A pill "kills" nearly a million people, and the mastermind behind it remains unscathed?

On October 29th, Matthew Perry, who portrayed Chandler in "Friends," was found dead in his bathtub at home. Local authorities stated that no drugs were found at the scene, and there were no signs of "harm caused by others." However, Matthew had struggled with substance addiction during his lifetime. In 1997, after an accident left him injured, doctors prescribed him a large amount of the painkiller OxyContin to alleviate his pain. Unfortunately, this led him into a downward spiral.

All of this traces back to one company - Purdue Pharma.

Insanely Ruthless Marketing Tactics

In 1952, the Sackler family acquired a pharmaceutical factory in Wisconsin, renaming it Purdue Pharma. The company primarily produced analgesics such as hydromorphone, hydrocodone, fentanyl, codeine, and oxycodone, and developed various (pseudo) opioid analgesic extended-release medications such as MS Contin and OxyContin.

MS Contin, Purdue Pharma's first (pseudo) opioid analgesic extended-release medication, brought in 25% of the company's sales profits. However, it was strictly limited to use as a surgical analgesic and cancer pain reliever, with significant restrictions on its use. Facing the expiration of the patent for MS Contin, the Sackler family decided to develop a new opioid. They set their sights on oxycodone, a synthetic opioid created in 1916.

Around 1939, oxycodone entered the United States and became a commonly used oral analgesic. Purdue Pharma was attracted not only to oxycodone's simple synthesis but also its low cost. Thus, the oral extended-release form of oxycodone, OxyContin, was introduced. However, due to OxyContin being an opioid, its use faced strict limitations, and the conventional marketing approach was not effective.

"Do not limit your thinking too much; the market needs to find its own creative solutions," said Arthur Sackler. Consequently, the Sackler family began an extensive campaign, spending massive amounts to bribe relevant individuals and facilitate the release of OxyContin.

In a clinical trial involving elderly patients with osteoarthritis, designed to test the safety and efficacy of OxyContin, 133 patients were recruited, but only 63 completed the trial. Approximately 82% of patients experienced some adverse events related to the treatment. Despite this, Purdue University concluded that the study "indicated that OxyContin is a safe and effective analgesic for controlling osteoarthritis-related pain."

When OxyContin entered the market in 1996, the FDA approved its original label, stating that if opioid drugs were legally used for pain management, iatrogenic addiction was "extremely rare." Thus, OxyContin was successfully approved.

You may be familiar with the pharmaceutical representative marketing model, but do you know which company originated it? Yes, it is Purdue Pharma. In the early stages of the pharmaceutical industry, companies primarily promoted their products to the entire society through extensive advertising, a business-to-consumer (B2C) marketing approach. Purdue Pharma, however, directly broke the rules. Pharmaceutical representatives "went to great lengths" to gain the trust of doctors, using their reputation and prestige in local communities to endorse and sell specific drugs to the local population.

Essentially, the pharmaceutical representative model is a business-to-business (B2B) sales method. Through communication and the exchange of benefits, pharmaceutical representatives gradually transform numerous doctors and pharmacy owners into "salespeople" for pharmaceutical companies.

Upon the introduction of OxyContin, Purdue Pharma's more than 700 pharmaceutical representatives across the country used various methods to financially support and recruit doctors in their respective regions. Their common argument was that "extended-release products like OxyContin are less prone to addiction, abuse, or diversion compared to other opioid analgesics."

In the TV series "Dosed Amounts," pharmaceutical representatives spared no effort in promoting their products. In 2001, the average annual salary for pharmaceutical representatives reached a staggering $55,000, with an average year-end bonus of $71,500, ranging from $15,000 to nearly $240,000.

According to a survey by Boston Medical Center and NYU School of Medicine, from 2013 to 2015, pharmaceutical companies provided nearly $40 million in subsidies to nearly 70,000 doctors across the United States, citing expenses such as meals, travel, and consulting fees.

Distribution of OxyContin, hydrocodone (excluding OxyContin), and hydromorphone per 100,000 population in Virginia in 2000:

It is not difficult to see from this chart that Purdue Pharma's marketing of their cash cow drug OxyContin was quite "successful," and their methods were indeed extreme.

The "Cost" of "Joy"

In 1999, 16-year-old Lindsay tried this drug for the first time. She watched as her friends tossed a blue pill into their mouths, held it for a few minutes, spat it out, wiped it on their T-shirts, wrapped it in a piece of paper folded into a small triangle, put it in their mouths, bit down hard, and then poured the crushed pill powder onto a CD case. Lindsay imitated them, took a hit, and the initial attempt didn't get her high. So, she purchased OxyContin on the black market and crushed the pills to snort them.

Initially, Lindsay felt nauseous and wanted to vomit, but the feeling quickly passed. The drug's effects relaxed her muscles, and a warm rush surged through her entire body. All tension and worries evaporated, and everything in the world had never given her this kind of sensation.

Lindsay is a character in Barry Meier's book, "Pain Killer: An Empire of Deceit and the Origin of America's Opioid Epidemic," and her story is more of a realistic portrayal than just a character.

According to a report by the Council on Foreign Relations, since 2000, over a million people in the United States have died from drug overdoses, and drug addiction has become a persistent epidemic, endangering public health and economic output. Data from the Centers for Disease Control and Prevention (CDC) shows that in 2022, over 109,600 people in the United States died from drug overdoses, setting a new record. Fortune magazine reported that the number of deaths from drug overdoses in the United States now exceeds the combined total of deaths from gun violence and car accidents.

The proliferation of drugs exacerbates various societal issues. Drug abuse causes damage to the brain, intensifies psychological anxiety and cognitive disorders among drug users, and can lead to mental illnesses, increased emotional volatility, triggering family crises, violent crimes, and psychological trauma. Additionally, it worsens intergenerational poverty and racial discrimination issues.

Legal Tug-of-War

Purdue Pharma's practices sparked widespread public protests, with continuous calls for legal action against the company.

New Hampshire initiated an investigation into opioid manufacturers in 2015, and in 2017 and 2019, the state separately filed lawsuits against Purdue Pharma and its owners, the Sackler family.

The charges claimed that the Sackler family guided Purdue Pharma's opioid sales strategies through fraudulent marketing activities, downplaying the health risks of opioid drugs and asserting that prescription drugs rarely caused abuse, addiction, or death. As opioid addiction surged, they reaped enormous profits. Subsequently, Purdue Pharma and the Sackler family faced lawsuits from eight other state attorneys general, accusing them of contributing to the opioid epidemic in the United States. In the end, Purdue Pharma pleaded guilty to three federal felonies through a settlement with the Justice Department.

Following this, Purdue Pharma filed for bankruptcy in the Southern District of New York in 2019. In 2021, the bankruptcy court approved a plan that required the Sackler family to pay $4.325 billion to various states, municipalities, and plaintiffs who sued the company within nine years. However, several state attorneys general, led by Attorney General Mefford, opposed the plan, arguing that the Sackler family's contribution was insufficient and that the plan would effectively force other states to waive all civil claims against the Sackler family.

As a result, a U.S. district court revoked Purdue Pharma's bankruptcy order, stating that the bankruptcy court lacked the authority to compel states to release claims against the Sackler family. The settlement was conditional on the bankruptcy court approving the modified bankruptcy plan.

In 2022, Purdue Pharma reached a settlement with nine state attorneys general, agreeing to increase the initial $4.5 billion compensation to $6 billion to secure approval for the bankruptcy application and thereby avoid the risk of being sued. However, on August 10 of the same year, the U.S. Supreme Court blocked Purdue Pharma's $6 billion bankruptcy settlement because the agreement granted the Sackler family immunity from civil lawsuits related to the opioid crisis.

This legal battle involving Purdue Pharma is expected to be protracted. Regardless of the outcome, Purdue Pharma has already considered its next steps and plans to reorganize as a company called Knoa Pharma, continuing its involvement in the production and sale of opioid drugs.

Reference sources

[1] https://www.purduepharma.com/restructure/

[2] https://edition.cnn.com/2023/08/10/politics/supreme-court-purdue-pharma-opioid-settlement/index.html

[3] https://www.statnews.com/2019/12/03/oxycontin-history-told-through-purdue-pharma-documents/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/

[5] https://www.pharmaceutical-technology.com/news/purdue-pharma-opioid-lawsuit-us/?cf-view

[6] https://zhuanlan.zhihu.com/p/652273539?utm_id=0

[7] https://zhuanlan.zhihu.com/p/634796459