Read: November 2022

Inspiration: What is the history of the opioid crisis and Purdue Pharma?


Written with the help of ChatGPT, below is a brief summary to understand what is covered in the book.

“Empire of Pain”, published in 2021 by author and journalist Patrick Radden Keefe, tells the story of the Sackler family, who built a multibillion-dollar pharmaceutical empire based on the sale of prescription painkillers. The book discusses the ways in which the Sacklers aggressively marketed their drugs, including OxyContin, and the consequences of this marketing for the opioid epidemic in the United States. Keefe also explores the ways in which the Sacklers used their wealth and influence to shape the drug regulatory environment, as well as the broader culture through philanthropy and the arts. Empire of Pain is a compelling look at the role of one family in the opioid crisis, and the broader issues of corporate responsibility and the role of money in society.

Unedited Notes

Direct from my original book log, below are my unedited notes (abbreviations and misspellings included) to show how I take notes as I read.

Arthur, Mortimer and Raymond Sackler born 1910s NYC to immigrant family—Arthur eldest/leader, family was doing well then great depression crush finances so brothers self finance college, all 3 bros doctors, Arthur take up job at asylum for mental illness (fascinated by it and sympathetic, age of electroshock therapy which he opposed), other bros join at Creedmoor asylum, lobotomy also popularized at asylums (stick pick in brain, cut nerves), bros all confused how nothing better, begin experiment with patients via histamine injections—focus on brain chemistry and gain press coverage as work, Arthur join advertiser late 40s/early 50s covering Pfizer and revolutionize pharma by doing like consumer products to doctors to sell, Arthur soon bought the agency and take over—in Medical Ad Hall of Fame, McAdams was Arthur’s firm and main competitor run by Bill Frohlich (zero sum with pharma clients) but in reality Arthur owned majority stake and helped create Frohlich to avoid conflict (secret til death), 1952 3 bros buy Purdue Frederick small pharma biz (Arthur orchestrate but behind the scenes), mid 50s experiment to make minor tranquilizers after major of Thorazine (want less side effect), Miltown huge but then Librium follow by Roche with Arthur doing ads (massive success)—millions sold, Sternbach made Librium keep working and ’59 create Valium as even better smaller dose vs Librium (valium to release ’63 but not want to cannibalize—do same thing but McAdams advertise for diff ailments), Valium first $100m drug in history—Roche lead drugs industry, Henry Welch led FDA in late 50s but also ran medical journals running ads for drugs in partnership with Sackler and Felix Marti-Ibanez—often made up claims in ads, investigative reporter John Lear pursue Welch and surveil Sackler, senate hearings expose Pfizer and Welch in cahoots (bribery), acquired small pharma co called Napa which developed MS Contin (smaller dose morphine with new delivery system), MS Contin big success as launch in early 80s, Purdue want to leverage delivery system for other drugs to avoid eventual MS patent cliff, oxycodone is cousin of morphine and heroin but much more potent than morphine, oxycodone in percocet but small doses, apply Contin system to Oxycodone to administer larger dose filtered more slowly, Richard and Kathe Sackler argue over whose idea, 1991 create Purdue Pharma, 1993 aim to launch Oxycontin for pain in many areas not just cancer pain (chronic pain), Richard lead push, MS Contin just cancer now want to grow, oxycontin derived from opium poppy, heroin created by Bayer as refined morphine (said to be safer, same team that invented aspirin), morphine viewed as last resort drug so market oxy as milder/replacement to MS Contin (doctors wrongly thought not as strong as morphine), oxycontin approved by fda and sales blitz in 1996 (~10-15 years after ideation), sales rep go far and wide for pain doctors (target fam physicians, naive docs who lack knowledge on opiods but prescribe lots—reps persuade/educate docs themselves), 1997 did 44 million sales then 1999 600 mill+, advertised with no max dosage (no risk), 1bn in sales within 4 years, ’99-’01 addiction/abuse become clear but Purdue blame personalities of absusers not drug itself, Purdue cozy with FDA (many come on as advisers when leave gvt), 2003 Meier at NYT publish book exposing—stories/investigation pick up but Sacklers fight and deny, guilty plea from 3 execs ’06 but company and Sacklers distance selves and payout execs for taking the hit (purdue frederick take plea but purdue pharma safe and continue selling), oxycontin patent cliff 2013, 2010 purdue create abuse resistant Oxy OP (new capsule seal can’t be crushed up)—help reduce abuse but also extend patent, once oxy patent up FDA not allow generics b/c new coating safer so purdue keep exclusivity, 2010 reformulated oxy come out and notice sales slow, was harder to abuse but then ignite heroin epidemic as users turn there, Sacklers feel vindicated as abuse due to addictive personalities not Purdue, lawsuits pile up but sacklers resist, 2016 really when public turned, museums deny funds, 2019 january sacklers finally named in lawsuit as defendants in massachussetts (previously able to distance selves), Sacklers keep finding workarounds in interim to profit but challenged by publicity/protests, multidistrict lawsuits bring states together pooling resources and uncover purdue story, purdue try to stop release but MA allow it (OH had stopped it), expose Richard Sackler micromanage and dismiss abusers, expose targeting of pill mills for profit even after VA guilty plea 2007, soon in ’19 sacklers file bankruptcy which halted lawsuits—try to prevent this but prevail in White Plains with cozy judge who seem to side with sacklers, Trump admin want to clean up pre 2020 election so not come after sacklers with federal crimes (target company only not people, and company fined in excess of assets so not paid, sacklers only fined 200m), Judge Drain continue to extend bar on further sackler litigiation thru bankruptcy (claim b/c in part hate seeing lawyers rack up billable hrs), settlement enrage prosecutors and states suing as let off easy with no jail time and wealth in tact, then congress hold public hearing 2020 to hold sacklers to account finally, sept 2021 final settlement for 4.3bn over 11 years so not much given other wealth of 13bn invested, also protected from future litigation

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