As parents wrote to Purdue Pharma about their children who had died of OxyContin overdoses, and as federal prosecutors reported increases in deaths connected to the powerful opioid painkiller, Richard Sackler, a member of the family that founded the company that made the drug, had a plan for how to respond.
“We have to hammer on the abusers in every way possible,” Sackler wrote in a confidential email in 2001, as the opioid crisis was escalating and pressure was mounting on Purdue. “They are the culprits and the problem. They are reckless criminals.”
The email was obtained as part of a lawsuit Massachusetts Attorney General Maura Healey has filed against the company, in which she alleges Purdue deceived patients and doctors to get them to prescribe and take the addictive drug. Healey claims Purdue then pushed higher doses of OxyContin and provided misleading information about it. This, her office said, led doctors to keep patients on higher doses of the drug for longer periods, a situation that created enormous profits for Purdue and a staggering toll of addiction, abuse and death in Massachusetts.
Healey squarely blames the Sackler family for prioritizing profits over safety and responsibility, even as evidence mounted that OxyContin was fueling the opioid crisis.
“By their misconduct, the Sacklers have hammered Massachusetts families in every way possible. And the stigma they used as a weapon made the crisis worse,” Healey’s office wrote in a 312-page memo filed ahead of a Jan. 25 hearing, noting that the company has sold more than 70 million doses of opioids in Massachusetts since 2007, netting more than $500 million in revenue.
Opioids are now more likely to kill people than car crashes, according to the nonprofit National Safety Council. The epidemic started in the late 1990s when people became addicted to prescription painkillers such as OxyContin; after a crackdown on prescribing made the pills harder to obtain, users shifted to heroin and fentanyl, a synthetic opioid now driving overdose deaths.
Massachusetts and hundreds of other government entities are suing opioid manufacturers, including Purdue, as well as companies that distributed the drugs, claiming that they should pay for the damage the pills wrought.
The litigation is consolidated in a Cleveland courtroom, with all documents relating to the case under seal. But Purdue and Healey’s office reached a deal that included the release of the documents, the first time the public has been able to see internal emails and other records related to how Purdue marketed OxyContin and dealt with the growing problem of addiction and overdose death.
Purdue said in a statement Tuesday that the memo vilifies “a single manufacturer whose medicines represent less than 2 percent of opioid pain prescriptions.” It “irresponsibly and counterproductively” claims all OxyContin prescriptions are dangerous, Purdue said, “substituting its lawyers’ sensational allegations for the expert scientific determinations of the Food and Drug Administration” and ignoring people in chronic pain.
“The complaint is littered with biased and inaccurate characterizations of these documents and individual defendants, often highlighting potential courses of action that were ultimately rejected by the company,” Purdue said.
The filing shows a desire to sell OxyContin as an unregulated drug in certain countries and a family motivated by profit.
When the family held a party to announce the launch of OxyContin, Sackler told the crowd to imagine natural disasters, including a hurricane and a blizzard.
“The launch of OxyContin Tablets will be followed by a blizzard of prescriptions that will bury the competition,” Sackler said, according to an email message quoted in the documents. “The prescription blizzard will be so deep, dense, and white.”
Healey’s office wrote that the company’s “blizzard of dangerous prescriptions buried children and parents and grandparents across Massachusetts, and the burials continue.”
An employee told Sackler in 1999 that the company was making $20 million a week, according to the documents, and Sackler replied in an email that sales “were not so great.”
In 2007, Purdue paid $600 million in fines and its executives pleaded guilty to federal criminal charges for claiming the product was less addictive than other painkillers.
The complaint also alleges that Purdue targeted the state with a deceptive sales campaign, including claims that addiction to the drug is rare. Prosecutors wrote that to try to dispel doctors’ concerns that patients could become addicted, Purdue “peddled the false notion that patients suffered from ‘ “pseudoaddiction.’ ”
In 2010, the company put out a reformulated pill that was more difficult to crush and snort, an effort to defeat abuse of the drug. The following year, the filing said, the company continued to try to push sales of OxyContin, even as the Sacklers received a map showing the correlation between dangerous prescribers and poisonings, burglaries and robberies.
Healey alleges that Purdue pushed doctors to prescribe patients higher and higher doses of OxyContin, a move motivated by money.
In 2015, Healey’s office wrote, OxyContin’s prices rose as the dose increased; a bottle of 100 10-milligram tablets cost $269.17, while 100 80-mg tablets cost $1,500.18.
A year later, the Centers for Disease Control and Prevention announced guidelines aimed at reducing fatal overdoses, including urging doctors not to prescribe more than 30 mg of oxycodone, the active ingredient in OxyContin, twice a day.
Purdue’s bottom line was threatened; according to the memo, its staff told the Sacklers that the company stood to lose $24 million in Massachusetts each year from the changes the guidelines recommended.
That year, the complaint shows, Purdue continued to aggressively market the drug to doctors, asserting it was a solution to the “undertreatment of pain.” But the filing said that doctors were more attuned to the nation’s rapidly worsening addiction and overdose problem. The CDC also reported that prescription painkillers were killing people.
When opioid overdoses had become a full-blown crisis by 2017, Purdue CEO Craig Landau wrote notes on the crisis, according to the documents.
“There are,” he wrote in notes, “Too many Rxs being written . . . Too high a dose . . . For too long . . . For conditions that often don’t require them . . . By doctors who lack the requisite training in how to use them appropriately.”