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.”

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Sackler’s comments at the party and his email are contained in newly public portions of a lawsuit filed by the state of Massachusetts against Purdue that alleges that the company, the Sackler family, and company executives misled prescribers and patients as they aimed to blanket the country with prescriptions for their addictive medications.

“By their misconduct, the Sacklers have hammered Massachusetts families in every way possible,” the state’s complaint says, noting that since 2007, Purdue has sold more than 70 million doses of opioids in Massachusetts for more than $500 million. “And the stigma they used as a weapon made the crisis worse.”

The new filing also reveals how Purdue aggressively pursued tight relationships with Tufts University’s Health Sciences Campus and Massachusetts General Hospital — two of the state’s premier academic medical centers — to expand prescribing by physicians, generate goodwill toward opioid painkillers among medical students and doctors in training, and combat negative reports about opioid addiction.

Lawsuit filed by the state of Massachusetts against Purdue Pharma

Under an agreement with Mass. General, Purdue has paid the hospital $3 million since 2009 and was allowed to propose “areas where education in the field of pain is needed” and “curriculum which might meet such needs,” the court document shows. Tufts made a Purdue employee an adjunct associate professor in 2011, Purdue-written materials were approved for teaching to Tufts students in 2014, and the company sent staff to Tufts as recently as 2017, the complaint says. Purdue’s New England staff was congratulated for “penetrating this account.”

A Tufts spokesman declined to comment, citing the ongoing legal process. Mass. General did not immediately comment.

In a statement Tuesday, Purdue criticized the Massachusetts Attorney General Maura Healey’s office, which is spearheading the lawsuit, and said the complaint was “a rush to vilify” Purdue. It noted that its medications were approved by the Food and Drug Administration and regulated by the government, and that the company promoted the medications “to licensed physicians who have the training and responsibility to ensure that medications are properly prescribed.”

“Massachusetts’ amended complaint irresponsibly and counterproductively casts every prescription of OxyContin as dangerous and illegitimate, substituting its lawyers’ sensational allegations for the expert scientific determinations of the [FDA] and completely ignoring the millions of patients who are prescribed Purdue Pharma’s medicines for the management of their severe chronic pain,” the company said.

It also said the state attorney general’s office omitted information about the steps Purdue has taken in the past decade to promote safe and appropriate use of opioid medicines.

“To distract from these omissions of fact and the other numerous deficiencies of its claims, the Attorney General has cherry-picked from among tens of millions of emails and other business documents produced by Purdue,” the company said. “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.”

Healey’s office sued Purdue, current and former executives, and members of the Sackler family in June. In December, it filed an amended complaint that was nearly 200 pages longer than the June filing, with more allegations spelled out against the individual defendants. Many of the details were redacted; a portion of them were made public in an updated document filed Tuesday in state court, though much of the complaint is still blacked out.

The state’s suit focuses on Purdue’s actions since 2007, when the company and three current and former executives pleaded guilty in federal court to fraudulently marketing OxyContin and the company agreed to pay $600 million in fines. The case is separate from litigation being waged by STAT to obtain sealed Purdue documents in Kentucky, including the only known deposition of Richard Sackler, about the company’s marketing practices in earlier years, which have been blamed for seeding the current opioid addiction crisis.

The Massachusetts complaint sketches an image of the Sacklers, as board members, exercising tight control over the company, overseeing the deployment of a phalanx of sales representatives who were pushed to get Purdue medications into more hands, at higher doses, and for longer periods of time. The Sacklers, the complaint states, reaped “billion of dollars,” even as the company blurred the risks of addiction and overdose that came with the drugs.

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.

“I feel very certain this is an organized drug ring,” the employee wrote, adding “Shouldn’t the DEA be contacted about this?” Purdue did nothing for two years, according to the complaint.

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.

The effort to protect the disclosure of board-related documents serves another purpose not cited by the company: It protects the Sackler family, whose members have long constituted the majority of board members.

In its filing last month, Purdue also said one company official, whom it did not name, was concerned for his safety because his home address was listed in the complaint along with “numerous irrelevant, incendiary, and misleading comments about his career at Purdue.”

Purdue’s attorneys contend the Massachusetts amended complaint is a “concerted effort by the Commonwealth to use confidential documents in an attempt to publicly embarrass Purdue and its officers, directors and employees.” They claim the information selected was “cherry-picked” to “bolster a series of inflammatory and misleading allegations against Purdue.”

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:

“There are:
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.”

This story has been updated.

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  • I was given this opioid pain killer after two back surgeries from being injuried on the job and had no knowledge of this pain killer or the effects it would have on me. I am a family man married with children, there is no way that I can get off this medication without having a near death or death experience. I took them as prescribed and did not abuse them at all, I actually tried to get off them and nearly died.

    • Hey Johnny. I was prescribed an unimaginably large dose after 6+ surgeries (including open heart) for almost an entire year, with the dose increasing every few weeks. Getting off of it was one of the worst things I’ve ever encountered. I understand how hard it is and the nightmares/cold sweats/ diarrhea, but you need to know that the withdrawal does not kill you. It’s one of the most addictive things in the world, but it doesn’t matter. You can even quit cold turkey and it will not kill you, no matter the dose your body is accustomed too. Alcohol withdrawals can kill you, but opioids do not. Keep trying and if you feel like you’re dying, just know you are not. The only thing that will kill you is if you don’t stop.

    • The key to getting off opiates is a VERY SLOW taper, especially for long term users. I am talking about 90 days of very gradual dose reduction, and if you need it, a gradual shift away from your current opiate towards buprenorphine and then a taper off that. This is usually effective at dealing with physical addiction/withdrawal issues because your body has time to adjust to the gradual loss of the drug. Some rapid detox treatment programs put you in a medically induced loss of consciousness for rapid withdrawal. In either case, you still have to deal with the more insidious psychological addiction if you are prone to drug seeking behavior. That takes time and support. Thankfully, a lot of real chronic pain sufferers exhibit little or no drug seeking behavior, and we have a visceral dislike of the meds in general because we associate them with pain and sickness. Many of us see taking less meds as a better “high” because it means we are feeling better and our heads are less cloudy and we endure fewer side effects from the meds.

      A lot of meds, especially some anti-depressants, need tapering to avoid withdrawal unpleasantless. But there is a new stigma about opiates that leads to judgments against those taking them, and some doctors fail to appreciate someone with a 5-10 year history of managed opiate care is not going to do well with a final 14-day supply to kick them off the meds.

  • I also have chronic intractable pain, from RSD. 24 years. I was with a fabulous management team that tried everything to help. Docs, nurses, psychologists worked together on each patient. Interventional and experimental treatments. Tai chi class and group therapy. A neurolitic block caused arachnoidosis and I could not allow anything to touch me from T 2 to my knee. I wanted to die. They did an IV drug test with different medications and the only thing that gave any relief without adverse reaction was morphine. I was started at 900mg per day. I had been on percocet for a year prior. I was still in pain but saw a future. Over time I stablized and wanted off the morphine because it was too sedating. I was offered Oxycontin as an alternative. I had read a Newsweek cover story titled Hillbilly Heroin and even though I had taken percocet for prior surgeries and the RSD with no problem that terrified me – no thanks I will not try it. My trusted doctors assured me they had good results with other patients by I refused. The article dated back to 1998(?) I can not find it listed on line. I settled on ER morphine and ir oxycodone, it worked better and was able to start cutting back the morphine.
    A few things my doctors said in 1997. Be prepared at anytime for the government to change policy on narcotic prescribing. They were aware of potential harm and only used narcotics as a last resort but grateful they could more easily prescribe for those who truly needed them. And there is no upper limit for morphine in opioid tolerant patients. I was with them until they were closed by their state teaching hospital because they did not care about making money but patient care. 6 weeks later a new no nonsense pain management was in their offices. I left after one bad visit. Despite my condition and history they wanted to give me more nerve blocks! The very thing that truly crippled me.
    My old doctors referred me to a colleague who I am still with after 17 years. The narcotics allowed me to rehab and reverse a lot of symptoms. I was still in pain and very limited but I did reach a point where I could do virtually anything several hours a day. I had a life. could were loose clothes and eventually socks. I removed the cradles from my bed that kept the bedding from touching me. I was able to drop 2/3 of my dose over time and dropped the ER completely. I was on a stable 30 mg oxycodone for 7 years when my doctor informed me last year he could no longer write it. It triggers a DEA flag for him and the pharmacy. So back to the morphine Er & IR. 380mg a day vs 180mg oxycodone. My doctor is over 70 and took many patients of his colleagues who left the field for fear so he isnot retiring for now. I have looked and called and spoken to others, No one prescribes anything stronger than Tramadol. I tried the alternative use drugs decades ago they made me crazy or suicidal (Neurontin) after one dose. Dibenzaline gave me horrific violent bloody nightmares every single night for a year, again one dose of the drug compounded down to a small trial dosage. Narcotics work well for me. The only problem I had was strictures from the plastics in the ER morphine causing emergency bowl section. I lost a foot of small intestine to what the Cornell pathologists called NSAID WEBS. I am not happy to be back on ER RX with the same sedating quality I disliked so decades ago.
    For now I am ok. I am now 60 and fear the future were this is concerned. I learned and use alternative healing, visualization, energy and vibrational medicine, tuning forks help myself and others almost instantly. I use herbs and homeopathy. My husbands accupunturist told me they do not stick needles in RSD patients, for good reason. I take no other allopathic medicine. I have various other health issues I self manage because none of my docs know or understands what the heck is wrong with me. I think it is probably just the effect of having RSD for 25 years. what I have read it seems to fit. The harm done to millions is cruel. The IV drug test should be standard for chronic patients to quickly identify what may or may not work and in which dose. I agree at one time over prescribing for in appropriate issues was a problem but I never met those doctors. I know dozens who used opiates for a few weeks or months and stopped when they no longer needed them, as I did in a former life, I do not know anyone who had a problem. I read it came out in court discovery Oxycontin applied for approval as a 6-8 hour drug but FDA wanted 12 hours so they came back and stated ok it works for twelve without reformulation. That is part of the problem. If it only lasts for 6 or even 8 hours a patient will take it earlier and run out needing more or will go through withdrawl effects every day. They will soon be accused of abuse because Perdue lied to regulators. I just read Mallinkroft is approved for abuse deterrent oxycodone and will stop making IR. Even though it states it really isn’t deterrent. We do not need more plastics in pills. My gut has never been the same.

  • These were not opiate only ODs. It is rather difficult to OD on opiates alone. And virtually NONE of them were pain patients. Whatever the who, what, why and where, opiates are an essential part in the treatment of incurable severe pain. Between 7 and 50 million American Moms and Dad’s and Elder Folk have been force tapered leading directly to suicides, immobility, poverty, despair and grief. The newest CDC figures reflect 70K OD deaths BUT WITHOUT distinguishing if these were pharmaceutical or street fentanyl users. We feel the true number of opiate only death may be closer to 500 (five-hundred), …again not pain patients. It is good to curb illicit use and smuggling of the deadly fentanyl analogs but OD death is WAY up with prescribing WAY down WHILE every single pain patient is abandoned or in fear of being abandoned and Medical Doctors leaving the prescribing of opiates wholesale for fear of DEA ‘witch hunts’. WHY THIS CRUELTY and PHOBIA? That’s not the American way for its workers. AND NOTHING can EVER stop smuggling or the self-confidence of the illicit users. Please separate severe pain patients from “opioid crisis”.
    facebook.com/poppnow/

    • Check out Buprenorphine. (Belbucca, Butrans) It can offer amazing levels of pain relief with virtually no sedation or euphoria. It truly is a miracle drug, so of course, many insurance comoanies don’t want to pay the higher price. When used with other opioids, only if needed, it can help to reduce the adverse affects of those drugs, while still allowing them to aid in the pain relief. My Dr has many patients on this medication. You can also stop taking the classical opioid for periods if needed and not suffer withdrawal.

    • The Pharma idnustry did not release the fats about bupenorpherine. People on it can experience horiffic pain, if they are injured and have to undergo surgery.

  • Many of the commenters and policy makers do not know the difference between Oxycontin and Oxycodone. Oxycontin was the expensive time relase formula pedddled by Perdue. Ocycodone is a relatively cheap instant release opiate, that was used for years. Oxycontin is highly addictive, because it contains multiple doses, making it attractive to the addicted.

  • Dear Pam:
    I am sorry for those that truly NEED the pain relief. My complaint, as you may have read, is in being encouraged to use it. However, most healthcare folks feared exactly what has happened. Those who need it for whatever reason may be deprived. I am on your side.

  • I am so sick and tired of this FALSIFIED OPIOID EPIDEMIC that was created bty money hungry, corrupt lawmakers and their sidekicks the DEA<CDC<FDA<PROP. I am a intractable pain sufferer for 20 years. Opioids were my LAST RESORT after trying all the alternative therapies that did not work and left me thousands in debt. Failed fusions that left me with severe nerve damage. Epidurals that gave me adhesive arachnoiditis. and so much more. I suffer every dam day in severe pain. Pain that was once controlled by high dose LIFESAVING PAIN MEDICATION !!!! I am a rapid metabolizer that requires higher doses in order to get relief. For ten years I was on the SAME STABLE DOSE AND GUESS WHAT……IT WORKED AND I HAD A QUALITY OF LIFE AND NOW BECAUSE OF THIS BULLSHIT ADDICTION DRIVEN AGENDA, MYSELF AND MILLIONS MORE ARE BEING ABANDONED BY THE MEDICAL COMMUNITY AND LEFT IN A TORTUROUS HELL UNTIL WE KILL OURSELVES OR TURN TO THE STREETS FOR RELIEF GETTING GOD KNOWS WHAT AND POSSIBLE OVERDOSING AND DYING! WHAT THE F*** KIND OF COUNTRY IS THIS THAT IS ALLOWING THE TORTURE OF INNOCENT LAW ABIDING CHRONICALLY ILL CITIZENS AND OUR VETS?!?!?! The corrupt lawmakers have used FALSIFIED OD STATS that were made to fit their agenda and make them lots of money…. What is being done to WE THE PEOPLE is CRUEL, INHUMANE AND IT SURE AS HELL IS TORTURE!!!

    I urge you all to fight back and join in the NATIONWIDE DON'T PUNISH PAIN RALLY ON JANUARY 29TH AT EACH STATE CAPITOL. PLEASE GOOGLE DONTPUNISHPAINRALLY AND YOU WILL GET THE INFO….IT IS SO IMPORTANT WE FIGHT FOR OUR RIGHT TO PAIN RELIEF!!!!!.

    • Hey Pam. I don’t know where you live, or how many different walks of life you cross path with, but from my experience, the opioid epidemic is VERY REAL.

      Heroine/fentanyl outbreaks are at record highs with people dying left are right around me. 90% of these people are previously prescribed OxyContin patients who either shouldn’t have been prescribed in the first place, or weren’t given the proper information and assistance to properly ween off, which made them turn to the streets and overdose.

      I personally believe that OxyContin should continue production, but there needs to be extreme reasoning to prescribe it. I don’t live in Florida, but I know that 4 years ago you could go to 25% of the doctors there for “back pain” and walk out 30 minutes later with an oxy script. Now that it’s harder to get, people overdose on what they find in the street. Also, as a note to anybody reading this who is takes this drug for their pain but thinks the people ODing on the street are weak willed drug addicts, please look in the mirror real quick and evaluate your own dependence. Imagine if this drug you are dependent on was taken away. You are just as addicted, but taking it from a pharmacy. It’s the same family. Yours is just legal, so please don’t look down from an imaginary pedestal.

      If they were never prescribed, they never would have been addicted, and never would have OD’d.

      Saying this is a false issue is incorrect.

  • Purdue is not the only one. As a hospital inpatient several months ago. I was im ediayely setup bedside with a post-op pump containing Oxycontin. I told the nurse I did NOT want that drug for pain. Tylenol was suitable. The pump was left there and I was repeatedly encouraged to useit. I did not. When I was getting ready to be discharged, a nurse cam in with a piece of paper she announced was
    my prescription for Oxycontin (or -codone). Again I refused. She was shocked, are you sure?, she asked. Whe I got home I checked my online chart and sure anough, there was an “open” prescription for “Oxy”. Really???

  • Cain Lang,

    If acupuncture is a placebo, and if that placebo can treat 100+ diseases or disorders please give me acupuncture placebo treatments anytime. 100+ healing disorders capability!
    THIS placebo must be a hell of placebo.

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