Introduction: The Sackler family has donated countless art buildings and research institutions around the world, but the painkiller OxyContin produced by its family business Purdue has produced millions of drug addicts in the United States.

Introduction: The Sackler family has donated countless art buildings and research institutions around the world, but the painkiller OxyContin produced by its family business Purdue has produced millions of drug addicts in the United States. And this is all attributed to the unprincipled marketing of painkillers by the Sackler family.

The Sackler family's large-scale art investment

The north side of the Metropolitan Museum of Art in New York is a vast and airy hall-style building, where the Egyptian government presented the Temple of Daldel, the Temple of the United States, presented here. This sandstone monument was completed on the Nile River two thousand years ago. The Egyptian government dismantled it as a gift and shipped it to the United States and assembled it again. The Sackler Pavilion, which houses the Dedal Temple, was opened to the public in 1978 and is also one of the iconic buildings of the Sackler family, the great American philanthropist. Arthur, Mortimer and Raymond, born in Brooklyn, the three brothers of the Sackler family are doctors and donated money to build many facilities throughout their lives. Many of the institutions named after their surnames are still familiar today: the Sackler Museum in Washington, the Sackler Museum in Haval University, the Sackler Center for Art Education in Guggenheim; the Sackler Museum in the Louvre. In addition, there are Sackler Institute and related facilities located in more than a dozen well-known institutions such as Columbia University and Oxford University. The Sackler family has been awarded various professorship positions and has also taken on various medical research. Art scholar Thomas Lawton once compared Arthur to a "contemporary pioneer." Before Arthur's death in 1987, he told his children, "The world when you left is better than when you came."

Motimer died in 2010, and Raymond died earlier this year. What these brothers left to their heirs was not only a commendable charitable tradition, but also a huge wealth that was as rich as a country. Arthur's daughter Elizabeth is on the board of the Brooklyn Museum and she donated to establish the Elizabeth A. Sackler Center for Feminist Arts. Raymond's sons Richard and Jonathan are professors at Yale Cancer Center. "My father made Jon and I believe that philanthropy is an important part of our lives," said Richard. "My father made Jon and I believe that philanthropy is an important part of our lives. Mortimer's 36-year-old daughter Marissa Sackler and Mortimer's third wife Theresa Rowling founded a nonprofit incubator Beespace, which supported many charitable funds. Marisa recently pointed out that she found the word "philanthropy" was outdated. She considered herself a "social entrepreneur."

When the Metropolitan Museum was first completed in 1880, Joseph Choate, the lawyer who was one of its trustees, gave a speech at the inauguration ceremony, preaching the immortality of philanthropy: "Think about how great honors many millionaires in the industry will receive." All you do is to listen to our advice, turn pork into porcelain, turn raw materials into priceless pottery, and turn rough ore into exquisitely sculpted marble. Through such a transformation, many wealth will be transformed into permanent public institutions. Over time, family wealth will be forgotten, but buildings named after donors will always exist. According to Forbes, Sackler is now one of the wealthiest families in the United States, with a net worth of about $13 billion, even surpassing the Rockefeller or Mellons.?

Real assets: Pain-Anti-Power Empire

Most of the wealth of the Sackler family has accumulated over recent decades, but like most people, their source of wealth is secretive. While the Sackler family often talks about generous charity, they hardly talk about family businesses. Its family-owned Purdue Pharmaceuticals, a private company based in Stamford, Connecticut, developed and launched the prescription painkiller OxyContin. After the drug went to market in 1995, OxyContin was hailed as a medical breakthrough, an anesthetic drug that can help patients with moderate to severe pain. The drug became a bombshell for Purdue Pharmaceuticals, with revenue reportedly about $35 billion.

But OxyContin is a controversial drug.Its only active ingredient is oxycodone, a chemical cousin of the famous heroin, and its strength is as high as twice that of morphine. In the past, because it is well known that this synthetic drug is extracted from opiates, because this type of drug is addictive, doctors have been reluctant to prescribe opioids for pain relief, except for the pain caused by cancer and the use of end-of-life treatment. David Kessler, former director of the Food and Drug Administration, said, "There are almost no drugs as dangerous as opioids." Purdue Pharmaceuticals launched a series of marketing campaigns against OxyContin's promotion, trying to oppose inherent attitudes and change doctors' prescription habits for opioids. The company funded research and increased doctor pay was to illustrate that concerns about opioid addiction were overblown, and that OxyContin could be safely used in the treatment of more diseases. Pharmaceutical sales representatives called OxyContin a “long-term use” drug, and millions of patients have found the drug to be an excellent remedy for pain. However, many patients are becoming more and more dependent, and once the amount is reduced, the feeling of weakness follows.

The painkiller in controversy: addicted or not?

Since 1999, 200,000 Americans have died from overdoses associated with OxyContin and other prescription opioids. Many drug users have turned to heroin because they find prescription painkillers too expensive or difficult to obtain. According to the American Association of Addiction Medicine, four in five people who are addicted to heroin start with painkillers. The latest data from the Centers for Disease Control and Prevention shows that 145 Americans die from opioid overdoses every day. Andrew Kolodny, co-director of the collaboration on opioid policy at Brandeis University, collaborated with hundreds of patients with opioid addiction to conduct opioid receptor studies. He said that while opioids, mainly outside of OxyContin, have caused many addictions, the prescription culture carefully designed by Purdue Pharmaceuticals has gradually led to the crisis. "If you look closely at the prescription trends of some of the opioids, you can see that in 1996, the volume of relevant prescriptions increased sharply. It's not a coincidence. Purdue Pharmaceuticals launched a multi-party campaign that misled the medical community's awareness of this risk. "When I asked how responsible Kordue Pharmaceuticals should be for the current public health crisis, he replied, "the largest share."

Although you can find the name of the Sackler family on dozens of buildings, Purdue Pharmaceuticals’ website rarely has the family members, and the company’s board of directors does not contain eight family members of the Sackler family’s three generations. Allen Frances, former president of Duke University School of Medicine and professor of psychiatry, noted, "I don't know how many rooms in different parts of the world are named after the Sackler family. Their names have become a microcosm of the achievements of capitalist systems. But, after all, they have obtained this wealth at the expense of millions of addicts. What is shocking is that they actually got rid of this stain."

Raymond Sackler and Beverly Sackler

"Dr. Sackler believes that he is also considered the patriarch of the Sackler family," said the lawyer representing the descendants of Arthur Sackler once observed. Arthur is a commander with a gap in front teeth. He studied under the Dutch psychoanalyst Johan HW van Ophuijsen. Sackler proudly described van Ophuijsen as "Freud's favorite disciple." Arthur and his brothers were children of Galician and Polish Jewish immigrants, and grew up in Brooklyn during the Great Depression. All three of them went to medical school and collaborated on a hundred and fifty academic papers at the Creedmoor Psychiatric Center in Queens. In Arthur's own words, he was particularly fascinated by the way "nature and disease human secrets." The Sackler family is interested in the biological direction of mental illness, such as those of shock therapy and psychoanalysis.

However, what the three brothers really accumulate wealth is in the business field, not in the medical practice.They shared their entrepreneurial journey with the public. Mortimer was an advertising manager for high school newspapers as a teenager. After lobbying Chesterfield for a cigarette ad, he received a commission of five dollars, which was a huge sum of money at the time. In 1942, Arthur obtained a writing position at William Douglas McAdams, a small advertising agency specializing in the field of medicine, and received a reward for paying for his medical expenses. He proved to be very good at the job, and eventually Arthur acquired the agency and revolutionized the entire pharmaceutical industry. Prior to this, pharmaceutical companies had not been advertising. As a doctor and an advertiser, Arthur's familiarity with marketing demonstrates a mad man-like intuition. He realized that selling new drugs not only requires attracting patients, but also needing approval from prescribers.

Sackler believes that doctors are unquestionable public health stewards. He is used to saying, “I prefer to put myself and my family under the judgment and compassion of a fellow doctor. So when selling new drugs, he designed a campaign directed to clinicians, put advertisements in medical journals, and distributed literature to doctors’ offices. Realizing that doctors are most influenced by their peers, he cites outstanding representatives in the industry to approve his products and scientific research (which are often borne by pharmaceutical companies) to support the effect. John Calill, who worked under Sackler for a decade, recalled: “Sackler’s advertising looks very serious and can be called a conversation between doctors. But this is still an advertisement. "In 1997, Arthur was admitted to the Medical Advertising Hall of Fame, and his lifelong achievement was "introducing advertising into pharmaceutical marketing." But Alan Francis pointed out: "The suspicious practices that caused the current situation in the pharmaceutical industry are attributed to Arthur Sackler. ”

Generally speaking, advertising has a certain degree of persuasion, but Arthur’s marketing skills are sometimes a blatant deception. In the 1950s, he created an ad about the Pfizer antibiotic Sigmamycin: a series of doctors’ business cards, and “more and more doctors have found Sigmamycin the best choice for antibiotic treatment,” which is equivalent to having baseball star Mickey Manto advertise cereals. But in 1959, an investigative reporter from Saturday Review tried to contact some doctors on the business card. It was found that these doctors didn’t exist at all.

During the 1960s, Arthur sold a lot of sedatives Librium and Valium. An advertisement about Librium depicted a young woman carrying a bunch of books and suggested that if a freshman feels anxious after leaving home, the best way is to treat it with a sedative. Such students “can be tortured by a sense of identity,” in addition to adding that college life brings “anxiety about a whole new world.” "This ad runs in a medical journal. In addition, Sackler also promoted Valium extensively in 1965, a doctor wrote in the journal Psychology: "When should we not use this drug?" "An activity encourages doctors to prescribe Valium for those who do not have symptoms of psychiatric: "For patients with no pathology to prove, Valium may be considered. “Valium’s maker Roche hasn’t done a deep dive into its potential addiction. After years of Win Gerson, the company has worked with Sackler, noted that Valium’s marketing campaign has been a huge success, in part because the drug works very well. “It’s been a lot of waste people early on, but the drug is effective,” Gerson said. "By 1973, American doctors prescribed more than 100 million sedative prescriptions every year, and countless patients began to rely on sedatives. The Senate had held hearings on what Edward Kennedy called "the nightmare of dependence and addiction."

When running an advertising company, Arthur Sackler also set up a publishing house that publishes the Medical Tribune once a half month, with an audience of 600,000 doctors. He joked that he was both the head of a pharmaceutical advertising company and the head of a medical journal publisher.But in 1959, his MD Press paid nearly $300,000 to Henry Welch, head of the antibiotics department of the U.S. Food and Drug Administration, to help promote certain drugs. Sometimes when Welch spoke, he would insert some drug advertising slogans into his speech. (Wilch was forced to resign after the deal was discovered.) When I asked about the scandal about Weilch, the respondent laughed and said, "He was chosen by Arthur."

In 1952, the Sackler Brothers acquired Purdue Frederick, a small patented drug company based in Greenwich Village, and its main business is to produce simple drugs such as laxatives and ear drops. According to relevant legal documents, each holds a third of the shares, but Arthur, who is plagued by publishing and advertising businesses, played a negative role. In his 2003 book "The Pain Killer: Addiction and the Road to Death" published by journalist Barry Meier pointed out that Arthur treated his brothers "not like siblings at all, but like children." And now, Raymond and Mortimer become co-CEOs and own their own companies. In the early 60s, Senator Estes Kefauver of Tennessee formed a subcommittee on researching the pharmaceutical industry and was growing rapidly. Kefoway, who had investigated the underworld, was particularly interested in the Sackler brothers. A memorandum prepared by staff under Kefoway stated: "The Sackler Empire had a fully integrated action to purposefully create a new drug in the drug development companies it controls, have clinical tests about the drug, and obtain favorable reports on drug testing from hospitals, have contact information, have advertising means, and publish clinical articles and advertising copy in its own medical journals, and also conduct marketing implants through public articles in newspapers and magazines. "In January 1962, Arthur went to Washington to cross-examination with Kefoway's subcommittee. The Senate panel raised all sorts of sharp questions to him, but Arthur was a powerful interlocutor – sleek, indifferent, impeccable, and no senator could deny him. Sackler caught a mistake from Kefovir and said, "If you have received degree training in medical-related majors, you wouldn't make this mistake." Some people questioned that a cholesterol drug can cause side effects such as hair loss. Sackler said expressionlessly, "I would rather lose my hair than thicker coronary arteries."

As the Sackler family became richer, they became regular customers of art. In 1974, the three brothers donated $35 million to the Metropolitan Museum to build the wing of the Temple of Daldel. Mortimer held a luxurious birthday party here that year. The cake is in the shape of a great sphinx, but its face has been replaced by Mortimer.

In April 1987, when Arthur Sackler was 73 years old, he let his third wife, Gilian, take charge of the entire family expenses. He dictated a brief memo: "I decided to take responsibility for my legacy issues myself." A month later, Arthur died of a heart attack. The family held a memorial service for it at the Metropolitan Museum, but Arthur's children and Gillian repeatedly argued over the distribution of the estate and argued with Mortimer and Raymond over the property. They accuse Gillian of trying to steal their worthy legacy. According to family meeting minutes, Arthur's daughter Elizabeth believes Arthur has hidden some real value investments because he doesn't want Mortimer and Raymond to know. "A family lawyer told the children, "Neither side has an absolute chance of winning." "

Arthur's descendants still own a third of the shares of Purdue Frederick Pharmaceuticals, and Mortimer and Raymond are also interested in buying shares. The company has moved to Connecticut and eventually renamed Purdue Pharma Pharmaceuticals, investing a lot of money under the management of the family. However, such wealth does not seem to be much. At the time of the two brothers' bid, Purdue Pharmaceuticals had developed a new drug: OxyContin.

Humans have grown poppy for five thousand years. The father of medicine, Hippocrates, also acknowledged the efficacy of the plant. But even in ancient times, it was clear that the efficacy of anesthetic drugs was offset by the dangers of their addiction.In the 1996 book Opium: History, Martin Booth pointed out that for the Romans, poppy was a symbol of sleep and death. In the 1980s, Raymond and Mortimer had a huge success with Purdue Pharmaceuticals, developing a new painkiller, MS Contin, a morphine pill with a patented "controlled release" formula: the drug gradually dissolves into the blood within hours. ("Contin" is the abbreviation of "continuity".) MS Contin became the largest sales drug in Purdue Pharmaceuticals' history. But by the late 1980s, when product patents were about to expire, Purdue Pharmaceutical executives began looking for an alternative drug.

The one in charge of this is Raymond's son Richard, a mysterious, slightly clumsy-behaved man who had received medical training. Richard joined Purdue Pharmaceuticals in 1971 and rose all the way since he served as his father's assistant. His name has appeared in many medical patents. In the summer of 1990, Purdue Pharmaceutical scientists sent a memorandum to Richard and several other colleagues, noting that MS Contin had “limited ability to face severe general competition and had to consider other controlled release opioids.” The memorandum describes ongoing research and development to develop a product containing oxycodone, an opioid developed by German scientists in 1916.

Oxycodone is cheaper to produce and has been used in other drugs, such as oxycodone Percodan mixed with oxycodone and aspirin, and acetaminophen Percocet mixed with oxycodone and tylenol. Purdue has developed a pure oxycodone pill with a similar release formula as MS Contin. The company decided to make small dose pills as low as 10 mg, while doses of 80 mg and 160 mg pills are far more effective than any prescription opioids available on the market. As Barry Meier wrote in Pain Killer, “OxyContin is definitely a nuclear weapon in terms of the efficacy of anesthesia.”

Prior to the launch of OxyContin to the market, Purdue focused on arguments with doctors, inferring that the “biggest negative” that might prevent the widespread use of the drug was concerns about the “abuse” of opioids. However, as the company's development of OxyContin gradually matures, some doctors have begun to argue that the American medical community should correct the bias of "abuse" opioids. Even some famous doctors, such as Russell Portenoy of Memorial Sloan Kettering Cancer Center in New York, New York, have introduced targeted various problems caused by untreated chronic pain and the benefits of opioid treatment. “There is an increasing amount of literature that shows that these drugs can last for a long time and have few side effects,” Portnano said in an interview with The Times in 1993, describing opioids as a “nature gift,” saying that bias needs to be eliminated. Portonano received funding from Purdue, denounced clinicians’ Chen Mo and rejection of drugs for chronic pain anesthetics, claiming it was a manifestation of “opioid phobia” and said concerns about addiction and abuse were “medical jokes.” In 1997, both the American Academy of Pain Medicine and the American Academy of Pain issued statements on the use of opioids to treat chronic pain. The statement was written by a committee chaired by paid speaker Dr. J. David Haddox, who also received funding from Purdue.

Richard Sackler worked tirelessly for OxyContin's stunning success, telling his colleagues that he was very pleased with the success of the drug. F.D.A. approved OxyContin for the market in 1995 for the treatment of moderate to severe pain. But Purdue has not conducted any clinical studies on drug addiction or abuse. However, F.D.A., highly unusually approved OxyContin's drug packaging, which promotes the drug safer than other competitors' painkillers, because the patented delayed absorption mechanism in the drug "is believed to reduce the risk of abuse." David Kessler, who worked at F.D.A at the time, said he was "not involved in the approval process." Curtis Wright, the examiner at the time who was in charge of the entire oversight process, resigned soon after. Within two years, he obtained a position at Purdue.

The OxyContin marketing initiated by Mortimer, Raymond and Richard of the Sackler family is one of the largest drug marketing campaigns in history, using many persuasive methods pioneered by Arthur. "At the time, we felt like we were doing something just," recalled Steven May, who joined Purdue as an OxyContin sales representative in 1999. He once told himself, "Millions of people were enduring pain, and we had solutions." (May no longer worked at Purdue) The company formed a marketing team of up to a thousand sales representatives and showed them the advantages of OxyContin in the form of a graph. May attended a three-week training course at Purdue Headquarters. At the celebration dinner after the training, he sat on the same table as Richard Sackler. “I was shocked,” he recalls, “My first impression of him was ‘this playboy made it all’, and he had a family business. I wanted to be him one day. “The main purpose of the

sales campaign was that OxyContin should not only be used for severe short-term pain associated with surgery or cancer, but it can also be applied to less urgent, longer-lasting pain: arthritis, back pain, sports injuries, fibromyalgia. The pain that OxyContin can treat seems limitless. According to internal documents, Purdue management found that many doctors mistakenly believe that oxycodone is less potent than morphine, a misunderstanding that the company has exploited.

In 1995, a memo to the promotion team emphasized that the company "don't want to day" OxyContin is just for the treatment of cancer pain. A major goal of Purdue's 2002 budget plan is to "expand" the use of OxyContin in pain treatment. As May said, “There is one thing Purdue does a good job, and its lobbying targets not only pain experts, but also general practitioners.” In its internal literature, Purdue also mentions exposure to “opioid intolerance patients”, and David Kessler told me because OxyContin is so powerful, from a public health perspective, “the goal should be to sell the smallest amount of drugs to as few patients as possible.” But this approach doesn’t match the competitive requirements of pharmaceutical companies, so Purdue does the opposite.

May told me that sales reps were trained on how to get clinicians to “eliminate objections”. If a doctor asks questions about addiction, May has a prepared conversation point. He would say, “The drug distribution system reduces the likelihood of drug abuse,” he smiled. “These are concrete rhetorics. After so many years, I still remember, “He continued, “soon I realized that it was incorrect.” In 2002, a sales manager at Purdue, William Gergely, told a state investigator in Florida that Purdue managers “tell us to say that it is actually ‘no addiction’.”

May does not simply repeat OxyContin's promotional language to doctors; he introduces them to research reports and literature provided by other doctors. Purdue has a lobbying department and funding thousands of clinicians to attend various medical meetings to introduce the benefits of the drug. In places like Boca Raton, doctors are funded to attend pain management workshops. Such investments are very effective: Purdue’s internal records show that doctors attending these workshops in 1996 prescribed OxyContin as prescribed by other doctors. The company advertises in medical journals, sponsors websites that introduce chronic pain, and divides the public into various gadgets containing OxyContin information: fishing hats, plush toys, luggage tags. Purdue also made a promotional video of patient satisfaction, just like a construction worker talking about how OxyContin relieves his chronic low back pain and gets him back to work. The videos also include recommendations from pain experts, sent to thousands of doctors. ?OxyContin's marketing relies on an empirical logical circle: the company's conclusion on drug safety used to convince doctors is precisely the hands of the company-funded doctors.

Mr. David Juurlink, Department of Clinical Pharmacology and Toxicology at the University of Toronto, told me that part of the reason for OxyContin's success is because many doctors tend to believe in the therapeutic effects of opioids."The main goal of medical practice is to relieve pain, and one of the most common pain doctors see is pain. You have a painful patient, you have a doctor who really wants to help, and now all of a sudden, you have a solution and are told it is safe and effective." Keith Humphreys, a professor of psychiatry at Stanford University who serves as a consultant for government drug policy, is Keith, a professor of psychiatry at Stanford University who serves as a consultant for government drug policy. Humphreys said: “It’s a true Greek tragedy, so many kind-hearted doctors were selected. The impact is incredible. Purdue University funded medical re-education, funded medical committees, funded grassroots organizations. “Based on the training materials, Purdue asked sales representatives to assure doctors that repetitive and without evidence, “less than 1%” of patients taking OxyContin to become addicted. (In 1999, a Purdue-funded study using OxyContin to treat headaches found an addiction rate of 13%.)

received a billion dollars a year within five years of OxyContin’s launch. “There is no sign that its sales slowed,” Richard Sackler told a company’s sales representative team in 2000. Sales staff are also vigorously promoting this drug. In a memo, the Tennessee sales manager wrote: "This is the recent dividend era!" May, who was allocated to the area of ​​Virginia, was surprised to find that many skilled colleagues were able to earn hundreds of thousands of dollars in commissions. May's sales have been very optimistic in the year since entering the company, and Purdue rewarded a trip to Hawaii. As the number of prescriptions increases, Purdue executives and members of the Sackler family on the company’s board seem happy to fund the situation. The internal budget plan describes the company's sales force as "the most valuable resource." In 2001, Pudu Pharmaceuticals paid a $40 million bonus.

One day, May and a colleague drove to a small city in , West Virginia. They went there to visit a doctor who had already prescribed the highest amount. When they arrived, the doctor turned pale. She explained that one of her relatives had just passed away and that the girl used OxyContin excessively.

Arthur and Mortimer Sackler both experienced three marriages, and Raymond had one. The second generation of Sackler family has 15 people, most of whom have their own children. The Sackler family has various industries and related interests. ?In 2011, Mortimer's widow, Purdue board member, Teresa, was awarded the Wells Prince Award Art Charity Medal. When the medal was presented, Ian Dejardin, head of the Dewey Gallery funded by the Sackler family, said: "It's hard to deny that her voice is completely holy." Theresa 's daughter Sophie has married England cricketer Jamie Dalrymple, whose London property is worth $40 million. Raymond's 37-year-old grandson David Sackler runs a family investment fund and is the only third-generation member of the Purdue board. The fact that Purdue is privatized is one of the main reasons why the Sackler family still has a blurred relationship with OxyContin. Listed companies will regularly disclose relevant information to shareholders. But as Barry Meier wrote: Purdue is "the private territory of the Sackler family."

Sometimes, news conferences focusing on OxyContin mention profits from drug sales to the Sackler family, but these stories often portray the Sackler family as a behemoth that has been involved in many industries. However, like any large family, there are also rifts of discord within. In the 1980s, Mortimer sued his ex-wife Gertraud, claiming she illegally owned the apartment she owned on Fifth Avenue and lent it to models and photographers. There was no descendant of Arthur on the board of directors of Purdue. In the courthouse on Long Island, documents about the Sackler family fighting for Arthur's wealth, I found a document that showed that after "long-term negotiations", the "Purdue shares" in Arthur's legacy were sold to Raymond and Mortimer.

"I don't have any shares in Purdue," Michael Sackler-Berner, the Brooklyn singer and composer, Arthur Sackler's grandson, told me in an email.“Arthur M. Sackler’s descendants have no relationship or benefit from the sale of OxyContin.” Sackler-Berner did not mention drugs like Librium, Valium or MS?Contin, but added: “In view of the controversy currently arises around OxyContin, I appreciate the clarification.”

Although Mortimer Sackler owns a large stake in Purdue, he only works occasionally at the company’s headquarters in Connecticut. ?In 1974, it is said that due to tax reasons, he gave up his American citizenship and enjoyed this luxurious life in Europe, constantly traveling back and forth between luxury houses in Britain, Swiss Alps and Cape Andebion. (In 1999, Queen Elizabeth awarded him the title of Honorary Knight in recognition of his charity.) But Raymond Sackler, who lives in Connecticut, was gentle and always liked to work every day at his office in Purdue, where he was called Dr. Raymond. "Ray was quiet, frank, and had only one marriage. He was the least romantic of the three brothers." After OxyContin was launched, there were signs of substance abuse in rural areas like Maine and Appalachia. If you grind the tablets, suck the drugs, or dissolve them in the liquid and inject them, you can completely go beyond the drug release mechanism and get huge anesthesia at one time. Users can learn about these methods by reading the warning labels that come with each prescription, which clearly states: "Using broken, chewed or crushed OxyContin tablets can lead to rapid release and absorption of toxic doses". As more and more doctors use OxyContin for more pain symptoms, some patients are starting to sell medicine on the black market, with the street price being a dollar a milligram. Doctors who are easily manipulated by patients or those who are easily controlled by money will prescribe more OxyContin prescriptions.

However, the company did not remove the drug from the shelves or admit it is somewhat addictive. Instead, Purdue insists that the only problem is that drug addicts are not taking OxyContin as prescribed. "Their rhetoric has been that some trash people have ruined their products," said Stanford professor Keith Humphreys. In 2001, Purdue executive vice president Michael Friedman testified at a congressional hearing that aims to find out the reasons for the growing opioid abuse. He insists that OxyContin marketing is “conservative by any standard. Almost all of these reports are about people who abuse substances, not patients with legal medical needs.”

In 2002, Jill Skolek, a 29-year-old woman from Jill Skolek, New Jersey, took OxyContin due to back pain. One night after taking the medication for four months, she stopped breathing during her sleep and eventually died, leaving only a six-year-old son. Her mother, Marianne Skolek Perez, is a nurse. This incident disturbed and confused her, and she was convinced that OxyContin was dangerous. Perez wrote to F.D.A. officials, urging them to add warnings about the risk of addiction to the OxyContin packaging.

The following year, Perez attended a conference on addiction held by Columbia University. A sofa-haired man named Robin Hogen, wearing a knitted striped suit and bow tie, also attended the meeting. He is a PR expert at Purdue and has launched a powerful campaign to defend the rationality of the drug, warning newspapers to be careful about their coverage. "We're going to see what they say," he agreed. He also pulled New York City Mayor Rudolph Giuliani and his deputy Bernard Kerik to prevent blows from the government. Hogan once said: "We must win the day through Machiavelli-like politics." At an event in Colombia, he was asked about the tragedy of Perez's daughter. He warned that the tragedy should not be interpreted by Purdue as any responsibility.He said the real problem was Jill Skolek: "We think she abused drugs" (Hogan apologized for after leaving Purdue).

Another spokesperson is J. David Haddox, a senior medical consultant at Purdue, who insists that OxyContin is not addictive. He once likened the medicine to a vegetable, saying, "If I give you a celery, you eat it, it will be healthy. But if you put it in a blender and try to inject it into your blood vessels, it certainly won't be very good." When Hardox walked out of the venue, Perez hit him. Hardox poured back into a row of folding chairs. Perez recalls: "It was one of the Kodak moments. It could be wrong. But I like it."

Arthur Sackler once wrote: "All health problems should be attributed to individuals," and Purdue's view is that OxyContin overdose is a matter of personal responsibility, not drug addiction. In addition to people like Hogan and Hardox, company executives include legal counsel Howard Udell is also supporting the drug. The lawyer handling his affairs noted that Udell "like Tom Hagen in The Godfather, he was very loyal to the Sackler family." However, Udell was well aware of the abuse of OxyContin. His own secretary was addicted to drugs and was subsequently fired by Purdue, according to court documents.

In 2003, the Drug Administration found that Purdue's "aggressive approach" had intensified the abuse of the drug OxyContin. "Rogelio Guevara, a senior official at the Drug Administration, concluded that Purdue "deliberately minimizes drug-related dangers." But the company continued to shift the blame to drug users, and even publicizes the public that some addicted teenagers sneaked through their parents' medicine cabinets.

In a telephone interview, Hogan told me that for Purdue and Sackler, "there is a feeling of betrayal - how can people get pleasure by abusing the product?" "Hogan said the company has received a lot of letters from pain patients, thanking Purdue for giving them a new life. "Today, drug addiction is seen as a disease." "But that wasn't. Over the past fifteen years I think our understanding of addiction has increased significantly."

I responded that people have known for thousands of years that opium derivatives are addictive.

"You really need to communicate with the clinician," Hogan replied. "I'm not a doctor."

J. David Haddox is a doctor. In 2001, he told the Associated Press reporter: "A lot of patients say this, 'I'm obeying the medicine prescribed by the doctor,' and they start taking more and more,'" he added, "I didn't find it to be my problem." (Haddox is still working at Purdue and declined to comment on the matter.)

The fact is that the danger of OxyContin is inherent in drugs, and Purdue understands that. The sustained release mechanism of the drug means that in principle it is safe for patients to take it every twelve hours. They can sleep at night, which is an important improvement for routine painkillers (such as morphine, etc.) and no longer require more frequent administration. One of Purdue’s initial ads was a comparison photo of two small dose cups, one marked “8 am” and the other “8 pm” and a line of words “Remember, just take twice,” but Purdue’s internal documents show that it realized that not all patients taking OxyContin strictly followed the 12-hour interval, even before the company received FDA approval. A recent Los Angeles Times leaked that in a study conducted by Purdue, the first patient to use OxyContin was 90 women who recovered after surgery in Puerto Rico. About half of women need more medication twelve hours ago. This study was never published. For Purdue, the commercial purpose of masking this result is clear: the twelve-hour pain relief is a valuable marketing tool. However, for many patients, the pill will take only 8 hours. Although Purdue claims to be unadditive, many ordinary patients who follow the doctor's advice still develop withdrawal symptoms.In March 2001, a Purdue employee told the supervisor via email describing internal data about the patient's withdrawal symptoms and wanted to determine whether to write the results. But doing so will only increase the current negative news, so it is - "I won't write this."

The doctor who prescribes OxyContin has begun reporting on patients' constant withdrawal symptoms (itritic, nausea, trembling) and requesting more medications. Hardox has the answer. In a 1989 article, he coined the term "pseudo-addiction". Purdue explained that the symptoms of pseudo-addiction appear to be similar to those of addiction, but are caused by unexplained pain. The brochure continues, “Misunderstanding this phenomenon can lead clinicians to label patients as “addicts.” This pseudo-addiction usually stops once pain symptoms are alleviated, but pain relief is usually due to an increase in opioid doses.

“When you promote these overdoses of opioids, similar opioid abuse increases,” David Kessler said. “This is almost linearly growing.” "OxyContin's sales performance in the U.S. market quickly surpassed Viagra. Substance abuse and addiction are everywhere. Steven May, a pharmaceutical sales representative in Virginia, said it seems that the problems related to OxyContin are constantly shifting, "like cancer."

According to Robin Hogan, members of the Sackler family were "who were shocked by what happened to the proud product. "Sacklam has no normal relationship with Purdue," Hogan said. "It's an active family and an active board of directors. “In 1999, Richard Sackler became Purdue president. However, as the head of a private company, he did not have the pressure on the company’s business, nor did anyone like Hardox openly stand up for Purdue. In fact, although Sackler dominated the promotion of OxyContin, he never had a documented interview about the drug. Andrew Kolodny, a former economics consultant and addiction expert, said, “I have many years of experience in Purdue and have been to various occasions at the company, but I have never met Richard Sackler.” Even if he stood in front of me, I wouldn't know him. "

Even after confirming that OxyContin was widely abused, Purdue refused to admit that it was a problem that it brought. The company's leaders were primarily concerned that preventing overdoses could cause patients with real pain to lose access to the drug. "They said, 'We need to make sure these products are available for patients,'" Hogan noted, "that's their only focus. "According to Steven May, salespeople were instructed to get rid of the controversy, ignore the abuse reports, and "continue selling." By the end of 2003, F.D.A. sent Purdue a warning letter, prompting that "there is no mention of the serious potential fatal risk of the drug in the promotional body, seriously exaggerating the safety of OxyContin."

Richard Sackler's deputy Michael Friedman In April 2000, Purdue was first aware of OxyContin's problems after getting a series of Maine news reports about people's substance abuse. But Purdue didn't rely on the media to get a deeper understanding of OxyContin distribution. For years, it has been in partnership with a well-known company founded by Arthur Sackler to provide customers with detailed information about individual doctors' prescription habits. Purdue's sales representatives used this data to determine which doctors need attention.

This data can also be used to track patterns of substance abuse. "They know who is prescribing." They also know when doctors will miss the pills. "At the 2001 hearing, Pennsylvania Councilman James Greenwood asked Friedman if possible, whether Purdue would take action. Relevant data showed that a rural doctor could prescribe thousands of OxyContin prescriptions.

Friedman replied that Purdue assessed "whether the doctor's prescription is reasonable."

"So why do you need such information?" Greenwood said in response to his own question: “Look at how successful your marketing skills are."

Greenwood observed that in a recent case involving Pennsylvania doctor Richard Paolino, he wanted to exaggerate the efficacy of the OxyContin drug, a local pharmacist reminded the authorities to pay attention. "He looked at the data and said, "Oh my God, Ben Salam has a guy named Paulino, who is prescribing a lot of prescriptions," Greenwood said. "Now, he has this data, but he whistles. You have data, and what will you do?"

Purdue did not remind the authorities. Clinicians like Paulino were breaking the law and ended up being sentenced to at least thirty years in prison. But the doctor's excessive income also brought corresponding huge income to the company. According to four people I interviewed, in Purdue, such prescription personnel were given the name of Las Vegas casinos for gamblers: whales.

In July 2001, Richard Blumenthal, then the Attorney General of Connecticut, wrote a letter to Richard Sackler. “I’m surprised and worried about the various problems and escalating abuse caused by OxyContin,” he said, citing overdose deaths, addictions, pharmacy robberies and “abnormal Medicaid growth” in the payment of OxyContin drugs. Blumenthal admits other prescription drugs will also be abused. “But OxyContin is different,” he wrote, “it is stronger, more addictive, more wider in sales, more illegally acquired and spread faster.” He called on Purdue to “correct and reform” OxyContin’s marketing.

Sackler ignored his advice, so in 2004 Blumental launched a complaint against Purdue on behalf of Connecticut. It cites relevant data, showing that one in five OxyContin prescribed patients has a shorter interval of administration than twelve hours. In fact, Blumenthal obtained Purdue records, indicating that company officials knew in 1998 that many prescriptions were given at eight hours or less. In a document, a Purdue employee called the number “very scary.”

Compared with public health concerns, Purdue considers more about company profits, so it does not alert you about such situations. If OxyContin dosing intervals generally shorter than twelve hours spread, the company may lose the claimed market advantage of "two pills per day" because of this, and insurance companies may start to refuse to pay fees. Back in 1997, some welfare programs had used the abuse of OxyContin as an excuse to ignore companions. In a 1997 email, Richard Sackler urged colleagues to oppose the resistance, warning that for insurance companies, "addiction" could be an easy way to say "no."

Purdue has been complained thousands of times since OxyContin went public. In 2002, Howard Udell said the company would defend itself entirely. Paul Hanly, a New York lawyer, filed a lawsuit and obtained commissioned signatures from 5,000 patients who said they would become addicted to OxyContin after receiving a doctor's prescription. During the investigation, Hanly obtained thousands of documents. "These documents confirm that the company has begun to commit fraud across the medical community. The safety statements about the drug were issued by the marketing department, not by the science department. It was very shocking, they just brought this thing to the market."

In 2006, Purdue reached a settlement with Hanly's client to compensate $75 million. Not long after, the company admitted that the company had "intentionally deceived or misleading" in the sale of OxyContin in a case filed by the federal prosecutor of Virginia, and executive vice president Michael Friedman, Howard Udell and Paul Goldenheim, the company's chief medical officer, pleaded guilty to criminal misdemeanors.

Marianne Perez testified in Virginia. “I’m very happy,” she recalls. She has been working with the prosecution and has done everything she can to inform the public of the dangers of OxyContin. Prior to the sentence, Perez published a report on the patient's impact. “I wonder why the Sackler brothers were not held accountable,” she said.

Perez looked at Friedman, Kimheim and Udel during the recess and told herself: "I weigh ninety-eight pounds and can knock one down," this time she controlled herself. Instead, she told them, “You’re evil, asshole.” The executives blushed, but said nothing. They all received probation and paid a fine of nearly $35 million. Purdue also agreed to pay an additional $600 million in fine. As the Sackler family and Purdue earned billions of dollars from OxyContin, some observers believe the company will pay the fine soon. Sen. Arlen Spectre, Republican of Pennsylvania, said the fine was a "license for criminal conduct."

Arthur Sackler once wrote a regular column for the Medical Tribune, one of which was concluded to be the immoral behavior of tobacco companies. In 1979, he identified the "crawling warning" on cigarette packaging as insufficiently informative, believing that "the harm to health should be more specific." He also condemned newspapers and magazines for accepting “misleading” advertising and believed that publishers must “contribute to our country’s mortality with their own conscience.”

In 1998, the tobacco industry, which has been sued by dozens of countries, reached the largest civil litigation settlement in history, agreeing to pay $24.6 billion. Tobacco and opioids are largely different. ?F.D.A. Approved OxyContin is a drug, and for tobacco, even if used according to the guidance, it can kill you. Purdue believes that OxyContin cannot be equated with tobacco. As Mississippi Attorney General , Mike Moore, who plays a key role in tobacco litigation, points out another difference: Tobacco companies have more money than Purdue. “To solve the opioid problem, you’ll need billions,” he said. “The cost of treatment alone can reach over $5 billion. And you also need prevention and education expenses.”

More is now working with other lawyers such as Paul Hanly to launch new lawsuits against Purdue and other pharmaceutical companies. Ten states have filed lawsuits and private lawyers are working with dozens of cities and counties to serve others. Many public officials are angry at the makers of powerful painkillers. Regarding the expensive prescription of OxyContin, taxpayers often pay bills through Medicaid. And with the devastating consequences of opium addiction, public funds must pay for public services such as emergency services or drug rehabilitation treatment. Moore believes that the Sackler family, as the initiator, should be publicly criticized. “I don’t call it Purdue, I call it Sackler,” he said. "They are the main culprits. They deceived the Drug Administration and said its effects could last 12 hours. They cheated the addicts' property. They did it all to expand the opioid market and turn this market into a comfortable pot of warm water. Then, some other companies saw that the water was warm and they said, "OK, we can jump in, too." "There may be significant legal differences between tobacco companies and opioid producers, but Moore's moral parallel is undoubtedly: "They all seek benefits through killing." ”

One day in August 2015, a plane landed in Louisville, Kentucky, and Richard Sackler walked out of the airport and was surrounded by lawyers. Eight years ago, Kentucky sued Purdue, believing that the company had adopted deceptive marketing methods. Attorney General Greg Stanbo Stumbo) filed a lawsuit; his cousin’s son died of an OxyContin overdose. Purdue used conventions to deal with the lawsuit, seeking to hand over the lawsuit elsewhere, citing the company’s inability to get a fair trial in Pike County, Kentucky. In support of the motion, the company commissioned Pike County to conduct a demographic study and submitted it to the court as an illustration of potential bias against the jury. The report revealed what Purdue might not have expected: According to the survey, 99% of the county’s residents said they or their families knew someone died of using OxyContin. Seven out of ten respondents described OxyContin’s impact on the community as “destructive.”

Judge ruled that Purdue could not be replaced, so Richard Sackler had to fly to Louisville. He remained silent in court. But four lawyers questioned his role in OxyContin R&D and marketing. Chief attorney Tyler Thompson told me that Sackler’s behavior during the meeting reminded him of Jeremy Irons’s biopic film “The Reversal of Wealth” released in 1990, and Sackler was like Claus von Bülow, a nobleman accused of murdering his wife. “With a smirk and an absolute lack of remorse. It reminded me of a lot of mining companies coming here, digging in a mess, and then saying, ‘This is not my backyard, so I don’t care.’ Mitchel Denham, a litigant at the time of the Kentucky Attorney General’s office, also testified. “It was bizarre,” he recalled, “we had face-to-face cross-examination with everyone in the company that developed opioid drugs. "Denham told me that at the impending trial he found a picture of the 1997 Parkville High School football team. "Nearly half of the players died from overdose. "This will achieve a very impactful visual effect."

However, Denham never submitted the photo to the jury because Purdue had reached a $24 million settlement before the case was tried. This is Sackler's decision. This price is far more than Purdue’s original offer - $500,000, but it still doesn’t meet the needs of Parker County. Purdue will not assume any responsibility and the company will seal the relevant internal documents in the event of a public settlement. Purdue sometimes claims that there have never been cases related to OxyContin, but rather, the company never allowed the case to enter trial, usually a settlement. And the Sacklers "is the main reason why these people are not tried," Denham noted, "because all these documents may end up in public records." Kentucky prosecutors were asked to destroy millions of documents or return them to Purdue. Medical news website STAT then sued Richard Sackler for sealing internal documents. A state judge agreed with this, but Purdue refused. "Their efforts to hide should tell you something," Mike Moore noted. Richard Sackler resigned as president of Purdue in 2003, but remains chairman of the company's board of directors. After years of working as an adjunct professor of genetics at Rockefeller University, he moved to Austin, Texas in 2013. He lives in a modern mountaintop building on the outskirts of the city, where tech entrepreneurs dream of it. He continued to donate to Yale University, according to his personal foundation’s tax disclosures, but the most donated in 2015 was to give $100,000 to the neoconservative think tank, the Foundation for Democratic Democratic Countries. I contacted more than a dozen members of the Sackler family, but they all refused to answer questions about OxyContin. London media consultant Jo Sheldon called me and said she still works with some members of the Sacra family. When I told her I had questions about the Sackler family, she said my question would be better to point to Purdue. Speaking of the Sackler family, she said: "Some of these family members are still involved in Purdue's affairs, but some have nothing to do with it," except for funding.

Given all the usual impatience of the Sackler family, it is shocking that they remain silent about OxyContin. These are people with higher education. Maybe they don't know about the evidence of their wealth stain? Did they just simply put it in memories? “Greed can offset negative behavior,” Andrew Kolodny told me, someone knew Mortimer, “I think for him, most of the time he just said, ‘Wow, we’re really rich. It’s cool, and I don’t want to think too much about the other side of the matter.’” Paul Hanly, an attorney at

, noted that the Sacklers’ firm refusal to resolve the legacy of OxyContin could be a legitimate strategy and a smart one."The more you interview, the more goals you create by lawyers and government investigators like me," he said. "I wonder if philanthropy is a form of atonement for some members of the Sackler family. However, when considering the breadth of the family’s donations, one area is clearly lacking: addictive treatment or any measures that may be used to combat opioid abuse.

In August 2010, Purdue quietly replaced OxyContin with a subtle and different drug. The company has obtained a patent for reformulated OxyContin. If you crush these new pills, they are no longer a tiny, soluble powder, but a gelatinous substance that is insoluble in water. F.D.A. approves Purdue’s new products, but emphasizes safety on packaging. F.D.A. has approved the first such label, which includes claims regarding the drug’s “abuse deterrent” property.

Pudu CEO Craig Landau said in an interview: "After 2001, Purdue's R&D department was mainly committed to addressing the specific vulnerabilities of the original OxyContin products." Conventionally, it seems that OxyContin manufacturers finally saw the errors in their approach after years. But Purdue is almost certainly considering another factor: It needs to stop competition from generic drugs. Arthur Sackler often uses the Medical Tribune to criticize generic drugs. In 1985, the newspaper published a story about a veteran hospital becoming a mess after the psychiatric department replaced brand antipsychotic drugs with a general purpose drug. (But according to the Times investigation, the FDA found that the story was fake because "generic drugs" were introduced six months before the reported and claimed problems appeared"). I once talked with a patent lawyer who often worked with generic drug manufacturers. According to her, the company often fine-tuned the branded products shortly before the patent expires to obtain new patents and redevelop the time for the proprietary production of the drug. The original OxyContin patent will expire in 2013.

disguisedly admits that the drug is not safe and develops a new drug

Purdue has long denied that the original OxyContin is prone to abuse. However, after receiving a patent for reformulated drugs, the company filed a document with F.D.A. asking the agency to refuse to accept a generic version of the original drugs because they are not safe. F.D.A. had been obliged to block any low-cost generic drug competition from Purdue. For more than a year, Purdue has continued to sell the original OxyContin formula in Canada. According to a recent study, OxyContin is in Ontario. Sales (adjacent to Detroit, USA) suddenly quadrupled sales, which clearly shows that the drug is flowing to the U.S. black market. Through I.M.S. tracking data, Purdue was able to monitor the surge in Canada and infer the cause. (The company acknowledged that it was aware of the peak sales, noting that it had reminded the authorities but refused to say when it did.)

The whole country was in the midst of a full-scale spread of painkiller addiction as Purdue redeveloped OxyContin. Addiction expert Andrew Colodney Kolodny told me that many older people are still addicted to re-formulated OxyContin and continue to get their medications through prescriptions. These people legally buy drugs and swallow pills as directed. “This is Purdue’s market,” Kolodny said. And it’s not easy for young people to prescribe, and OxyContin is too expensive for them, so many people turn to black market alternatives, including heroin. Just like Sam Quinones details his book "Island of Dreams: The True Story of the Opioid Epidemic in the United States", published in 2015, that heroin distributors in Mexico will provide drugs to local pill addicts across the United States. This is a terrible paradox in OxyContin's history: the original formula created a generation of pill addiction that forced young users to withdraw but made them addicted to heroin. A recent article by the economist team said heroin addiction has risen sharply since 2010, titled "How OxyContin has changed the addiction of heroin." A survey showed that 244 people turned to other drugs after entering OxyContin withdrawal treatment. 70% of them turned to heroin.

One of the most surprising aspects of the Quinnos survey was the fact that he found that heroin traffickers in Mexico were highly conscious of their business, and the so-called Harlix Island boys and Purdue had similar light marketing strategies. When the Harlix Islands boys arrive in a new town, they will determine their market through their local methadone clinic. Purdue uses I.M.S. data to locate similar target groups that are sensitive to its products. Kentucky attorney Mitchel Denham told me that Purdue noted that “the communities that are poor, lack education and opportunities” are their potential target clients. The company also added, “They visit doctors more frequently because of work-related injuries and have a more demand for pain treatment.” Similarly, the Harlix Islands boys will provide potential customers with free samples of their products. When Purdue first went public OxyContin, the company created a program that encouraged doctors to issue coupons for free prescriptions to patients. Four years after Purdue stopped the program, 34,000 coupons have been redeemed.

Purdue now acknowledges the opioid abuse crisis, but believes that everything feasible has been taken to address the problem, from sponsoring some states’ “prescription monitoring” programs to undertaking expenses for substance abuse education. "We have not found it yet if painkillers that are safe and effective for patients with severe pain and are at risk of abuse are compared to the holy grail," CEO Craig Landau told me, adding that the company is already working on developing "non-opia painkiller products." Pudu particularly emphasized that there are many other powerful painkillers on the market at present, and OxyContin has never exceeded 2% of the opioid market. Of course, from the perspective of prescription numbers alone, there is no problem with this statement. But it should be clear that most painkillers have very short prescription cycles, such as only being used in the recovery period after surgery, and with relatively small doses, but the sales of OxyContin are driven primarily by long-term high dose prescriptions. If the market share is measured by the actual amount of drugs sold, OxyContin will be quite high. Some doctors estimate that it may be as high as 30%.

The United States accounts for about one-third of the global opioid painkiller market. But as politicians and journalists become more alert to the addictive crisis, many American doctors are more cautious about the drugs. In a statement, Purdue said that even if OxyContin is taken according to FDA-approved label instructions, patients may experience physical dependence. "The company believes that physical dependence is different from drug addiction, but Jane, a physician at Physicians for Responsible Opioid Prescriber, is a doctor in Physicians for Responsible Opioid Prescriber. For patients, it could be a meaningless difference: If they find themselves unable to stop taking medication because they are afraid of reactions after stopping, they "can become addicted to some extent." The drugstore chain CVS has been accused of profiting from opioids and recently announced plans to limit prescriptions for powerful painkillers to less than a week, a change that could have a significant impact on drug abuse. It is also possible that OxyContin has reached market saturation. In recent years, U.S. clinicians have prescribed about 250 million opioids a year. Last year, in Ohio, where substance abuse is more severe, 2.3 million people, or about one-fifth of the state's population, received opioid prescriptions. In 2012, the Journal, the Milwaukee magazine, was prescribed for opioids. Sentinel published a story about pain patients who provided testimony about the OxyContin miracle in Purdue’s promotional video. Johnny Sullivan, a construction worker who talked about the efficacy of OxyContin, relieved low back pain but became addicted to drugs. In 2008, when he fainted while driving home on a hunting trip, he overturned his truck and died on the spot. Sullivan was quoted as saying in Purdue’s pamphlet that OxyContin pills “either put me in drowsiness or make me feel painless.”

Toronto doctor David Juurlink told me that even those who restrained addiction, opioids were problematic. “Opioids really do a relief.” But over time, the efficacy of the medicine tends to gradually decrease.That's why people increase the dose. They had to relieve the pain by adding dosage. These people I see are all convinced that they are "legal" pain patients. They took a lot of opioids and they told me they needed this medication and it was obviously doing harm to them. For many of them, the drug cannot be reduced once it is used.

Purdue-funded Dr. Russell Portenoy once advocated the possibility of extensive use of opioids for a long time, but his views have been reassessed. “Did I call pain management, especially about the way opioids are treated, convey the wrong message?” he told the Wall Street Journal in 2012, “I think I am.” (In a statement, Portnero told me that he “retuned the pain management approach and added: ‘No funder has an undue impact on my thoughts’”)

At the defense level, Portnero noted that two decades ago, doctors had not yet mastered the current knowledge about opioids and addiction. The Sackler family and Purdue Pharmaceuticals should probably be held responsible for this: apologize for the role that caused the disaster, because throughout the 1990s, they relied on a series of false assumptions made by Purdue about OxyContin security. But Purdue has fought against any measures that may limit the use of OxyContin, and in the face of measures that may damage the prescription of painkillers in any way, Purdue and its various allies often respond greatly, repeatedly saying that this is not in the interests of using OxyContin in pain patients. Puri Dave, a psychiatrist at the University of Washington, said: "Our products are not dangerous, but people are too dangerous."

Last year, the U.S. Centers for Disease Control and Prevention, which officially announced opioid abuse in 2011, released the first set of guidelines to help reduce prescriptions for powerful painkillers such as OxyContin. "Opioids should not be considered a routine treatment for chronic pain, and doctors are advised to first consider "non-drug" treatments, such as physical therapy, or choose "non-opia treatments."

Purdue and other pharmaceutical companies have long-term funding for nonprofits that often speak for pain patients. The Centers for Disease Control and Prevention's guidelines are not binding, and many nonprofits resist guidelines to prevent disbandment. This barrier is typical at the national and state levels. A series of recent reports published by the Associated Press and the Center for Public Integrity show that , Purdue executives pleaded guilty in 2007 to crack down on any legislative action that could infringe on its business. Purdue and other painkiller manufacturers and their related nonprofits spent nearly $900 million on lobbying and political donations between 2006 and 2015, which is eight times the amount of gun lobbying spent in the same period.

The number of prescriptions has dropped by 40% as Purdue made the OxyContin pills useless. This suggests that nearly half of consumers of the original drug may have crushed it. As David Juurlink said to me that it was not appropriate to call drug regeneration a “effective deterrent of abuse”, as the bottle indicated, painkillers can still be abused by addicts. However, Purdue faces shrinking markets and increasing competition, and has not given up on the development of new user markets. In August 2015, F.D.A. approved the expansion of OxyContin application to eleven-year-old children, which has been criticized by a large number of people.

Forbes estimates that Sackler's annual revenue from family businesses is about 700 million. Dollars, and as the Sacklers certainly would have thought, the actual future of OxyContin could be global. Many big companies turn their attention abroad once their sales peak in the U.S.. After listing OxyContin in the U.S., Purdue moved the second battlefield to Canada and the United Kingdom. At the University of Toronto, the company sponsored a course on pain management for medical and dental students. The lecturer is a member of Purdue’s spokesperson. The student union received a free textbook published by Purdue, describing oxycodone as a “moderate” opioid.The course has stopped after being widely criticized by students and doctors; one of the critics is university doctor Rick Glazier, whose son, Daniel , died in 2009 from an OxyContin overdose.

Due to OxyContin's launch outside the United States, its tragedy in the United States has been staged again: the geographical distribution of drugs is precisely an addictive area, drug abuse and various deaths caused by this prevail. However, the Sackler family is still increasing their drug promotion abroad and is now promoting its drug to Asia, Latin America and the Middle East through a Purdue affiliate called Mundipharma. Purdue’s strategy was from the outset to create a market for OxyContin, instilling cognitive needs by making bold statements about a large number of untreated chronic pain patients. As Purdue enters a country with negative sentiment towards opioids, its marketing methods have not changed. According to a 2016 Los Angeles Times report, just after the Sackler family's OxyContin marketing has been rejected by medical institutions, Mengti still commissioned relevant scholars to conduct research, showing that millions of people in these countries suffer from chronic pain. The company organized some people and paid doctors to introduce the benefits of OxyContin. In fact, some doctors who are currently advocating for OxyContin abroad are called "pain masters."

The Times report describes Florida doctor Joseph Pergolizzi, who runs a pain treatment clinic and promotes the use of painkillers he invented. He also promoted the effect of OxyContin in Brazil and other places. In Mexico, Mengdi asserted that 800,000 people (about a quarter of the country’s population) suffer from chronic pain. In a 2014 interview, Raman Singh, executive officer of Cynti, said: "Every patient in emerging markets should be able to get our medicines." For obvious reasons, the claim of "opioid phobia" has been largely abolished in the United States. But Mengdi's executives still use it abroad.

"This is the same thing as the tobacco industry's approach," Moore told me. “They were in trouble in the United States and they saw a decline in market share, so they exported to countries or regions that were less prescribed than those countries,” he added. “You know what to expect. You’ll see a lot of deaths caused by it.” In May, several members of Congress wrote to the World Health Organization urging it to help stop the spread of OxyContin and explicitly mentioned the Sackler family in it. They wrote: "The international health community has a rare opportunity to see the future. Don't let Purdue get rid of the tragedy they have caused to countless American families, and find new markets and new victims elsewhere." Former F.D.A. Commissioner David Kessler believes that whitewashing of opioid drugs in the United States is one of the "biggest mistakes" in modern medicine. When I asked Moete about selling OxyContin abroad, he said: "It made me sick and uncomfortable."

Earlier this year, Peter Salovey, president of Yale , announced that it would rename its boarding academy, once named after John C. Calhoun, because Calhoun "has actively promoted slavery as a white supremacist and national leader, contrary to Yale's mission and values." This move is not without criticism. Of course, this move marked Yale's beginning to reflect on those who had been worshipped in history and ask whether it matches contemporary moral standards. In Oxford, Rhodes scholars from South Africa recently launched a campaign to remove the statue of Cecil Rhodes.

Yet, the contemporary Sackler family escaped. Its suspicious business behavior is not an old thing centuries ago, but a reality that is happening. If the statistics now show any signs, you might have learned that six Americans died from opioid abuse during this time. Yet, Yale University does not seem to be in a hurry to rename the Institute of Biology, Physics and Engineering Sciences named after Raymond and Beverly Sackler.

Psychiatrist Allen Frances said of the Sackler family, “What’s amazing is that they are completely excluded from the debate on causality. From the past few decades, a real charity family would say, ‘You know there are millions of Americans who are directly or indirectly addicted to us,’ and real charity should be donating to take care of them. On this basis, these people’s names are added to the building. But what the Sackler family does is not charity. It’s just the glory of the Sackler family.” According to the American Association for Addiction Medicine, more than 2.5 million Americans suffer from opioid disorders. Francis continued: "If the Sacklers really want to clear their stigma, they can totally take out a large part of their wealth and create a mechanism that provides free treatment for all addicts." Bomb inventor Nobel created the Nobel Peace Prize. In recent years, several charitable organizations run by descendants of John D.Lockefeller have invested a lot of resources to combat climate change and criticized the environmental harm caused by the once-founded oil company (now known as ExxonMobil). Last year, Valerie Rockefeller Wayne told CBS: "We feel a greater moral responsibility because the source of family wealth is fossil fuels." Mike Moore, the Attorney General of Mississippi, believes that unless more public realizes that their wealth comes from the opioid crisis, the Sacklers will not have such a gesture at all until. Moore reviewed his first settlement meeting with the CEO of Tobacco Company: “We asked them, “What do you want?” "We wanted to go to a cocktail party and no one would come and ask why we were murdering." This is a clear reply. "Moore was confused that museums and universities were able to continue to collect money from the Sackler family, without any questions or controversy. He wondered, "If these foundations, medical schools and hospitals were sponsored, start saying, "How many babies have been addicted to opioids since birth, what would happen?" “Now every half hour there is a child with an opioid addiction. In Huntington, West Virginia, 10% of newborns rely on opioids. A district attorney in East Tennessee recently filed a lawsuit against Purdue and other companies on behalf of baby addict “Baby Doe”.

Moore firmly believes that Purdue executives will not be able to settle all cases. “Somewhere, there will always be a jury, somewhere, there will always be one of the biggest trials in the history of the country,” he said. Paul Hanly notes that the final trial could leave Purdue filing bankruptcy. “But even if they do, I’m sure I won’t give up,” he said. “I’ll start to take a closer look at the responsibilities of the Sackler family. "I don't want to be portrayed as an apology to the public health crisis," said Robin Hogen, former head of Purdue PR. But I want to be clear that you are talking to someone who once had a very respect for Sachler. Everything the Sacklers do is top notch. “I asked him what he thought about the fact that many doctors and public health agency officials believed the Sacklers should be morally responsible for substance abuse. “I’m not a doctor,” Hogan retorted, “I can’t really comment. "

The Sackler family has been doing well in marketing confidence games, and I was shocked that the biggest trick they have drawn was to strip the entire family from the history of the family business. I remembered the famous quote from Arthur Sackler - you should try to make the world when you left better than when you came, and I wondered about the moral code of conduct of the Sackler family. However, the entire family declined to comment.

I recently went to Amaganchet, Long Island, and met a man I called Jeff. At a restaurant, he told me in detail about his struggle with drug addiction. Ten years ago, he began to abuse opioids when he was a teenager. "It's everywhere." He especially liked OxyContin because it can bring "pure excitement."After sucking the red coating of the pill, he crushed the medicine with the flame of the cigarette lighter and sucked it. Fortunately, he didn't inject drugs. “When I grew up, I always warned myself, “I will never put the needle on my arm,” he said.

Jeff admitted that for the next ten years he had been abusing painkillers, meeting a girl, falling in love, and making her addicted to opioids too. One day his dealer was short of medication, but told him, “I will give you a bag of heroin for only twenty dollars.” "Jeff was reluctant, but eventually surrendered. At first, he and his girlfriend just took heroin and eventually they started to inject drugs. They got very addicted to drugs when they got married. Jeff's wife gave birth to a boy who was addicted to opioids. "The doctor had to wean the child with morphine," he said. ”

After a long rehabilitation treatment, Jeff has stopped taking opioids for more than a year. His baby is healthy and his wife has withdrawn. Looking back, he said he felt that an impulsive decision during adolescence had left him on the road of no return. “That’s everything about this drug,” he said, “I just experienced a hurricane past. ”

We left the restaurant and strolled along the tree-lined streets lined with big houses. In the worst years, Jeff was once a craftsman in the area. I had asked him to tell me a property he had served, and we stopped outside a villa hidden behind dense bushes. It was Mortimer Sackler’s property, and Jeff felt sarcastic. He said: “I won’t tell you how many times I’ve been here, sitting in a truck and taking pills.” "

Next to us is a gorgeously decorated wooden door, behind which is a yard with huge weeping willows. When I admire the tree, Jeff said it was simply "a pain about the butt" for those who were taking care of the lawn. He explained that whenever the wind blew, the willow branches scattered on the lawn. "But this place has to be perfect," he said, "there can't be a leaf on the ground." "So an employee came back regularly and cleaned up the mess.