It’s always easier to have a villain. And who we pick as our villains says as much about us as it does about them.
Take, for instance, the opioid epidemic. While the Trump administration bloviates about foreign drug cartels as justification for building his border wall, state attorneys general across the country have focused on a more useful villain: the Sackler family and their drug manufacturing company, Purdue Pharma. Both have been accused in multiple lawsuits of unleashing the addiction epidemic in the United States over the past decade through the deceptive marketing of its painkiller products — most notably, OxyContin.
The Sacklers make useful villains, frankly, because prosecutors can do something about them. If the lawsuits prove successful, prosecutors can procure some measure of justice from the wealthy family for the hundreds of thousands of Americans caught up in the surge of addiction wrought by prescription painkillers. For those of us not directly affected by the epidemic, a victory in court would provide some reassurance that the system works.
The problem with justice, however, is that there’s rarely enough of it to remedy the damage that spurred us to action. Nor is there any guarantee that any of the actors who aided the villain along the way will face a judgment of their own.
We have long known that Purdue Pharma worked to sell its products by breaking down the “opiophobia” among the medical community. Only now, thanks to the public release of a lawsuit against the company last week by the Massachusetts attorney general, are we getting a fuller sense of the marketing ploy — and, just like the art museums and Ivy League professorships that bear their family name, the Sackler name is all over it.
It’s clear from the suit brought against Purdue that the company pushed its sales team to promote its painkillers, as far as possible, to new patients, for longer prescription periods and in larger doses. Emails from the company also make clear that the Sacklers, especially former Purdue president Richard Sackler, son of the company’s founder, were intensely involved with the marketing operations, so much so that it irritated the sales team. Staff often advised each other, according to the court document, to “avoid as much e mail with dr. r as you can.” The former president was so intent on pushing its product that he allegedly suggested Purdue drop its health-insurance provider after it dropped OxyContin from its list of covered drugs and replaced it with another from a competitor promoting lower doses of opioids.
By far, the most repugnant detail to emerge from the lawsuit, however, is that the company, well aware of its products’ addictive qualities, reportedly began exploring the option to sell addiction treatment drugs alongside its painkillers.
Purdue Pharma rejected the details of the lawsuit in a statement as “riddled with demonstrably inaccurate allegations” and said it was “part of a continuing effort to single out Purdue, blame it for the entire opioid crisis,” stressing that most overdose deaths today are the result of illicit drugs such as heroin and fentanyl (even though most heroin users report starting with prescription painkillers). The company did not deny any specific detail in the suit, which remains undeniably ugly.
But even if states are able to turn these latest charges into some form of punishment for the Sacklers themselves, what about all those who promoted their cause? What about the researchers who accepted funding from drug manufacturers and carried out campaigns to destigmatize opioid painkillers? What about the officials at the Food and Drug Administration who not only approved OxyContin without any clinical studies on how addictive the drug might be, but also approved a package insert declaring the drug safer than its rival painkillers?
And more broadly, what about all the policymakers who waited for years before acting on the crisis and, in fact, stood in the way of expanding access to health care for vulnerable populations? What about Congress, which only passed a lackluster package to address the crisis late last year after nearly a half-million people already died of overdoses? What about lawmakers who slipped language into a bill that stripped Drug Enforcement Administration agents of their power to stop suspicious sales of prescription painkillers because they wanted — over agents’ objections — to better cooperate with drug manufacturers?
What about the medical community, which has failed to promote medication-assisted treatment for those with opioid addiction? A recent study of Veterans Health Administration facilities, which recommend such treatment, found that only 35 percent of veterans with an opioid-use disorder received treatment for the addiction, and less than half of the VHA providers credentialed to prescribe the treatment were actually doing so on a regular basis. Who holds such practitioners accountable?
And what about health-insurance companies, which for years have thrown up bureaucratic hurdles that make it more difficult for addicts to get the treatment they need? And what about society at large, which demonizes addicts and offers no compassion to those in desperate need of care?
Settlements against manufacturers such as the Sacklers will likely continue to extract money that policymakers could use to help address the epidemic, but it will almost certainly be a fraction of what is needed and will come far too late. The opioid saga — stemming from prescription painkillers — has irreparably damaged the lives of countless Americans over the past few decades. Don’t they deserve better?
The opioid epidemic is one of the worst systematic failures of health care in our country. For true justice, we need to root out all the villains, regardless of whether they have famous names.