resulted from opioids other than OxyContin, 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,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.”
Although the Sackler name can be found on dozens of buildings, Purdue’s Web site scarcely mentions the family, and a list of the company’s board of directors fails to include eight family members, from three generations, who serve in that capacity. “I don’t know how many rooms in different parts of the world I’ve given talks in that were named after the Sacklers,” Allen Frances, the former chair of psychiatry at Duke University School of Medicine, told me. “Their name has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.”
Dr. Sackler considered himself and was considered to be the patriarch of the Sackler family,” a lawyer representing Arthur Sackler’s children once observed. Arthur was a gap-toothed, commanding polymath who trained under the Dutch psychoanalyst Johan H. W. van Ophuijsen, whom Sackler proudly described as “Freud’s favorite disciple.” Arthur and his brothers, the children of Jewish immigrants from Galicia and Poland, grew up in Brooklyn during the Depression. All three attended medical school, and worked together at the Creedmoor Psychiatric Center, in Queens, collectively publishing some hundred and fifty scholarly papers. Arthur became fascinated, he later explained, by the ways that “nature and disease can reveal their secrets.” 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.
But the brothers made their fortunes in commerce, rather than from medical practice. They shared an entrepreneurial bent. As a teen-ager, Mortimer became the advertising manager of his high-school newspaper, and after persuading Chesterfield to place a cigarette ad he got a five-dollar commission—a lot of money at a time when, he later said, “even doctors were selling apples in the streets.” In 1942, Arthur helped pay his medical-school tuition by taking a copywriting job at William Douglas McAdams, a small ad agency that specialized in the medical field. He proved so adept at this work that he eventually bought the agency—and revolutionized the industry. Until then, pharmaceutical companies had not availed themselves of Madison Avenue pizzazz and trickery. As both a doctor and an adman, Arthur displayed a Don Draper-style intuition for the alchemy of marketing. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.
Sackler saw doctors as unimpeachable stewards of public health. “I would rather place myself and my family at the judgment and mercy of a fellow-physician than that of the state,” he liked to say. So in selling new drugs he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves). John Kallir, who worked under Sackler for ten years at McAdams, recalled, “Sackler’s ads had a very serious, clinical look—a physician talking to a physician. But it was advertising.” In 1997, Arthur was posthumously inducted into the Medical Advertising Hall of Fame, and a citation praised his achievement in “bringing the full power of advertising and promotion to pharmaceutical marketing.” Allen Frances put it differently: “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”
Advertising has always entailed some degree of persuasive license, and Arthur’s techniques were sometimes blatantly deceptive. In the nineteen-fifties, he produced an ad for a new Pfizer antibiotic, Sigmamycin: an array of doctors’ business cards, alongside the words “More and more physicians find Sigmamycin the antibiotic therapy of choice.” It was the medical equivalent of putting Mickey Mantle on a box of Wheaties. In 1959, an investigative reporter for The Saturday Review tried to contact some of the doctors whose names were on the cards. They did not exist.
During the sixties, Arthur got rich marketing the tranquillizers Librium and Valium. One Librium ad depicted a young woman carrying an armload of books, and suggested that even the quotidian anxiety a college freshman feels upon leaving home might be best handled with tranquillizers. Such students “may be afflicted by a sense of lost identity,” the copy read, adding that university life presented “a whole new world . . . of anxiety.” The ad ran in a medical journal. Sackler promoted Valium for such a wide range of uses that, in 1965, a physician writing in the journal Psychosomatics asked, “When do we not use this drug?” One campaign encouraged doctors to prescribe Valium to people with no psychiatric symptoms whatsoever: “For this kind of patient—with no demonstrable pathology—consider the usefulness of Valium.” Roche, the maker of Valium, had conducted no studies of its addictive potential. Win Gerson, who worked with Sackler at the agency, told the journalist Sam Quinones years later that the Valium campaign was a great success, in part because the drug was so effective. “It kind of made junkies of people, but that drug worked,” Gerson said. By 1973, American doctors were writing more than a hundred million tranquillizer prescriptions a year, and countless patients became hooked. The Senate held hearings on what Edward Kennedy called “a nightmare of dependence and addiction.”
While running his advertising company, Arthur Sackler became a publisher, starting a biweekly newspaper, the Medical Tribune, which eventually reached six hundred thousand physicians. He scoffed at suggestions that there was a conflict of interest between his roles as the head of a pharmaceutical-advertising company and the publisher of a periodical for doctors. But in 1959 it emerged that a company he owned, MD Publications, had paid the chief of the antibiotics division of the F.D.A., Henry Welch, nearly three hundred thousand dollars in exchange for Welch’s help in promoting certain drugs. Sometimes, when Welch was giving a speech, he inserted a drug’s advertising slogan into his remarks. (After the payments were discovered, he resigned.) When I asked John Kallir about the Welch scandal, he chuckled, and said, “He got co-opted by Artie.”
In 1952, the Sackler brothers bought a small patent-medicine company, Purdue Frederick, which was based in Greenwich Village and made such unglamorous staples as laxatives and earwax remover. According to court documents, each brother would control a third of the company, but Arthur, who was occupied with his publishing and advertising ventures, would play a passive role. The journalist Barry Meier, in his 2003 book, “Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death,” remarks that Arthur treated his brothers “not as siblings but more like his progeny and understudies.” Now Raymond and Mortimer, who became joint C.E.O.s, had a company of their own.
In the early sixties, Estes Kefauver, a Tennessee senator, chaired a subcommittee that looked into the pharmaceutical industry, which was growing rapidly. Kefauver, who had previously investigated the Mafia, was especially intrigued by the Sackler brothers. A memo prepared by Kefauver’s staff noted, “The Sackler empire is a completely integrated operation in that it can devise a new drug in its drug development enterprise, have the drug clinically tested and secure favorable reports on the drug from the various hospitals with which they have connections, conceive the advertising approach and prepare the actual advertising copy with which to promote the drug, have the clinical articles as well as advertising copy published in their own medical journals, [and] prepare and plant articles in newspapers and magazines.” In January, 1962, Arthur travelled to Washington to testify before Kefauver’s subcommittee. A panel of senators assailed him with pointed questions, but he was a formidable interlocutor—slippery, aloof, and impeccably prepared—and no senator landed a blow. At one point, Sackler caught Kefauver in an error and said, “If you personally had taken the training that a physician requires to get a degree, you would never have made that mistake.” Quizzed about his promotion of a cholesterol drug that had many side effects, including hair loss, Sackler deadpanned, “I would prefer to have thin hair to thick coronaries.”
As the Sacklers grew wealthy, they became patrons of the arts. In 1974, the brothers gave the Met three and a half million dollars, enabling the construction of the wing housing the Temple of Dendur. Mortimer used the space for a lavish birthday party. The cake was in the shape of the Great Sphinx, but its face had been replaced with Mortimer’s.
In April, 1987, when Arthur Sackler was seventy-three, he demanded that his third wife, Gillian, account for all their household expenditures. He dictated a terse memo: “I am determined to take command of all situations for which I personally and my estate bear the ultimate obligation.” A month later, he had a heart attack, and died. The family gathered for a fond memorial service at the Met, but Arthur’s children fought bitterly with Gillian, and sparred with Mortimer and Raymond, over the estate. They accused Gillian of trying to steal their inheritance, and of being “inspired variously by greed, malice, or vindictiveness toward her stepchildren.” According to the minutes of a family meeting, Arthur’s daughter Elizabeth suggested that he had hidden the true worth of some family investments, “because he didn’t want Morty and Ray to think they were more valuable.” A family lawyer told the children, “There were no absolutely white lilies here on either side.”
Arthur’s descendants still owned a third of Purdue Frederick, and Mortimer and Raymond were interested in buying the stake. The company, which had moved to Connecticut and would eventually change its name to Purdue Pharma, had made a great deal of money under their stewardship. But such riches were about to seem paltry. By the time the brothers made their bid, Purdue was already developing a new drug: OxyContin.
Humans have cultivated the opium poppy for five thousand years. The father of medicine, Hippocrates, recognized the therapeutic properties of the plant. But even in the ancient world people understood that the benevolent powers of this narcotic were offset by the perils of addiction. In his 1996 book, “Opium: A History,” Martin Booth notes that, for the Romans, the poppy was a symbol of both sleep and death. During the nineteen-eighties, Raymond and Mortimer Sackler had a great success at Purdue with an innovative painkiller called MS Contin, a morphine pill with a patented “controlled release” formula: the drug dissolved gradually into the bloodstream over several hours. (“Contin” was short for “continuous.”) MS Contin became the biggest seller in Purdue’s history. But, by the late eighties, its patent was about to expire, and Purdue executives started looking for a drug to replace it.
One executive who was centrally involved in this effort was Raymond’s son Richard, an enigmatic, slightly awkward man who, in the family tradition, had trained as a doctor. Richard had joined Purdue in 1971 as an assistant to his father, and worked his way up. His name appears on numerous medical patents. In the summer of 1990, a Purdue scientist sent a memo to Richard and several other colleagues, pointing out that MS Contin could “face such serious generic competition that other controlled-release opioids must be considered.” The memo described ongoing efforts to create a product containing oxycodone, an opioid that had been developed by German scientists in 1916.
Oxycodone, which was inexpensive to produce, was already used in other drugs, such as Percodan (in which it is blended with aspirin) and Percocet (in which it is blended with Tylenol). Purdue developed a pill of pure oxycodone, with a time-release formula similar to that of MS Contin. The company decided to produce doses as low as ten milligrams, but also jumbo pills—eighty milligrams and a hundred and sixty milligrams—whose potency far exceeded that of any prescription opioid on the market. As Barry Meier writes, in “Pain Killer,” “In terms of narcotic firepower, OxyContin was a nuclear weapon.”
Before releasing OxyContin, Purdue conducted focus groups with doctors and learned that the “biggest negative” that might prevent widespread use of the drug was ingrained concern regarding the “abuse potential” of opioids. But, fortuitously, while the company was developing OxyContin, some physicians began arguing that American medicine should reëxamine this bias. Highly regarded doctors, like Russell Portenoy, then a pain specialist at Memorial Sloan Kettering Cancer Center, in New York, spoke out about the problem of untreated chronic pain—and the wisdom of using opioids to treat it. “There is a growing literature showing that these drugs can be used for a long time, with few side effects,” Portenoy told the Times, in 1993. Describing opioids as a “gift from nature,” he said that they needed to be destigmatized. Portenoy, who received funding from Purdue, decried the reticence among clinicians to administer such narcotics for chronic pain, claiming that it was indicative of “opiophobia,” and suggesting that concerns about addiction and abuse amounted to a “medical myth.” In 1997, the American Academy of Pain Medicine and the American Pain Society published a statement regarding the use of opioids to treat chronic pain. The statement was written by a committee chaired by Dr. J. David Haddox, a paid speaker for Purdue.
Richard Sackler worked tirelessly to make OxyContin a blockbuster, telling colleagues how devoted he was to the drug’s success. The F.D.A. approved OxyContin in 1995, for use in treating moderate to severe pain. Purdue had conducted no clinical studies on how addictive or prone to abuse the drug might be. But the F.D.A., in an unusual step, approved a 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.” David Kessler, who ran the F.D.A. at the time, told me that he was “not involved in the approval.” The F.D.A. examiner who oversaw the process, Dr. Curtis Wright, left the agency shortly afterward. Within two years, he had taken a job at Purdue.
Mortimer, Raymond, and Richard Sackler launched OxyContin with one of the biggest pharmaceutical marketing campaigns in history, deploying many persuasive techniques pioneered by Arthur. Steven May, who joined Purdue as an OxyContin sales representative in 1999, recalled, “At the time, we felt like we were doing a righteous thing.” He used to tell himself, “There’s millions of people in pain, and we have the solution.” (May is no longer working for Purdue.) The company assembled a sales force of as many as a thousand representatives and armed them with charts showing OxyContin’s benefits. May attended a three-week training session at Purdue’s headquarters. At a celebratory dinner following the training, he was seated at a table with Richard Sackler. “I was blown away,” he recalled. “My first impression of him was ‘This is the dude that made it happen. He has a company that his family owns. I want to be him one day.’ ”
A major thrust of the sales campaign was that OxyContin should be prescribed not merely for the kind of severe short-term pain associated with surgery or cancer but also for less acute, longer-lasting pain: arthritis, back pain, sports injuries, fibromyalgia. The number of conditions that OxyContin could treat seemed almost unlimited. According to internal documents, Purdue officials discovered that many doctors wrongly assumed that oxycodone was less potent than morphine—a misconception that the company exploited.
A 1995 memo sent to the launch team emphasized that the company did “not want to niche” OxyContin just for cancer pain. A primary objective in Purdue’s 2002 budget plan was to “broaden” the use of OxyContin for pain management. As May put it, “What Purdue did really well was target physicians, like general practitioners, who were not pain specialists.” In its internal literature, Purdue similarly spoke of reaching patients who were “opioid naïve.” Because OxyContin was so powerful and potentially addictive, David Kessler told me, from a public-health standpoint “the goal should have been to sell the least dose of the drug to the smallest number of patients.” But this approach was at odds with the competitive imperatives of a pharmaceutical company, he continued. So Purdue set out to do exactly the opposite.
Sales reps, May told me, received training in “overcoming objections” from clinicians. If a doctor inquired about addiction, May had a talking point ready. “ ‘The delivery system is believed to reduce the abuse liability of the drug,’ ” he recited to me, with a rueful laugh. “Those were the specific words. I can still remember, all these years later.” He went on, “I found out pretty fast that it wasn’t true.” In 2002, a sales manager from the company, William Gergely, told a state investigator in Florida that Purdue executives “told us to say things like it is ‘virtually’ non-addicting.”
May didn’t ask doctors simply to take his word on OxyContin; he presented them with studies and literature provided by other physicians. Purdue had a speakers’ bureau, and it paid several thousand clinicians to attend medical conferences and deliver presentations about the merits of the drug. Doctors were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Such spending was worth the investment: internal Purdue records indicate that doctors who attended these seminars in 1996 wrote OxyContin prescriptions more than twice as often as those who didn’t. The company advertised in medical journals, sponsored Web sites about chronic pain, and distributed a dizzying variety of OxyContin swag: fishing hats, plush toys, luggage tags. Purdue also produced promotional videos featuring satisfied patients—like a construction worker who talked about how OxyContin had eased his chronic back pain, allowing him to return to work. The videos, which also included testimonials from pain specialists, were sent to tens of thousands of doctors. The marketing of OxyContin relied on an empirical circularity: the company convinced doctors of the drug’s safety with literature that had been produced by doctors who were paid, or funded, by the company.
David Juurlink, who runs the division of clinical pharmacology and toxicology at the University of Toronto, told me that OxyContin’s success can be attributed partly to the fact that so many doctors wanted to believe in the therapeutic benefits of opioids. “The primary goal of medical practice is the relief of suffering, and one of the most common types that doctors see is pain,” he said. “You’ve got a patient in pain, you’ve got a doctor who genuinely wants to help, and now suddenly you have an intervention that—we are told—is safe and effective.”
Keith Humphreys, a professor of psychiatry at Stanford, who served as a drug-policy adviser to the Obama Administration, said, “That’s the real Greek tragedy of this—that so many well-meaning doctors got co-opted. The level of influence is just mind-boggling. Purdue gave money to continuing medical education, to state medical boards, to faux grassroots organizations.” According to training materials, Purdue instructed sales representatives to assure doctors—repeatedly and without evidence—that “fewer than one per cent” of patients who took OxyContin became addicted. (In 1999, a Purdue-funded study of patients who used OxyContin for headaches found that the addiction rate was thirteen per cent.)
Within five years of its introduction, OxyContin was generating a billion dollars a year. “There is no sign of it slowing down,” Richard Sackler told a team of company representatives in 2000. The sales force was heavily incentivized to push the drug. In a memo, a sales manager in Tennessee wrote, “$$$$$$$$$$$$$ It’s Bonus Time in the Neighborhood!” May, who was assigned to the Virginia area, was astonished to learn that especially skillful colleagues were earning hundreds of thousands of dollars in commissions. One year, May’s own sales were so brisk that Purdue rewarded him with a trip to Hawaii. As prescriptions multiplied, Purdue executives—and the Sackler family members on the company’s board—appeared happy to fund such blandishments. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses.
One day, May drove with a colleague to Lewisburg, a small city in West Virginia. They were there to visit a doctor who had been one of May’s top prescribers. When they arrived, the doctor was ashen. A relative had just died, she explained. The girl had overdosed on OxyContin.
Arthur and Mortimer Sackler each married three times, and Raymond married once. There are fifteen Sackler children in the second generation, most of whom have children of their own. The Sackler clan has pursued a variety of causes and interests. In 2011, Mortimer’s widow, Theresa, who sits on the board of Purdue, was awarded the Prince of Wales Medal for Art Philanthropy. When the medal was conferred, Ian Dejardin, the Sackler Director of the Dulwich Picture Gallery, remarked, “It’s going to be difficult not to make her sound utterly saintly.” Theresa’s daughter, Sophie, is married to the English cricket player Jamie Dalrymple, and lives in a forty-million-dollar house in London. Raymond’s thirty-seven-year-old grandson, David Sackler, runs a family investment fund, and is the only member of the third generation who sits on Purdue’s board. The fact that Purdue is privately held is a major reason that the Sacklers’ connection to OxyContin has remained obscure. A publicly traded company makes periodic disclosures to its shareholders. But Purdue, Barry Meier writes, “was the Sackler family’s private domain.”
On occasion, press accounts about OxyContin note that profits from the drug flow to the Sacklers, but these stories tend to depict the family as a monolith. As with any large clan, however, there are fissures of discord. In the eighties, Mortimer sued his ex-wife Gertraud, claiming that she had illegally taken possession of an apartment that he owned on Fifth Avenue and had loaned it out to a contingent of models and photographers. None of Arthur’s descendants sit on the company’s board. At a courthouse in Long Island, in files stemming from the family fight over Arthur’s fortune, I came across a document indicating that, after a “protracted negotiation,” Arthur’s estate “sold its one third interest in Purdue” to Raymond and Mortimer.
“I have never owned any shares in Purdue,” Michael Sackler-Berner, a Brooklyn-based singer-songwriter who is a grandson of Arthur Sackler, told me, in an e-mail. “None of the descendants of Arthur M. Sackler have ever had anything to do with, or benefited from, the sale of OxyContin.” Sackler-Berner made no mention of Librium, Valium, or MS Contin, but he added, “Given the current controversy surrounding OxyContin, I appreciate your clarifying the matter.”
Even though Mortimer Sackler had a large stake in the company, he was only an occasional presence at the Connecticut headquarters. He renounced his U.S. citizenship in 1974, reportedly for tax reasons, and lived a flamboyant life in Europe, shuttling among residences in England, the Swiss Alps, and Cap d’Antibes. (In 1999, Queen Elizabeth conferred an honorary knighthood on him, in recognition of his philanthropy.) Raymond Sackler, who lived in Connecticut, had a more modest temperament and came to his office at Purdue—where he was respectfully known as Dr. Raymond—every day. John Kallir, Arthur’s former advertising colleague, recalled, “Ray was quiet, reasonably honest, always married to the same woman. The least interesting of the three brothers.”
Almost immediately after OxyContin’s release, there were signs that people were abusing it in rural areas like Maine and Appalachia. If you ground the pills up and snorted them, or dissolved them in liquid and injected them, you could override the time-release mechanism and deliver a huge narcotic payload all at once. Perversely, users could learn about such methods by reading a warning label that came with each prescription, which said, “Taking broken, chewed or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose.” As more and more doctors prescribed OxyContin for an ever-greater range of symptoms, some patients began selling their pills on the black market, where the street price was a dollar a milligram. 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.
The company did not pull the drug from shelves, however, or acknowledge that it was addictive. Instead, Purdue insisted that the only problem was that recreational drug users were not taking OxyContin as directed. “Their rap has always been that a bunch of junkies ruined their product,” Keith Humphreys, the Stanford professor, said. In 2001, Michael Friedman, Purdue’s executive vice-president, testified before a congressional hearing convened to look into the alarming increase in opioid abuse. The marketing of OxyContin had been “conservative by any standard,” he maintained. “Virtually all of these reports involve people who are abusing the medication, not patients with legitimate medical needs.”
In 2002, a twenty-nine-year-old woman from New Jersey, Jill Skolek, was prescribed OxyContin for a back injury. One night, after four months on the drug, she died in her sleep, from respiratory arrest, leaving behind a six-year-old son. Her mother, Marianne Skolek Perez, was a nurse. Distraught and bewildered, she became convinced that OxyContin was dangerous. Perez wrote to F.D.A. officials, urging them to append to OxyContin packaging a warning about the risk of addiction.
The following year, Perez attended a conference on addiction at Columbia University. A sandy-haired man named Robin Hogen, wearing a pin-striped suit and a bow tie, was there, too. He was a communications specialist for Purdue, and had launched a vigorous campaign to defend the drug, warning newspapers to be careful about their coverage. “We’re going to be watching them,” he had promised. He had also enlisted Rudolph Giuliani, the former mayor of New York, and his associate Bernard Kerik to preëmpt any government crackdown. “We have to be politically Machiavellian, often, to win the day,” Hogen once said. At the Columbia event, he was asked about Perez’s daughter. He cautioned that one should not read into the tragedy any liability on Purdue’s part. The real problem, he said, was Jill Skolek: “We think she abused drugs.” (Hogen subsequently apologized for his remark. He no longer works for Purdue.)
Another speaker at the event was Purdue’s senior medical adviser, J. David Haddox, who insisted that OxyContin was not addictive. He once likened the drug to a vegetable, saying, “If I gave you a stalk of celery and you ate that, it would be healthy. But if you put it in a blender and tried to shoot it into your veins, it would not be good.” When Haddox was walking out of the event, Perez, who is petite and rail thin, deliberately bumped into him. Caught off guard, Haddox staggered backward and fell, with a clatter, into a row of folding chairs. “It was one of those Kodak moments,” Perez recalled. “It was probably the wrong thing to do. But I loved it.”
Arthur Sackler once wrote that “all health problems devolve upon the individual,” and it was Purdue’s position that OxyContin overdoses were a matter of individual responsibility, rather than the drug’s addictive properties. In addition to people like Hogen and Haddox, the company put forward several top executives to mount a defense, including Howard Udell, Purdue’s general counsel, who had been a longtime legal adviser to the Sacklers. Udell “was like Tom Hagen in ‘The Godfather,’ ” an attorney who dealt with him told me. “Very loyal to the family.” Udell was clearly aware, however, of the abuse potential of OxyContin. According to court documents, his own secretary became addicted to the drug, and was subsequently fired by Purdue.
By 2003, the Drug Enforcement Administration had found that Purdue’s “aggressive methods” had “very much exacerbated OxyContin’s widespread abuse.” Rogelio Guevara, a senior official at the D.E.A., concluded that Purdue had “deliberately minimized” the risks associated with the drug. But the company continued shifting the blame to drug abusers, creating a public-service announcement that showed a teen-ager raiding his parents’ medicine cabinet.
In a phone interview, Hogen told me that, for Purdue and the Sacklers, “there was a sense almost of betrayal—how could people put the availability of that product in jeopardy by abusing it for pleasure?” Hogen said that the company received many letters from grateful pain patients, thanking Purdue for “giving them their lives back.” Asked about his reticence to acknowledge that OxyContin might be addictive, Hogen said, “Today, addiction is broadly seen as a disease. Then, it was not. I think our understanding of addiction has grown enormously in the last fifteen years.”
People have known for thousands of years that opium derivatives are addictive, I said.
“You really need to talk to a clinician,” Hogen replied. “I’m not a doctor.”
J. David Haddox is a doctor. In 2001, he told an Associated Press reporter, “A lot of these people say, ‘Well, I was taking the medicine like my doctor told me to,’ and then they start taking more and more and more.” He added, “I don’t see where that’s my problem.” (Haddox, who still works for Purdue, declined to comment.)
Doctors who prescribed OxyContin were beginning to report that patients were coming to them with symptoms of withdrawal (itching, nausea, the shakes) and asking for more medication. Haddox had an answer. In a 1989 paper, he had coined the term “pseudo-addiction.” As a pain-management pamphlet distributed by Purdue explained, pseudo-addiction “seems similar to addiction, but is due to unrelieved pain.” The pamphlet continued, “Misunderstanding of this phenomenon may lead the clinician to inappropriately stigmatize the patient with the label ‘addict.’ ” Pseudo-addiction generally stopped once the pain was relieved—“often through an increase in opioid dose.”
“When you promote these very massive doses of opioids, the more of it that is out there the more abuse there will be,” David Kessler said. “It’s almost linear.” U.S. sales of OxyContin soon exceeded those of Viagra. Everywhere the drug spread, addiction followed. To Steven May, the sales representative in Virginia, it seemed as if the problems associated with OxyContin were metastasizing, “like a cancer.”
According to Robin Hogen, the members of the Sackler family “were unified in their shock that this was happening to a product they were very proud of.” The Sacklers did not have an arm’s-length relationship with Purdue, Hogen said: “This was an active family and an active board.” In 1999, Richard Sackler became Purdue’s president. As the head of a privately held company, however, he felt no pressure to be the public face of the business, and he never appeared at forums where people like Haddox defended Purdue. Indeed, though Sackler presided over the tremendously successful launch of OxyContin, he has never given an on-the-record interview about the drug. “I’ve had a lot of experience with Purdue over the years, in different settings, but I’ve never even seen Richard Sackler,” the addiction specialist Andrew Kolodny, who is a frequent Purdue critic, told me. “I don’t think I’d know him if he was standing in front of me.”
Even after it became clear that OxyContin was being widely abused, Purdue refused to concede that it posed risks. Company leaders worried mainly that attempts to stem overdoses might deprive pain patients of access to the drug. “They said, ‘We need to make sure that these products are available for patients,’ ” Hogen said. “That was their sole focus.” According to Steven May, the sales force was instructed to ride out the controversy, ignore abuse reports, and “sell through it.” As late as 2003, the F.D.A. sent Purdue a warning letter about ads that “grossly overstate the safety profile of OxyContin by not referring in the body of the advertisements to serious, potentially fatal risks.”
In his congressional testimony, Michael Friedman, Richard Sackler’s deputy, said that Purdue first became aware of problems with OxyContin only in April, 2000, after a series of press reports about people abusing it recreationally in Maine. But Purdue didn’t need the media’s help to know that something was seriously off with the distribution of OxyContin. For years, it had maintained a contract with I.M.S., a little-known company, co-founded by Arthur Sackler, that furnished its clients with fine-grained information about the prescribing habits of individual doctors. Purdue’s sales representatives used the data to figure out which doctors to target.
Such data could also be used to track patterns of abuse. “They know exactly what people are prescribing,” Kolodny said. “They know when a doctor is running a pill mill.” At the 2001 hearing, James Greenwood, a Pennsylvania congressman, asked Friedman whether Purdue would take any action if, say, I.M.S. data revealed that a rural osteopath was writing thousands of prescriptions.
Friedman replied that it was not up to Purdue to assess “how well a physician practices medicine.”
“Why do you want that information, then?” Greenwood pressed, before answering his own question: “To see how successful your marketing techniques are.”
Greenwood then observed that, in a recent case involving a Pennsylvania doctor, Richard Paolino, who was wantonly overprescribing OxyContin, a local pharmacist had alerted the authorities. “He looked at this data and he said, ‘Holy God, there is some guy in Bensalem called Paolino, and he’s writing prescriptions out the wazoo,’ ” Greenwood said. “Now, he had that data and he blew the whistle. And you had that data. What did you do?”
Purdue had not alerted the authorities. Clinicians like Paolino were breaking the law—he was sentenced to a minimum of thirty years in prison. But overprescribing generated tremendous revenue for the company. According to four people I spoke with, at Purdue such prescribers were given a name that Las Vegas casinos reserve for their most prized gamblers: whales.
In July, 2001, Richard Blumenthal, who was then the attorney general of Connecticut, wrote to Richard Sackler. “I have been increasingly dismayed and alarmed about the problems and escalating abuse of OxyContin,” he began, citing overdose deaths, addiction, pharmacy robberies, and “the astonishing growth in state funding” that was being used to pay for OxyContin prescriptions through Medicaid and Medicare. Blumenthal acknowledged that other prescription drugs were also abused. “But OxyContin is different,” he wrote. “It is more powerful, more addictive, more widely sold, more illicitly available, and more publicized.” He urged Purdue to “overhaul and reform” its marketing of OxyContin.
The Sacklers disregarded his recommendation, and so in 2004 Blumenthal filed a complaint against Purdue, on behalf of the State of Connecticut. It cited data indicating that a fifth of OxyContin prescriptions were now for dosing intervals shorter than twelve hours. In fact, Blumenthal obtained Purdue records indicating that company officials knew by 1998 that prescriptions for eight-hour intervals were becoming more and more frequent. In one document, a Purdue employee called the numbers “very scary.”
Such alarm over off-label dosing may have been prompted less by concern about public health than by considerations of profit. If OxyContin was being widely prescribed at intervals of fewer than twelve hours, the company might lose its “two pills a day” marketplace advantage against cheaper alternatives, like generic morphine, and insurers could start refusing to cover the costs. As early as 1997, some benefit plans had begun citing abuse of OxyContin as an excuse not to pay. In a 1997 e-mail, Richard Sackler urged colleagues to counter this resistance, warning that, for insurance companies, “ ‘addiction’ may be a convenient way to just say ‘NO.’ ”
Purdue has been sued thousands of times over OxyContin since its release. (Steven May, the sales rep, initiated a whistle-blower suit years after leaving the company; it was dismissed, on procedural grounds.) In 2002, Howard Udell said that the firm would defend itself “to the hilt.” The next year, a New York trial lawyer named Paul Hanly assembled a lawsuit, signing up five thousand patients who said that they’d become addicted to OxyContin after receiving a doctor’s prescription. In discovery, Hanly obtained thousands of documents. “They demonstrated that this company had set out to perpetrate a fraud on the entire medical community,” he told me. “These pronouncements about how safe the drug was emanated from the marketing department, not the scientific department. It was pretty shocking. They just made this stuff up.”
In 2006, Purdue settled with Hanly’s clients, for seventy-five million dollars. Shortly afterward, the company pleaded guilty, in a case brought by federal prosecutors in Virginia, to criminal charges of misbranding, and acknowledged that Purdue had marketed OxyContin “with the intent to defraud or mislead.” (Rudolph Giuliani had tried, on Purdue’s behalf, to get the lead prosecutor to scuttle the case.) Michael Friedman, the executive vice-president, pleaded guilty to a criminal misdemeanor, as did Howard Udell and the company’s chief medical officer, Paul Goldenheim.
Marianne Perez attended the sentencing, in Virginia. “I was on cloud nine,” she recalled. She had been working with the prosecution, and doing everything she could to inform the public about the dangers of OxyContin. Before the sentence was handed down, Perez delivered a victim-impact statement. “I want to know why the Sackler brothers have not been held accountable,” she said. (Richard Sackler, despite his leadership role at Purdue, had not been charged.)
During a break in the proceedings, Perez looked over at Friedman, Goldenheim, and Udell, and told herself, “I could reach over, at ninety-eight pounds, and smack one of them.” This time, she restrained herself. Instead, she told them, “You are sheer evil. You are bastards.” The executives reddened, but said nothing. They all received probation, and were ordered, collectively, to pay nearly thirty-five million dollars in fines. Purdue agreed to pay an additional six hundred million. Given the billions of dollars that the Sacklers and Purdue had reaped from OxyContin, some observers felt that the company had got off easy. Arlen Specter, the Republican senator from Pennsylvania, remarked that such fines amounted to “expensive licenses for criminal misconduct.”
Arthur Sackler wrote a regular column for the Medical Tribune, and one of his fixations was the unethical behavior of tobacco companies. In 1979, he critiqued the “weasel-worded warning” on cigarette packages as insufficient, arguing that the “hazard to health should be more specific.” He also condemned newspapers and magazines for accepting “misleading” advertising about cigarettes, and contended that the publishers must “square with their own consciences their contribution to our national mortality.”
In 1998, the tobacco industry, which had been sued by dozens of states, entered into the largest civil-litigation settlement in history, agreeing to pay two hundred and forty-six billion dollars. Tobacco and opioids are different in significant ways. The F.D.A. approved OxyContin as a medicine, and, whereas tobacco can kill you even when used as directed, Purdue would argue that this isn’t the case with OxyContin. Mike Moore, who, as Mississippi’s attorney general, played a key role in the tobacco litigation, noted another difference: the tobacco companies had more money to spare than Purdue does. “To resolve the opioid problem, you’re going to need billions,” he said. “Treatment alone could be fifty billion dollars or more. And you need prevention and education programs on top of that.”
Moore is now working with Paul Hanly and other attorneys to bring a fresh wave of lawsuits against Purdue and other pharmaceutical companies. Ten states have filed suits, and private attorneys are working in partnership with dozens of cities and counties to bring others. Many public officials are furious at the makers of powerful painkillers. Prescriptions are expensive, and taxpayers often foot the bill, through programs like Medicaid. Then, as the ruinous consequences of opioid addiction take hold, the public must pay again—this time for emergency services, addiction treatment, and the like. Moore feels that the Sackler family, as the initial author and a prime beneficiary of the epidemic, should be publicly shamed. “I don’t call it Purdue. I call it the Sackler Company,” he said. “They are the main culprit. They duped the F.D.A., saying it lasted twelve hours. They lied about the addictive properties. And they did all this to grow the opioid market, to make it O.K. to jump in the water. Then some of these other companies, they saw that the water was warm, and they said, ‘O.K., we can jump in, too.’ ” There may be significant legal distinctions between a tobacco company and an opioid producer, but to Moore the ethical parallel is unmistakable: “They’re both profiting by killing people.”
One day in August, 2015, a plane landed in Louisville, Kentucky, and Richard Sackler stepped out, surrounded by attorneys. Eight years earlier, the State of Kentucky had sued Purdue, charging the company with deceptive marketing. Greg Stumbo, the state attorney general at the time, initiated the suit; the son of a cousin of his had fatally overdosed on OxyContin. Purdue fought the suit with its customary rigor, pushing to move the proceedings elsewhere, on the ground that the company could not get a fair trial in Pike County, Kentucky—the rural stretch of coal country where the state intended to try the case. In support of this motion, the company commissioned a demographic study of Pike County and submitted it to the court, as an illustration of potential bias in the jury pool. The report was revealing in ways that Purdue may not have intended: according to the filing, twenty-nine per cent of the county’s residents said that they or their family members knew someone who had died from using OxyContin. Seven out of ten respondents described OxyContin’s effect on their community as “devastating.”
A judge ruled that Purdue could not shift the venue for the trial, and so Richard Sackler flew to Louisville. He gave a deposition at a law firm. Four lawyers questioned him about his role in the development and the marketing of OxyContin. Tyler Thompson, the lead attorney, told me that Sackler’s demeanor during the session reminded him of Jeremy Irons’s portrayal of Claus von Bülow, the aristocrat accused of murdering his wife, in the 1990 bio-pic “Reversal of Fortune.” “A smirk and a so-what attitude—an absolute lack of remorse,” Thompson said. “It reminded me of these mining companies that come in here and do mountaintop removal, and leave a mess and just move on: ‘It’s not my back yard, so I don’t care.’ ” Mitchel Denham, a former litigator in the Kentucky attorney general’s office, also attended the deposition. “It was surreal,” he recalled. “We were face to face with the guy whose company had helped to create the opioid epidemic.” Denham told me that, in preparing for trial, he discovered a photograph of the 1997 Pikeville High School football team. “Nearly half the players had died of overdoses, or were addicted,” he said. “It was going to be a pretty good visual.”
But Denham never presented the photograph to a jury, because before the case could go to trial Purdue settled, for twenty-four million dollars. This was a coup for the Sacklers. The settlement was more than Purdue’s original offer—half a million dollars—but still totally incommensurate with Pike County’s needs; Purdue admitted no liability; and, in settling, the company sealed from public view both Richard Sackler’s deposition and internal documents obtained through discovery. Purdue has sometimes claimed to have never “lost a case” related to OxyContin, but it’s more accurate to say that the company has never allowed a case to go to trial, often settling rather than litigating the culpability of the company—and the Sacklers—in open court. “That’s the main reason these folks don’t go to trial,” Denham said. “Because all these documents could end up in the public record.” The Kentucky prosecutors were required to destroy millions of documents, or return them to Purdue. The medical-news Web site STAT subsequently sued to unseal Richard Sackler’s deposition. A state judge ruled in its favor, but Purdue appealed. I spent several months trying to obtain a copy of the deposition, but, because it remains under a protective order while Purdue appeals the matter, no lawyer would share it with me. Mike Moore said, “The idea that they’re fighting so hard to keep this deposition hidden should tell you something.
Richard Sackler stepped down as Purdue’s president in 2003, but stayed on as co-chairman of the company’s board. After spending several years as an adjunct professor of genetics at Rockefeller University, he moved to Austin, Texas, in 2013. He lives in a modern hilltop mansion on the outskirts of the city, in an area favored by tech entrepreneurs. According to tax disclosures from his personal foundation, he has continued giving money to Yale, but his largest donation in 2015 was a hundred-thousand-dollar gift to a neoconservative think tank, the Foundation for Defense of Democracies. Through a representative, Sackler declined to speak with me. I contacted a dozen other members of the Sackler family, but none of them would answer questions about OxyContin. Jo Sheldon, a London-based media adviser, called me, and said that she works with some of the Sacklers. (She would not identify which ones.) When I told her that I had questions for the Sacklers, she said that my inquiries would be better directed to Purdue. She said of the Sacklers, “Some of them are still quite involved in Purdue, but some have absolutely nothing to do with it,” apart from depositing checks.
Given the sometimes fractious nature of the Sackler family, it was striking that they were united in their silence on the subject of OxyContin. These were urbane, expensively educated, presumably well-informed people. Could they conceivably be unaware of the accumulated evidence about the tainted origins of their fortune? Did they simply put it out of mind? “Greed can get people to rationalize pretty bad behavior,” Andrew Kolodny had told me. Someone who knows Mortimer, Jr., socially told me, “I think for him, most of the time, he’s just saying, ‘Wow, we’re really rich. It’s fucking cool. I don’t really want to think that much about the other side of things.’ ”
Paul Hanly, the lawyer, said that the Sacklers’ steadfast refusal to address the legacy of OxyContin may just be a legal tactic—and a shrewd one. “The more interviews you give, the more targets you create for lawyers like me, and for government investigators,” he said. I wondered whether philanthropy might represent, for at least some of the Sacklers, a form of atonement. But, when you consider the breadth of the family’s donations, one field is conspicuously lacking: addiction treatment, or any other measures that might serve to counter the opioid epidemic.
In August, 2010, Purdue quietly replaced OxyContin with a drug that was subtly different. The company had been granted patents for a reformulated version of OxyContin. If you crushed these new pills, they became not a fine, dissolvable powder but an unwieldy gummy substance. Purdue had received F.D.A. approval for the reformulation, in part, by touting the ostensible safety of the new product. The F.D.A. had approved a label, the first of its kind, that included a claim about the drug’s “abuse deterrent” properties.
In an interview, Craig Landau, Purdue’s C.E.O., told me, “A very large proportion of Purdue’s R. & D. efforts post-2001 was dedicated toward addressing the specific vulnerability of the original OxyContin product.” To a casual observer, it might have seemed that the makers of OxyContin, after years of obstructing efforts to curb the disastrous impacts of their painkiller, had finally seen the error of their ways. But Purdue was almost certainly motivated by another consideration: it needed to block competition from generic drugs. Arthur Sackler had often used the pages of the Medical Tribune to criticize generics. In 1985, the paper had published a story, “Schizophrenics ‘Wild’ on Weak Generic,” describing how “all hell broke loose” at a veterans’ hospital after the psychiatric unit switched from a brand-name antipsychotic to a generic. (According to the Times, the F.D.A. investigated and found that the story was bogus, because “the generic had been introduced six months before the purported problems began.”) I spoke with a leading patent lawyer who frequently represents manufacturers of generic drugs, and she said that companies often make a minor tweak to a branded product shortly before the patent expires, in order to obtain a new patent and reset the clock on their exclusive right to produce the drug. The patent for the original OxyContin was set to expire in 2013.
Purdue had long denied that the original OxyContin was especially prone to abuse. But, upon receiving its patents for the reformulated drug, the company filed papers with the F.D.A., asking the agency to refuse to accept generic versions of the original formulation—because they were unsafe. The F.D.A., ever obliging, agreed, blocking any low-cost generic competition for Purdue. For more than a year, Purdue continued to sell the original formulation of OxyContin in Canada. According to a recent study, OxyContin sales in Windsor, Ontario—just across the border from Detroit—suddenly quadrupled, a clear indication that the pills were being purchased for the U.S. black market. Through I.M.S. tracking data, Purdue would have been able to monitor the Canadian surge, and to deduce the reason for it. (The company acknowledges that it was aware of the spike in sales, and maintains that it alerted authorities, but will not say when it did so.)
By the time Purdue reformulated OxyContin, the country was in the middle of a full-blown epidemic. Andrew Kolodny, the addiction specialist, told me that many older people remain addicted to the reformulated OxyContin, and continue to obtain the drug through prescriptions. These people purchase the drug legally, and swallow the pills whole, as instructed. “That’s Purdue’s market now,” Kolodny said. Younger people, who can less readily secure prescriptions for pain—and for whom OxyContin may be too expensive—have increasingly turned to black-market substitutes, including heroin. As Sam Quinones details in his 2015 book, “Dreamland: The True Tale of America’s Opiate Epidemic,” heroin dealers from Mexico fanned out across the U.S. to supply a burgeoning market of people who had been primed by pill addiction. This is one dreadful paradox of the history of OxyContin: the original formulation created a generation addicted to pills; the reformulation, by forcing younger users off the drug, helped create a generation addicted to heroin. A recent paper by a team of economists, citing a dramatic uptick in heroin overdoses since 2010, is titled “How the Reformulation of OxyContin Ignited the Heroin Epidemic.” A survey of two hundred and forty-four people who entered treatment for OxyContin abuse after the reformulation found that a third had switched to other drugs. Seventy per cent of that group had turned to heroin.
Perhaps the most surprising aspect of Quinones’s investigation is the similarities he finds between the tactics of the unassuming, business-minded Mexican heroin peddlers, the so-called Xalisco boys, and the slick corporate sales force of Purdue. When the Xalisco boys arrived in a new town, they identified their market by seeking out the local methadone clinic. Purdue, using I.M.S. data, similarly targeted populations that were susceptible to its product. Mitchel Denham, the Kentucky lawyer, told me that Purdue pinpointed “communities where there is a lot of poverty and a lack of education and opportunity,” adding, “They were looking at numbers that showed these people have work-related injuries, they go to the doctor more often, they get treatment for pain.” The Xalisco boys offered potential customers free samples of their product. So did Purdue. When it first introduced OxyContin, the company created a program that encouraged doctors to issue coupons for a free initial prescription. By the time Purdue discontinued the program, four years later, thirty-four thousand coupons had been redeemed.
Purdue Pharma now acknowledges that there is an opioid crisis, but maintains that it has taken every available step to address it, from sponsoring “prescription monitoring” programs in some states to underwriting drug-abuse education. Craig Landau, the C.E.O., told me, “If the Holy Grail is a pain medicine that is safe and effective for patients with severe pain but carries no abuse risk, we haven’t found it yet.” He added that the company has been trying to develop “non-opioid pain products.” Purdue likes to emphasize that there are many other powerful painkillers, and that OxyContin never had more than two per cent of the market for opioids. This is true in terms of the number of prescriptions. But most painkillers are prescribed for very short periods—following surgery, for instance—and in relatively small doses, whereas OxyContin’s sales have been driven by long-term, high-dose prescriptions. If one measured market share by the actual volume of narcotics administered, OxyContin’s would be considerably higher. Some doctors I spoke with estimated that it could be as high as thirty per cent.
The United States accounts for roughly a third of the global market for opioid painkillers. But, as politicians and journalists have raised alarms over the addiction crisis, many American doctors have grown leery, again, of prescribing these drugs. In a statement, Purdue acknowledged that even patients “who take OxyContin in accordance with its F.D.A.-approved labeling instructions will likely develop physical dependence.” The company maintains that physical dependence is different from addiction, but Jane Ballantyne, the president of Physicians for Responsible Opioid Prescribing, said that, for patients, this can be a meaningless distinction: if they find themselves unable to stop taking a drug, for fear of crippling withdrawal, “at a certain point that might as well be addiction.” The drugstore chain CVS, which has been accused of profiteering from opioids, recently announced that it plans to limit prescriptions for powerful doses to one week’s worth, a change that could have a major impact on the abuse of these drugs. It may also be that OxyContin has achieved market saturation. In recent years, American clinicians have issued about a quarter of a billion opioid prescriptions annually. Last year, in Ohio, a state particularly hard hit by the epidemic, 2.3 million residents—roughly one in five people in the state—received a prescription for opioids. In 2012, the Milwaukee Journal Sentinel published a story about pain patients who had offered testimonials about the wonders of OxyContin in Purdue promotional videos. Johnny Sullivan, the construction worker who had talked about OxyContin easing his back pain, became addicted to the drug. In 2008, while driving home from a hunting trip, he apparently blacked out; he flipped his truck, and died instantly. In a Purdue brochure, Sullivan is quoted as saying that OxyContin pills “don’t put me in a stupor or make me groggy.”
David Juurlink, the Toronto doctor, told me that opioids are problematic even for users who don’t succumb to addiction. “Opioids really do afford pain relief—initially,” he said. “But that relief tends to diminish over time. That’s, in part, why people increase the dose. They are chasing pain relief from a drug that has failed. I see all these people who are convinced they are one of the ‘legitimate’ pain patients. They’re on a massive dose of opioids, and they’re telling me they need this medication, which is clearly doing them harm. For many of them, the primary benefit of therapy, at this point, is not going into withdrawal.”
Even Russell Portenoy, the Purdue-funded doctor who advocated for wider long-term use of opioids, has reassessed his views. “Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation?” he said to the Wall Street Journal in 2012. “I guess I did.” (In a statement, Portenoy told me that he has “refocussed” his approach to pain management, adding, “No funder has had any undue influence over my thinking.”)
In his defense, Portenoy has pointed out that, two decades ago, doctors did not know what they know now about opioids and addiction. The Sackler family and Purdue Pharma could have taken responsibility in a similar spirit: apologizing for their role in unleashing a national catastrophe while noting that, during the nineties, they had relied on a series of mistaken assumptions about the safety of OxyContin. But Purdue has continued to fight aggressively against any measures that might limit the distribution of OxyContin, in a way that calls to mind the gun lobby’s resistance to firearm regulations. Confronted with the prospect of modest, commonsense measures that might in any way impinge on the prescribing of painkillers, Purdue and its various allies have responded with alarm, suggesting that such steps will deny law-abiding pain patients access to medicine they desperately need. Mark Sullivan, a psychiatrist at the University of Washington, distilled the argument of Purdue: “Our product isn’t dangerous—it’s people who are dangerous.”
Last year, the C.D.C., which formally declared an opioid epidemic in 2011, introduced the first set of guidelines to help reduce the prescribing of strong painkillers like OxyContin. “Opioids should not be considered first-line or routine therapy for chronic pain,” the guidelines said, recommending that doctors first consider “non-pharmacologic” approaches, such as physical therapy, and “non-opioid pharmacologic” treatments.
Purdue and other pharmaceutical companies have long funded ostensibly neutral nonprofit groups that advocate for pain patients. The C.D.C. guidelines were nonbinding, yet many of these organizations fought to prevent the agency from releasing them. This kind of obstruction is typical at both the state and the federal level. A recent series by the Associated Press and the Center for Public Integrity revealed that, after Purdue made its guilty plea, in 2007, it assembled an army of lobbyists to fight any legislative actions that might encroach on its business. Between 2006 and 2015, Purdue and other painkiller producers, along with their associated nonprofits, spent nearly nine hundred million dollars on lobbying and political contributions—eight times what the gun lobby spent during that period.
Since Purdue made it more difficult to grind OxyContin pills, prescriptions have reportedly plummeted by forty per cent. This suggests that nearly half of the original drug’s consumers may have been crushing it to get high. As David Juurlink pointed out to me, it is a misnomer to call the reformulation an “abuse deterrent.” It can still be abused—and is, widely, by people who become addicted by swallowing the pills, just as the bottle instructs. But Purdue, facing a shrinking market and rising opprobrium, has not given up the search for new users. In August, 2015, over objections from critics, the company received F.D.A. approval to market OxyContin to children as young as eleven.
Forbesestimates that the Sacklers continue to receive some seven hundred million dollars a year from the family companies, and, as the Sacklers are surely aware, the real future of OxyContin may be global. Many big companies, once their sales plateau in America, look abroad. After introducing OxyContin in the U.S., Purdue moved into Canada and England. At the University of Toronto, the company sponsored a class on pain management for medical and dental students. The instructor was a member of Purdue’s speakers’ bureau. Students received a complimentary textbook, produced by Purdue, that described oxycodone as a “moderate” opioid. The course was discontinued after students and doctors criticized it; one of the critics was Rick Glazier, a physician at the university, whose son, Daniel, had fatally overdosed on OxyContin in 2009.
As OxyContin spread outside the U.S., the pattern of dysfunction repeated itself: to map the geographic distribution of the drug was also to map a rash of addiction, abuse, and death. But the Sackler family 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. As Purdue moves into countries like China and Brazil, where opioids may still retain the kind of stigma that the company so assiduously broke down in the United States, its marketing approach has not changed. According to a Los Angeles Times report from 2016—well after the Sacklers’ playbook for OxyContin had been repudiated by the medical establishment as possibly the main driver of the opioid epidemic—Mundipharma commissioned studies showing that millions of people in these countries suffered from chronic pain. The company has organized junkets, and paid doctors to give presentations extolling OxyContin’s virtues. In fact, certain doctors who are currently flogging OxyContin abroad—“pain ambassadors,” they are called—used to be on Purdue’s payroll as advocates for the drug in the U.S.
The Times report described Joseph Pergolizzi, Jr.—a Florida doctor who runs a pain-management clinic and hawks a pain-relieving cream of his own invention on cable TV—giving paid talks in places like Brazil about the merits of OxyContin. 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 term “opiophobia” has largely fallen into disuse in America, for obvious reasons. Mundipharma executives still use it abroad.
“It’s a parallel to what the tobacco industry did,” Mike Moore told me. “They got caught in America, they saw their market share decline, so they export it to places with even fewer regulations than we have.” He added, “You know what’s going to happen. You’re going to see lots and lots of death.” In May, several members of Congress wrote to the World Health Organization, urging it to help stop the spread of OxyContin, and mentioning the Sackler family by name. “The international health community has a rare opportunity to see the future,” they wrote. “Do not allow Purdue to walk away from the tragedy they have inflicted on countless American families simply to find new markets and new victims elsewhere.” David Kessler, the former F.D.A. commissioner, believes that the destigmatization of opioids in the U.S. represents one of the “great mistakes” of modern medicine. When I asked for his thoughts on Mundipharma’s efforts to market OxyContin abroad, he said, “It gives me a sick feeling. It makes me ill.”
Earlier this year, Peter Salovey, the president of Yale, announced that the university will rename a residential college that was named for John C. Calhoun, because Calhoun’s “legacy as a white supremacist and a national leader who passionately promoted slavery as a ‘positive good’ fundamentally conflicts with Yale’s mission and values.” This move, which was not without its critics, was emblematic of a broader trend to look back skeptically at individuals who were venerated in earlier epochs, and ask how they should be judged by the moral standards of today. At Oxford, a Rhodes Scholar from South Africa recently led a campaign to take down a statue of Cecil Rhodes.
One great fortune—and reputation—that has evaded such scrutiny is that of the Sacklers, a family whose dubious business practices are not an artifact of previous centuries but an ongoing reality. If present statistics are any indication, in the time it likely took you to read this article six Americans have fatally overdosed on opioids. Yet Yale appears to be in no hurry to rename its Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, or its Richard Sackler and Jonathan Sackler Professorship of Internal Medicine. Perhaps it’s because the Sacklers, unlike the Calhoun family, still have a fortune to give away.
“It’s amazing how they are left out of the debate about causation, but also about solutions,” Allen Frances, the Duke psychiatrist, said of the Sacklers. “A truly philanthropic family, looking at the last twenty years, would say, ‘You know, there’s several million Americans who are addicted, directly or indirectly, because of us.’ Real philanthropy would be to contribute money to taking care of them. At this point, adding their name to a building—it rings hollow. It’s not philanthropy. It’s just a glorification of the Sackler family.” According to the American Society of Addiction Medicine, more than two and a half million Americans have an opioid-use disorder. Frances continued, “If the Sacklers wanted to clear their name, they could take a very substantial fraction of that fortune and create a mechanism for providing free treatment for everyone who’s become addicted.” Alfred Nobel, the inventor of dynamite, created the Nobel Peace Prize. In recent years, several philanthropic organizations run by the descendants of John D. Rockefeller have devoted resources to addressing climate change and critiquing the environmental record of the oil company he founded, now called ExxonMobil. Last year, Valerie Rockefeller Wayne told CBS, “Because the source of the family wealth is fossil fuels, we feel an enormous moral responsibility.”
Mike Moore, the former Mississippi attorney general, believes that the Sacklers will feel no pressure to emulate this gesture until more of the public becomes aware that their fortune is derived from the opioid crisis. Moore recalled his initial settlement conference with tobacco-company C.E.O.s: “We asked them, ‘What do you want?’ And they said, ‘We want to be able to go to cocktail parties and not have people come up and ask us why we’re killing people.’ That’s an exact quote.” Moore is puzzled that museums and universities are able to continue accepting money from the Sacklers without questions or controversy. He wondered, “What would happen if some of these foundations, medical schools, and hospitals started to say, ‘How many babies have become addicted to opioids?’ ” An addicted baby is now born every half hour. In places like Huntington, West Virginia, ten per cent of newborns are dependent on opioids. A district attorney in eastern Tennessee recently filed a lawsuit against Purdue, and other companies, on behalf of “Baby Doe”—an infant addict.
Purdue executives won’t be able to settle every case against them, Moore believes. “There’s going to be a jury somewhere, someplace, that’s going to hit them with the largest judgment in the nation’s history,” he said. Paul Hanly noted that, in the face of a crippling judgment, Purdue may have to declare bankruptcy. “But I’m certainly not going to walk away if they do,” he said. “At that point, I would start looking closely at individual liability on the part of the Sacklers.”
Robin Hogen, the former Purdue communications executive, said, “I don’t want to be portrayed as an apologist for what is clearly a public-health crisis. But I wanted to make sure you spoke to someone who had very high regard for the Sackler family. The Sacklers were first class in everything they did.” I asked him what he would say to the doctors and the public-health officials who believe that the heirs of Raymond and Mortimer Sackler bear some moral responsibility for the epidemic. “I’m not a doctor,” Hogen demurred. “I really can’t comment.”
The Sacklers have always excelled at the confidence game of marketing, and it struck me that the greatest trick they ever pulled was to write the family out of the history of the family business. I was reminded of Arthur Sackler’s admonition that you should endeavor to leave the world a better place than it was when you came into it, and I wondered about the moral arithmetic of the Sacklers’ deeds. But the family, through a Purdue representative, declined to comment.
I recently went to Amagansett, on Long Island, to meet a man I’ll call Jeff. At a restaurant, he told me about his struggles with addiction. A decade ago, when he was a teen-ager, he started abusing opioids. They were “everywhere,” he recalled. He particularly liked OxyContin, for the “clean high” it provided. After sucking the pill’s red coating off, he crushed the rest with the edge of a cigarette lighter, then snorted it. He didn’t inject it. “When I was growing up, I always told myself, ‘I’ll never stick a needle in my arm,’ ” he said.
In a soft, unflinching tone, Jeff recounted the next decade of his life: he kept abusing painkillers, met a woman, fell in love, and introduced her to opioids. One day, his dealer was out of pills and said, “I’ll sell you a bag of heroin for twenty bucks.” Jeff was reluctant, but when withdrawal set in he acquiesced. At first, he and his girlfriend snorted heroin. “But you build up a tolerance, just like with the pills,” he said, and eventually they started injecting it. They were high when they got married. Jeff’s wife gave birth to a boy, who was addicted to opioids. “The doctors weaned him off with droplets of morphine,” he said.
After a long stretch in rehab, Jeff has been sober for more than a year. His baby is healthy, and his wife is clean, too. Looking back, he said, he feels that an impulsive youthful decision to snort pills set him on a path from which he could not deviate. “It was all about the drug,” he said. “I just created a hurricane of destruction.”
We left the restaurant and strolled along a leafy side street flanked by grand houses. During the worst years of his addiction, Jeff worked as a tradesman in the area. I had asked him to show me a property that he had serviced, and we stopped outside a sprawling estate that was mostly hidden behind dense shrubbery. It was the home of Mortimer Sackler, Jr. Jeff, who knew about the family, appreciated the irony. “I couldn’t tell you how many times I was on that property, sitting in a work truck, snorting a pill,” he said.
We reached an ornamental wooden gate, beyond which was a yard dominated by a stately weeping willow. As I was admiring the tree, Jeff said that, for the people who maintained the grounds, it was “a pain in the ass.” Whenever the wind picks up, he explained, branches break and scatter all over the lawn. “But the place has to be flawless,” he said. “There can’t be a leaf on the ground.” So a crew comes by regularly, to clear away the mess. ♦
The Sackler Drug Rehab Facility, unlike the prestigious Sackler art galleries of New York and London does not exist. Yet.
If lawyers have their way, however, or public opinion pricks a few consciences, it may soon.
The Sackler family, a sprawling and now feuding transatlantic dynasty, is famous in cultural and academic circles for decades of generous philanthropy towards some of the world’s leading institutions, from Yale University to the Guggenheim Museum in the US and the Serpentine Gallery to the Royal Academy in Britain.
But what’s less well known, though increasingly being exposed, is that much of their wealth comes from one product – OxyContin, the blockbuster prescription painkiller first launched in 1996.
The pill is stronger than morphine and sparked the opioid crisis that’s now killingmore than 100 people a day in America and has spawned millions of addicts. It’s also attracted a wave of lawsuits alleging ongoing deception about the safety of OxyContin, which the company had previously admitted misbranding in a 2007 criminal case.
Two branches of the family control Purdue Pharma, which makes OxyContin but, unlike their company, none of the Sacklers are personally being sued over it.
Lawyers hope that might be about to change, however, as litigation engulfs the company, and the effects may end up rippling all the way to the society circles and venerable arts and science institutions where the billionaires spend the proceeds. What some call philanthropy, others, such as Stanford University ethics professor Rob Reich, call “reputation laundering”.
“The Sacklers have not been named as defendants but I know several of the firms working on these cases are doing a really deep dive to make that happen, working very hard to break through the corporate veil so they can name the owners,” Mike Moore, the former Mississippi attorney general told the Guardian. He’s one of the key attorneys in litigation brought by several states against Purdue and other pharmaceutical firms, collectively nicknamed Big Pharma.
“Greed is the main thing. The market for OxyContin should have been much, much smaller, but they wanted to have a $10bn drug and they didn’t tell the truth about their product,” he added.
Meet the Sacklers
The grandparents
Isaac Sackler and Sophie Greenberg
Jewish immigrants who arrived in New York before first world war. They had three sons...
First son
Arthur
His four children
Elizabeth Sackler
Dr Carol Master
Arthur Felix Sackler
Denise Marica
Died 1987 at 73 before OxyContin was invented and his heirs have not benefited from its sale. His third wife, Dame Jillian Sackler is active on the philanthropy circuit
Benefactor of the Elizabeth A. Sackler Center for Feminist Art at the Brooklyn Museum. Elizabeth has distanced her branch of the family from her uncles and cousins and called their OxyContin wealth ‘morally abhorrent’
Second son
Mortimer
His seven children
Three are board members of Purdue Pharma
Ilene Sackler Lefcourt
Director of Sackler Lefcourt Center
Kathe
Sackler
Founder of Acorn Foundation
Mortimer David Alfons Sackler
Samantha Sophia Sackler Hunt
Married to co-founder of Seattle Coffee Company
Died 2010 at 93, former chief executive of Purdue Pharma. His third wife, Dame Theresa Sackler is active on the philanthropy circuit
Michael Sackler
Film producer, founder of Rooks Nest Ventures
Sophie Sackler
Married to England cricketer Jamie Dalrymple
Marissa Sackler
Well known on the arts charity circuit
Third son
Raymond
His two children and one of his grandchildren
Are board members of Purdue Pharma
Jonathan
Sackler
Richard Sackler
Former president and co-chairman of Purdue Pharma
David Sackler
Raymond’s grandson. Son of Richard
Died 2017 at 97, former chief executive of Purdue Pharma. His wife Beverly Sackler, 93, was a board member until recently
