Nonprofits should not allow themselves to be used by the wealthy to scrub their consciences.
When it comes to blood money for the arts, how bloody is too bloody?
On Wednesday, the Metropolitan Museum of Art decided that money made from selling the opioids that have killed several hundred thousand people is too bloody. It announced it would no longer take donations from members of the Sackler family linked to OxyContin. “On occasion, we feel it’s necessary to step away from gifts that are not in the public interest,” Daniel H. Weiss, the Met’s president, said.
“Gifts that are not in the public interest.” It is a pregnant, important phrase. Coming on the heels of similar decisions by the Tate Modern in London and the Solomon R. Guggenheim Museum in New York, the spurning of Oxy-cash seems to reflect a growing awareness that gifts to the arts and other good causes are not only a way for ultra-wealthy people to scrub their consciences and reputations. Philanthropy can also be central to purchasing the immunity needed to profiteer at the expense of the common welfare.
Perhaps accepting tainted money in such cases isn’t just giving people a pass. Perhaps it is enabling misconduct against the public.
This was the startling assertion made by New York State in its civil complaint, filed in March, against members of the Sackler family and others involved in the opioid crisis. It accused defendants of seeking to “profiteer from the plague they knew would be unleashed.” And the lawsuit explicitly linked Sackler do-gooding with Sackler harm-doing: “Ultimately, the Sacklers used their ill-gotten wealth to cover up their misconduct with a philanthropic campaign intending to whitewash their decades-long success in profiting at New Yorkers’ expense.”
It was strong stuff: The State of New York was officially claiming that in taking Sackler money, arts institutions had allowed themselves to be used as lubricant in a death machine. “It’s a remarkable statement,” Benjamin Soskis, a historian of philanthropy at the Urban Institute in Washington, told me this week, “the sort of thing we heard from critics of philanthropy on the periphery of power but rarely, in recent decades, from those at the center.”
Are museums, opera houses, food pantries and other nonprofits to be held responsible for how their donors have made their money? It is a question being asked more and more as a century-old taboo shatters.
“No amount of charity in spending such fortunes can compensate in any way for the misconduct in acquiring them,” Theodore Roosevelt said after John D. Rockefeller proposed starting a foundation in 1909. It was not a lonely thought at the time.
But in the decades since, not least because of the amount of philanthropic coin that has been spent (can it still be called bribing when millions are the recipients?), touching all corners of our cultural life, attitudes have changed. And, as I found in spending the last few years reporting on nonprofits and foundations, a deeply complicit silence took hold: It was understood that you don’t challenge people on how they make their money, how they pay their taxes (or don’t), what continuing deeds they may be engaged in — so long as they “give back.”
When I speak privately with people working in nonprofits, as I often do, especially younger people, I hear this complaint again and again: They agonize about having to stay quiet not only about their donors’ membership in a class that has benefited from an age of inequality but also about specific conduct by many donors that often worsens the problems the donors and nonprofits are working to solve.
And so the decision by the Met and the other museums may be a small sign that this compact is cracking — and perhaps that nonprofits are taking a broader view of their role in public life: not only as doers of good in a particular area of work but also, if they’re not careful, as enablers of broader, if more generalized, societal harm.
“Turning down money runs against the grain of the thinking that’s long governed charitable boards — that they are stewards of the interests of particular institutions, with considerations of broader public interest being peripheral,” Mr. Soskis, the historian, said when I asked him about the Met. “What we are seeing more and more of, through the spread of social media, and an increased willingness to critically engage major philanthropic gifts, is the assertion of the public’s interest in the philanthropic exchange.”
It remains to be seen whether other arts institutions will follow the lead of the Met, Tate and Guggenheim — and more broadly, whether the nonprofit sector will begin asking itself some deeply uncomfortable questions.
Should anyone working to make cities better and more equitable take money from JPMorgan Chase, which paid a huge sum for its role in helping to bring about the 2008 mortgage disaster and financial crisis? Should anyone working to help families affected by President Trump’s immigration policies take money from Mark Zuckerberg, whose soft-pedaling of Russian interference in the 2016 election allowed anti-immigrant hate to spread and potentially helped Mr. Trump gain votes?
It remains to be seen whether other arts institutions will follow the lead of the Met, Tate and Guggenheim — and more broadly, whether the nonprofit sector will begin asking itself some deeply uncomfortable questions.
Should anyone working to make cities better and more equitable take money from JPMorgan Chase, which paid a huge sum for its role in helping to bring about the 2008 mortgage disaster and financial crisis? Should anyone working to help families affected by President Trump’s immigration policies take money from Mark Zuckerberg, whose soft-pedaling of Russian interference in the 2016 election allowed anti-immigrant hate to spread and potentially helped Mr. Trump gain votes? Should any health institution take money tied to Pepsi or Coca-Cola?
Make no mistake: To ask these questions opens a can of worms. The Sacklers are an easy case. Once the complicity turns more diffuse, it is hard to say whether a nonprofit is participating in an injustice by taking money — or doing the best it can in a flawed reality. What’s next after this? Is there a statute of limitations on looking for blood money? What kind of moral purity test are these institutions supposed to use? Once you begin to raise these dilemmas, how do you actually draw those lines around what’s acceptable?
The Met has already drawn some lines. It won’t remove the Sackler name from its galleries; it won’t return money already donated. What it should do is go beyond a single act of rebuffing to model a new process for evaluating money.
Past and future donations could be judged on various criteria:
- Was the money legally and fairly made?
- Is the money owed to tax evasion or extreme legal tax avoidance?
- Is the museum effectively selling a modern papal indulgence for a sin that shouldn’t be so easily pardoned?
- Does the donor have a duty of reparation to people they have exploited or harmed that gives those parties more of a right to the money?
And the public should be brought into the process. Public-facing institutions enjoy the privilege of being untaxed, so citizens should be able to comment on and scrutinize prospective donations.
These questions will long be with us. These museums have forced an essential conversation. For far too long, generosity has been allowed to serve as a wingman of injustice; giving back disguises merciless taking; making a difference becomes inseparable from making a killing — sometimes literally. It is high time to reject these alibis for treachery.
We can save our broken economic system from itself.
Despite the lowest unemployment rates since the late 1960s, the American economy is failing its citizens. Some 90 percent have seen their incomes stagnate or decline in the past 30 years. This is not surprising, given that the United States has the highest level of inequality among the advanced countries and one of the lowest levels of opportunity — with the fortunes of young Americans more dependent on the income and education of their parents than elsewhere.
But things don’t have to be that way. There is an alternative: progressive capitalism. Progressive capitalism is not an oxymoron; we can indeed channel the power of the market to serve society.
In the 1980s, Ronald Reagan’s regulatory “reforms,” which reduced the ability of government to curb the excesses of the market, were sold as great energizers of the economy. But just the opposite happened: Growth slowed, and weirder still, this happened in the innovation capital of the world.
The sugar rush produced by President Trump’s largess to corporations in the 2017 tax law didn’t deal with any of these long-run problems, and is already fading. Growth is expected to be a little under 2 percent next year.
This is where we’ve descended to, but not where we have to stay. A progressive capitalism based on an understanding of what gives rise to growth and societal well-being gives us a way out of this quagmire and a way up for our living standards.
Standards of living began to improve in the late 18th century for two reasons:
- the development of science (we learned how to learn about nature and used that knowledge to increase productivity and longevity) and
- developments in social organization (as a society, we learned how to work together, through institutions like the rule of law, and democracies with checks and balances).
Key to both were systems of assessing and verifying the truth. The real and long-lasting danger of the Trump presidency is the risk it poses to these pillars of our economy and society, its attack on the very idea of knowledge and expertise, and its hostility to institutions that help us discover and assess the truth.
There is a broader social compact that allows a society to work and prosper together, and that, too, has been fraying. America created the first truly middle-class society; now, a middle-class life is increasingly out of reach for its citizens.
America arrived at this sorry state of affairs because we forgot that the true source of the wealth of a nation is the creativity and innovation of its people. One can get rich either by adding to the nation’s economic pie or by grabbing a larger share of the pie by exploiting others — abusing, for instance, market power or informational advantages. We confused the hard work of wealth creation with wealth-grabbing (or, as economists call it, rent-seeking), and too many of our talented young people followed the siren call of getting rich quickly.
Beginning with the Reagan era, economic policy played a key role in this dystopia: Just as forces of globalization and technological change were contributing to growing inequality, we adopted policies that worsened societal inequities. Even as economic theories like information economics (dealing with the ever-present situation where information is imperfect), behavioral economics and game theory arose to explain why markets on their own are often not efficient, fair, stable or seemingly rational, we relied more on markets and scaled back social protections.
We are now in a vicious cycle: Greater economic inequality is leading, in our money-driven political system, to more political inequality, with weaker rules and deregulation causing still more economic inequality.
If we don’t change course matters will likely grow worse, as machines (artificial intelligence and robots) replace an increasing fraction of routine labor, including many of the jobs of the several million Americans making their living by driving.
The prescription follows from the diagnosis: It begins by recognizing the vital role that the state plays in making markets serve society. We need regulations that ensure strong competition without abusive exploitation, realigning the relationship between corporations and the workers they employ and the customers they are supposed to serve. We must be as resolute in combating market power as the corporate sector is in increasing it.
If we had curbed exploitation in all of its forms and encouraged wealth creation, we would have had a more dynamic economy with less inequality. We might have curbed the opioid crisis and avoided the 2008 financial crisis. If we had done more to blunt the power of oligopolies and strengthen the power of workers, and if we had held our banks accountable, the sense of powerlessness might not be so pervasive and Americans might have greater trust in our institutions.
The neoliberal fantasy that unfettered markets will deliver prosperity to everyone should be put to rest. It is as fatally flawed as the notion after the fall of the Iron Curtain that we were seeing “the end of history” and that we would all soon be liberal democracies with capitalist economies.
Most important, our exploitive capitalism has shaped who we are as individuals and as a society. The rampant dishonesty we’ve seen from Wells Fargo and Volkswagen or from members of the Sackler family as they promoted drugs they knew were addictive — this is what is to be expected in a society that lauds the pursuit of profits as leading, to quote Adam Smith, “as if by an invisible hand,” to the well-being of society, with no regard to whether those profits derive from exploitation or wealth creation.
The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts.
An addiction specialist said that the Sacklers’ firm, Purdue Pharma, bears the “lion’s share” of the blame for the opioid crisis.
.. 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.
.. Marissa Sackler, the thirty-six-year-old daughter of Mortimer
.. 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:
.. 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.
.. Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin.
.. four out of five people who try heroin today started with prescription painkillers.
.. a hundred and forty-five Americans now die every day from opioid overdoses.
.. 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.
.. 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.
.. In 1942, Arthur helped pay his medical-school tuition by taking a copywriting job
.. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.
.. 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).
.. “Most of the questionable practices that propelled the pharmaceutical industry into the scourge it is today can be attributed to Arthur Sackler.”
.. Arthur’s techniques were sometimes blatantly deceptive.
.. “More and more physicians find Sigmamycin the antibiotic therapy of choice.”
.. The Saturday Review tried to contact some of the doctors whose names were on the cards. They did not exist.
.. 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.
.. 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,”
.. By 1973, American doctors were writing more than a hundred million tranquillizer prescriptions a year, and countless patients became hooked.
.. 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.
.. 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.
“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.”
.. 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.
.. 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.”
.. A family lawyer told the children, “There were no absolutely white lilies here on either side.”
.. for the Romans, the poppy was a symbol of both sleep and death.
.. 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.
.. “In terms of narcotic firepower, OxyContin was a nuclear weapon.”
.. 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.
.. Describing opioids as a “gift from nature,” he said that they needed to be destigmatized.
.. claiming that it was indicative of “opiophobia,” and suggesting that concerns about addiction and abuse amounted to a “medical myth.”
.. 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.
.. 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
.. launched OxyContin with one of the biggest pharmaceutical marketing campaigns in history
.. 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.
.. Purdue similarly spoke of reaching patients who were “opioid naïve.”
.. “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.
.. Purdue had a speakers’ bureau, and it paid several thousand clinicians
.. 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.
.. OxyContin’s success can be attributed partly to the fact that so many doctors wanted to believe in the therapeutic benefits of opioids.
.. Purdue gave money to continuing medical education, to state medical boards, to faux grassroots organizations.”
.. 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.)
.. Internal budget plans described the company’s sales force as its “most valuable resource.” In 2001, Purdue Pharma paid forty million dollars in bonuses.
.. The fact that Purdue is privately held is a major reason that the Sacklers’ connection to OxyContin has remained obscure.
.. Mortimer Sackler .. 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.
.. 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
.. Purdue insisted that the only problem was that recreational drug users were not taking OxyContin as directed.
.. 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.
.. Robin Hogen .. had launched a vigorous campaign to defend the drug, warning newspapers to be careful about their coverage
.. 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,”
.. 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.”
.. it was Purdue’s position that OxyContin overdoses were a matter of individual responsibility, rather than the drug’s addictive properties.
.. Howard Udell, Purdue’s general counsel, who had been a longtime legal adviser to the Sacklers
.. 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.
.. 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?”
.. the dangers of OxyContin were intrinsic to the drug—and Purdue knew it.
.. They could sleep through the night—a crucial improvement over conventional painkillers, such as morphine
.. Roughly half the women required more medication before the twelve-hour mark.
.. the claim of twelve-hour relief was an invaluable marketing tool. But prescribing a pill on a twelve-hour schedule when, for many patients, it works for only eight is a recipe for withdrawal, addiction, and abuse.
.. many people who were not drug abusers—and who took OxyContin exactly as their doctors instructed—began experiencing withdrawal symptoms between doses.
.. 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.”
.. Pseudo-addiction generally stopped once the pain was relieved—“often through an increase in opioid dose.”
.. though Sackler presided over the tremendously successful launch of OxyContin, he has never given an on-the-record interview about the drug.
.. 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.
.. 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.
.. “They know exactly what people are prescribing,” Kolodny said. “They know when a doctor is running a pill mill.”
.. 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.”
.. overprescribing generated tremendous revenue for the company.
.. such prescribers were given a name that Las Vegas casinos reserve for their most prized gamblers: whales.
.. in 2004 Blumenthal filed a complaint against Purdue, on behalf of the State of Connecticut.
.. 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.
.. “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
.. Rudolph Giuliani had tried, on Purdue’s behalf, to get the lead prosecutor to scuttle the case.
.. Arlen Specter, the Republican senator from Pennsylvania, remarked that such fines amounted to “expensive licenses for criminal misconduct.”
.. one of his fixations was the unethical behavior of tobacco companies.
.. 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.”
.. 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.
.. 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.
.. 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.
.. 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.”
.. 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,”
.. 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.”
.. 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.
.. 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 idea that they’re fighting so hard to keep this deposition hidden should tell you something.
.. 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?
.. 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.’ ”
.. 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.
.. 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.
.. 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.
.. “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.
.. 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.
.. 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
.. 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.
.. Purdue acknowledged that even patients “who take OxyContin in accordance with its F.D.A.-approved labeling instructions will likely develop physical dependence.”
.. It may also be that OxyContin has achieved market saturation.
.. 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.
.. “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.
.. 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.”
.. 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.
.. In August, 2015, over objections from critics, the company received F.D.A. approval to market OxyContin to children as young as eleven.
.. the Sacklers continue to receive some seven hundred million dollars a year
.. the real future of OxyContin may be global
.. 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.
.. Mundipharma commissioned studies showing that millions of people in these countries suffered from chronic pain.
.. 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.
.. 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.
.. 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.”
.. in the time it likely took you to read this article six Americans have fatally overdosed on opioids.
.. “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.
.. adding their name to a building—it rings hollow. It’s not philanthropy. It’s just a glorification of the Sackler family.”
.. more than two and a half million Americans have an opioid-use disorder.
.. “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.
.. the descendants of John D. Rockefeller have devoted resources to addressing climate change and critiquing the environmental record of the oil company he founded
..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.’
.. An addicted baby is now born every half hour.
.. In places like Huntington, West Virginia, ten per cent of newborns are dependent on opioids.