When Purdue Pharma started selling its prescription opioid painkiller OxyContin in 1996, Dr. Richard Sackler asked people gathered for the launch party to envision natural disasters like an earthquake, a hurricane, or a blizzard. The debut of OxyContin, said Sackler — a member of the family that started and controls the company and then a company executive — “will be followed by a blizzard of prescriptions that will bury the competition.”
Five years later, as questions were raised about the risk of addiction and overdoses that came with taking OxyContin and opioid medications, Sackler outlined a strategy that critics have long accused the company of unleashing: divert the blame onto others, particularly the people who became addicted to opioids themselves.
“We have to hammer on the abusers in every way possible,” Sackler wrote in an email in February 2001. “They are the culprits and the problem. They are reckless criminals.”
Richard Sackler, who was named president of the company in 1999 before becoming co-chairman in 2003, is singled out in the complaint as particularly domineering as he demanded greater sales. In 2011, he decided to shadow sales reps for a week “to make sure his orders were followed,” the complaint states.
Russell Gasdia, then the company’s vice president of sales and marketing, who is also a defendant in the Massachusetts lawsuit, went to Purdue’s chief compliance officer to warn that if Sackler directly promoted opioids, it was “a potential compliance risk.”
“LOL,” the compliance officer replied, according to the complaint. Other staff raised concerns, but they ultimately said that “Richard needs to be mum and anonymous” when he went into the field.
After the visits to doctors, Richard Sackler claimed that Purdue’s drugs shouldn’t need a legally mandated warning. He wrote in an email cited in the complaint that the warning “implies a danger of untoward reactions and hazards that simply aren’t there.”
The following year, Sackler’s pressure on the staff grew so intense that Gasdia asked the CEO to intervene: “Anything you can do to reduce the direct contacts of Richard into the organization is appreciated,” Gasdia wrote in an email cited by the complaint.
It apparently didn’t work: The next week, Richard Sackler emailed sales managers to say that U.S. sales were “among the worst” in the world.
Sales managers were badgered on nights, weekends, and holidays, according to the filing. The marketing campaigns focused on high-volume doctors, who were visited repeatedly by salespeople, and pushed doctors to prescribe high doses. The demands on sales managers created such a stressful environment that, in 2012, they threatened to fire all sales representatives in the Boston area because of lackluster numbers.
The complaint also accuses Purdue of rarely reporting allegedly illegal activity, such as improper prescribing, to government officials when it learned about it. In one 2009 case, a Purdue sales manager wrote to a company official that Purdue was promoting opioids to an illegal pill mill.
In addition to relying on its sales force, Purdue cultivated ties with academic hospitals, which both treat patients and train the next generation of prescribers.
In 2002, the company started the Massachusetts General Hospital Purdue Pharma Pain Program after a Purdue employee reported that access to the hospital’s doctors “is great … they come to us with any questions, and allow us to see them when we need to.” The hospital, the staffer added, “has significant influence through most of New England, simply because they are MGH.”
As part of the program, Purdue gained influence over training programs and organized a symposium in the hospital’s famed “Ether Dome” — the site of the first public surgery with anesthetic.
The Sacklers renewed the deal with Mass. General in 2009 and agreed to contribute $3 million to fund the program, the lawsuit says.
Purdue’s funding, however, didn’t stop researchers at Mass. General from raising concerns about its products. The complaint cites a July 2011 email from Purdue’s then-chief medical officer Craig Landau — who is now the CEO and is a defendant in the lawsuit — flagging a study questioning the use of opioid painkillers for chronic pain that was conducted by Mass. General researchers with Purdue funding. Landau wanted to make sure that any Purdue-funded study supported the use of its medicines.
Purdue’s ties to Tufts date back even further, according to the lawsuit. In 1980, three Sacklers donated funding to launch the Sackler School of Graduate Biomedical Sciences. In 1999, the Sacklers gave money to help start the Tufts Masters of Science in Pain Research, Education, and Policy. Through the program, “Purdue got to control research on the treatment of pain coming out of a prominent and respected institution of learning,” the filing states. Purdue employees even taught a Tufts seminar about opioids, and Tufts and its teaching hospital collaborated with Purdue on a publication for patients called “Taking Control of Your Pain.”
Purdue also allegedly used Tufts’s ties in Maine as reports about addiction emerged in the state. Tufts ran a residency program in the state, the complaint says, and in 2000 “agreed to help Purdue find doctors to attend an event where Purdue could defend its reputation.”
The bulk of the documents cited in the Massachusetts complaint were filed by Purdue in federal court in Ohio as part of a consolidated case involving hundreds of lawsuits filed by states, cities, counties, and tribes against Purdue, other opioid manufacturers, and others in the pharmaceutical industry.
Purdue says it produced 45 million pages of documents for the federal court case — known as a multidistrict litigation. In a motion filed last month and in an emergency hearing before the federal judge in Ohio overseeing the MDL, Purdue argued that the details in Massachusetts’s amended complaint were largely drawn from about 500 Purdue documents it had filed on a confidential basis in the federal court. The company’s lawyers argued the rules of confidentiality established in the federal court should apply to Massachusetts’ filing in state court, while state officials say the issue of what should be made public should be decided in state court.
Among the records Purdue said last month should remain confidential are those involving the company’s board of directors. Making them public, the company argued, would have a “chilling effect” on corporate governance.
In September 2017, Landau, by that time Purdue’s CEO, jotted down a note summarizing some of the roots of the opioid crisis. It reads:
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.”
The state’s lawsuit concludes: “The opioid epidemic is not a mystery to the people who started it. The defendants knew what they were doing.”
Parts of this story are credited to Andrew Joseph, who broke this story in January 2019