Sackler Family Threatens Media After Opioid Settlement

Cristiano

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The Oxycontin vultures that have been made one of the wealthiest families in the US are trying to intimidate the media after the recent $270 million settlement between Perdue Pharma and the State of Oklahoma over the opioid crisis fueled by Oxycontin. The Huffington Post decided to publish the letter they received instead of being intimidated.

 

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Some related stuff:



 

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Innula Zenovka

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I'm a bit confused about this whole story, I have to admit, and I hope someone can help me clarify my thoughts on the matter.

I'm particularly confused about what the Sackler family, whether individually or collectively, have done or not done (or are said to have done or not done) of their own motion, and what individuals employed by companies they own are said to have done.

Similarly, I'm a bit confused about the roles of doctors, pharmaceutical representatives and patients in all this.

Some years ago, as I've now and again mentioned, I was treated for throat cancer and radiotherapy to the throat is very very painful indeed.

No hugs please -- it was a horrible experience but now I am through it, which I wouldn't have been, I don't think, without the fentanyl patches the oncologist prescribed for pain relief, along with plenty of liquid morphine for "spike" pain as and when I felt I needed it (several times a day over several weeks)

Anyway, I took the meds as directed by my oncologist and after about 3 months, as soon as he told me to cut down on them, with a view to giving them up altogether, I did.

I experienced no particularly difficulty or discomfort so doing, either, presumably because the oncologist knew what he was doing when it came to dealing with pain management (oncologists have to be, after all) and I'm reasonably responsible about following medical advice and instructions, particularly when I don't want to run the risk of becoming addicted to something.

However, had things turned out differently, and, assuming I'd not abused the painkillers or ignored my doctor's advice, I'd been minded to sue someone, I'd have started with the doctor who got me addicted to them or failed to monitor my progress sufficiently closely rather than with the ultimate owners of the company who manufactured the pharmaceuticals.

I know that drugs companies spend huge amounts on trying to impress doctors about their various products but, at least as I understand it, prescribing is pretty straightforward -- several doctors have told me, in conversation, that once something is properly diagnosed, a senior practice nurse could, most of the time, do what they do and take the diagnosis, look it up in something like MIMS and follow the recommendations there.

In other words, I expect -- and reasonably so in the UK at least -- that prescriptions are based on a professional consensus about the most effective treatments and medications, contraindications and so on, underpinned by the hospital/NHS trust's guidelines and those of NICE.

Are people going after the Sacklers because theirs are the deepest pockets, or are there some particular misdeeds in this affair that are alleged to be their fault and theirs alone?
 

Eunoli

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Innula, this isn't about the kind of treatment you had. This is about doctors prescribing opiates for things that really didn't need opiates and for doctors continuing to prescribe them long after they should have stopped, to people who couldn't manage to stop on their own afterward. In one case, one small pharmacy in a rural area was selling millions of dollars of opiates to people from all over the place. These are all conditions that were not just ignored, but pretty much encouraged by the Sacklers and their company.

John Oliver explains it all pretty well.
 

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Are people going after the Sacklers because theirs are the deepest pockets, or are there some particular misdeeds in this affair that are alleged to be their fault and theirs alone?
From what I've read, only one branch is directly in the management of the family-owned company, so some of the broad-based attacks on the Sackler name (such as campaigns to boycott a Sackler museum) are misplaced.

Aside from that distinction, however, there are some very blatant misdeeds by management. They've taken advantage of valid use cases for pain management -- such as you described for your own condition -- as cover for a massively misleading promotions campaigns that severely underemphasized the additive quality of opioids; and then they went much farther than that. There were pill mills throughout Ohio and other Appalachian regions that ordered staggering numbers of opioids, well beyond what any legitimate health clinic would need, and the company did not raise any flags about the obvious misuse of their product.
 

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I'm a bit confused about this whole story, I have to admit, and I hope someone can help me clarify my thoughts on the matter.

I'm particularly confused about what the Sackler family, whether individually or collectively, have done or not done (or are said to have done or not done) of their own motion, and what individuals employed by companies they own are said to have done.

Similarly, I'm a bit confused about the roles of doctors, pharmaceutical representatives and patients in all this.

Some years ago, as I've now and again mentioned, I was treated for throat cancer and radiotherapy to the throat is very very painful indeed.

No hugs please -- it was a horrible experience but now I am through it, which I wouldn't have been, I don't think, without the fentanyl patches the oncologist prescribed for pain relief, along with plenty of liquid morphine for "spike" pain as and when I felt I needed it (several times a day over several weeks)

Anyway, I took the meds as directed by my oncologist and after about 3 months, as soon as he told me to cut down on them, with a view to giving them up altogether, I did.

I experienced no particularly difficulty or discomfort so doing, either, presumably because the oncologist knew what he was doing when it came to dealing with pain management (oncologists have to be, after all) and I'm reasonably responsible about following medical advice and instructions, particularly when I don't want to run the risk of becoming addicted to something.

However, had things turned out differently, and, assuming I'd not abused the painkillers or ignored my doctor's advice, I'd been minded to sue someone, I'd have started with the doctor who got me addicted to them or failed to monitor my progress sufficiently closely rather than with the ultimate owners of the company who manufactured the pharmaceuticals.

I know that drugs companies spend huge amounts on trying to impress doctors about their various products but, at least as I understand it, prescribing is pretty straightforward -- several doctors have told me, in conversation, that once something is properly diagnosed, a senior practice nurse could, most of the time, do what they do and take the diagnosis, look it up in something like MIMS and follow the recommendations there.

In other words, I expect -- and reasonably so in the UK at least -- that prescriptions are based on a professional consensus about the most effective treatments and medications, contraindications and so on, underpinned by the hospital/NHS trust's guidelines and those of NICE.

Are people going after the Sacklers because theirs are the deepest pockets, or are there some particular misdeeds in this affair that are alleged to be their fault and theirs alone?
I don’t have enough information to answer these questions, but I can say I’ve seen disability Twitter light up with tweets from people who seriously need adequate pain management and can’t get it. Even though the Sacklers have done wrong, it’s not right that this is turning into another Puritanical abolition scare, with the patients paying the price. Ever since the FDA changed the guidelines, long-standing pain management patients are having trouble getting adequate care. The FDA is saying that’s “not what they meant” but doctors are panicking and refusing to prescribe, prescribing inadequate amounts or setting conditions the patients are too sick to meet, such as having to refill weekly.

This is affecting surgery patients too.

I suppose someone could say Twitter is hearsay but I’m seeing a *lot* of activity on this issue, including from disability activists.
 

Innula Zenovka

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Innula, this isn't about the kind of treatment you had. This is about doctors prescribing opiates for things that really didn't need opiates and for doctors continuing to prescribe them long after they should have stopped, to people who couldn't manage to stop on their own afterward. In one case, one small pharmacy in a rural area was selling millions of dollars of opiates to people from all over the place. These are all conditions that were not just ignored, but pretty much encouraged by the Sacklers and their company.

John Oliver explains it all pretty well.
I can quite see suing particular doctors and clinics for their irresponsible prescribing practices. I'm just less clear about why it is argued the Sackler family (whether all adult living family members or particular individuals) should be held responsible for what sounds like the prescribing doctors' malpractice.

Isn't this sort of thing regulated? I mean, over here there are all sorts of regulatory regimes here designed to detect irregular and possibly fraudulent prescriptions for opiates -- I know this from my experience of having to take them. There are similar (though by no means near as strict) regulations about prescribing addictive sleeping pills. I'd be astonished if there weren't similar rules in force in the US -- some states are quite content to micromanage women's reproductive health, after all. Why didn't the state regulators do anything?

I'm not defending the Sackler family if they're responsible for any wrongdoing. It's just that had I emerged from my treatment addicted to something as what I said was the result of my doctor's irresponsible prescribing habits, my lawyers would be going after the doctor and the hospital/NHS trust involved. They wouldn't be going after the directors of the company who manufactured the drugs to which I had become addicted without a very clear idea of what they were said do have done that made them responsible for misbehaviour by a doctor who seems, on the face of it, quite far removed from them.

It's the link between the the Sackler family and the "one small pharmacy in a rural area" that was selling millions of dollars worth of opiates that eludes me. Why would a member of the family -- unless she or he worked for the company and monitoring this kind of thing was part of the job -- be at all aware of the details of drug sales to particular rural pharmacies?

If it's said that the sales manager responsible for that area drew the unexpectedly high sales to the attention of some of the Sackler family that's a bit different, but is that what's said?
 
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Think 'payola' but for exorbitantly over-priced, addictive, and proven dangerous substances. Someone needs to drive the incentive-mobile. (^_^)
 

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I don’t have enough information to answer these questions, but I can say I’ve seen disability Twitter light up with tweets from people who seriously need adequate pain management and can’t get it. Even though the Sacklers have done wrong, it’s not right that this is turning into another Puritanical abolition scare, with the patients paying the price. Ever since the FDA changed the guidelines, long-standing pain management patients are having trouble getting adequate care. The FDA is saying that’s “not what they meant” but doctors are panicking and refusing to prescribe, prescribing inadequate amounts or setting conditions the patients are too sick to meet, such as having to refill weekly.

This is affecting surgery patients too.

I suppose someone could say Twitter is hearsay but I’m seeing a *lot* of activity on this issue, including from disability activists.
We have, from what I've seen, an odd situation in the US. We have some doctors prescribing prescription-quality drugs willy-nilly to some people and absolute refusal to prescribe to others. I am old enough to remember when drug ads were not allowed on television. I also remember that there was a problem with the drug companies peddling to doctors, with some in turn over-prescribing, but nothing like today, where people see an ad telling them surely they need such and such drug and go ask your doctor about getting it. Now, usually these ads aren't promoting the types of drugs that people are getting addicted to such as oxycontin, fetanyl, etc...but I do believe it has contributed somewhat. There are also some high profile deaths in the public sphere such as Prince. If you have the money or good insurance, or in the case of the ultra-wealthy, can find an unscrupulous doctor, then here have the drugs.

There's also the fact that drug companies have been conspiring to fix prices and Republicans telling them to not cooperate with investigations. Like everything else happening corruption is the name of the day. Add the profit motive to any endeavor and this is what you can see.

Here's Wanda Sykes talking about who gets the drugs and who doesn't.

 

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Isn't this sort of thing regulated? I mean, over here there are all sorts of regulatory regimes here designed to detect irregular and possibly fraudulent prescriptions for opiates -- I know this from my experience of having to take them.
That's just the point. Purdue Pharma -- which is owned by the Sacklers -- was well aware of the clinic orders that were operating as pill mills. It was obvious from the exceptionally high orders for opioids. But the company did not flag them and alert authorities.

There are dozens of articles just in the Washington Post about the role the Sackler family played in Purdue Pharma's exploitation of opioid sales. Here's just two of them:

Five more states take legal action against Purdue Pharma for opioid crisis

Recent state lawsuits are increasingly naming Sackler family members, in part because of evidence that they may have transferred billions of dollars out of the company and into personal accounts over about a decade. Some of the attorneys general also said Richard Sackler controlled the company’s strategy to push high doses and increasing amounts of the drug.
Lawsuit claims Sackler family disregarded safety, opioid addiction in Purdue push to profit from OxyContin

The lawsuit argues that the Sacklers falsely blamed patients for the dangers of opioids; pushed them on older people without disclosing the higher risk; constantly tried to persuade doctors and others to prescribe higher doses, especially the extremely profitable 80-milligram tablet; and continually returned to doctors who were vastly overprescribing OxyContin to encourage them to hand out more.
 

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Thanks, Beebo. That puts it all in some context, and I can see the Sacklers do have some specific and difficult questions to answer.

I'm still not clear on why the various states' regulatory authorities didn't notice something was amiss. I'm assuming that local laws restricting the supply and use of opiates include some requirements on the manufacturers and pharmacists to record and report patterns of use, so I'm wondering why the problem wasn't spotted earlier by local regulators -- who, as I've suggested, seem very willing to micromanage other areas like women's reproductive health and possible drug abuse by welfare recipients.

Maybe such things aren't monitored in the US, or not particularly closely. I can see how it's different with the NHS. since the various NHS trusts constitute various levels of oversight in such matters.

It's just that, one way or another, had I emerged from my cancer treatment addicted to morphine or fentanyl, I would have blamed myself and the doctor who prescribed them, and probably, too, the hospital and NHS staff charged with monitoring prescription patterns for dangerous and addictive drugs. Going for the manufacturers and the company's owners seems to me to be starting at the wrong end, unless there's something really remarkable there -- which maybe there is.
 

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It's just that, one way or another, had I emerged from my cancer treatment addicted to morphine or fentanyl, I would have blamed myself and the doctor who prescribed them, and probably, too, the hospital and NHS staff charged with monitoring prescription patterns for dangerous and addictive drugs. Going for the manufacturers and the company's owners seems to me to be starting at the wrong end, unless there's something really remarkable there -- which maybe there is.
What if the drug manufacturer had incentivized the doctor to prescribe that drug to you? What if, further - they were well aware how addictive it was and neglected to mention that to your doctor? Would you still blame yourself and your doctor?

This is basically what has been happening in the US. The Sacklers knew what would happen and celebrated it. They pushed for it to happen because of the massive profit they would make. They didn't care who it killed or how many lives it would ruin.
 

Beebo Brink

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It's just that, one way or another, had I emerged from my cancer treatment addicted to morphine or fentanyl, I would have blamed myself and the doctor who prescribed them, and probably, too, the hospital and NHS staff charged with monitoring prescription patterns for dangerous and addictive drugs. Going for the manufacturers and the company's owners seems to me to be starting at the wrong end, unless there's something really remarkable there -- which maybe there is.
I'm not an expert on health administration in the U.S., but my impression is that there is far less of the kind of regulation you describe for the NHS. Perhaps precisely because we do not have a national health service.

Anecdotally, from my own direct experience, both my wife and I have been prescribed pain meds, including OxyContin, from local doctors for a variety of what I would consider to be moderate conditions (knee pain, post surgical pain). Whenever we question the need for such high-powered medications, we get the same basic reassurances: You can't get addicted if you take them when you're in pain. My favorite: THIS one isn't addictive (we looked it up; it is).

We have a few bottles of these opioids in our (overflowing) medicine cabinet, but we are both very loathe to use them. We've taken two or three pills at the height of whatever pain episode we were going through, then ignored the rest. I'm fine with some discomfort and don't expect to be totally pain-free, not when there's such a high risk. But I also have a long history of skepticism with doctors and medicines, which runs counter to the general culture of the U.S. which meekly accepts the authority of doctors and expects that any ailment can and should be erased by taking a pill.

In the context of that culture, we have drug manufacturers that brainwash and/or reward/bribe/corrupt the judgment of our medical community. It's turned into a lethal combination. Here's a harrowing story from ground zero:


The United States is in the midst of the deadliest, most widespread drug epidemic in its history. Unlike epidemics of the past, this one did not start with mafias or street dealers. Some people have blamed quack doctors—profiteers running pill mills—but rogue physicians wrote no more than a fraction of the opioid prescriptions in America over the past two decades. In fact, the epidemic began because hundreds of thousands of well-meaning doctors overprescribed narcotic painkillers, thinking they were doing the right thing for suffering patients. They had been influenced by pain specialists who said it was the humane thing to do, encouraged by insurance companies that said it was the most cost-effective thing to do, and cajoled by drug companies that said it was a safe thing to do.

Opioid painkillers were promoted as a boon for doctors, a quick fix for a complicated problem. By the end of the 1990s, Ortenzio was one of his region’s leading prescribers of pain pills. It was a sign of the times that he didn’t think there was anything wrong with that.
 

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Isn't this sort of thing regulated? I mean, over here there are all sorts of regulatory regimes here designed to detect irregular and possibly fraudulent prescriptions for opiates -- I know this from my experience of having to take them. There are similar (though by no means near as strict) regulations about prescribing addictive sleeping pills. I'd be astonished if there weren't similar rules in force in the US -- some states are quite content to micromanage women's reproductive health, after all. Why didn't the state regulators do anything?
My rudimentary understanding of this particular suit is that there is a statistical component to the way the dosage and prescription guidelines were written. (Sorry I cannot find links off hand because I am lazy, and this is going from memory, which is a long way of saying I am an expert and you should trust me implicitly because I always mean well.) Anyways... The allegation is that the prescription guidelines recommend a large number of pills that the large majority of people do not medically need. At the same time it is estimated that 5-8% of the people taking the medicine have a high risk to becoming addicted. The prescription guidelines insure that those people have enough pills to get close to the edge of addiction. Because a large number of people have too many pills there is a large supply which results in sharing the pills which further increases the probability that the people at risk will be able to obtain more pills and will be more likely to become addicted. Once that 5% becomes addicted then they will pursue other means outside of their circle of friends to obtain more medicine.

Off hand I do not recall how this involves the Sackler family. From what I recall a small number of the members of the family took an active role in shaping the guidelines and the way the medicines were distributed and marketed. Personally, I am a bit torn about this. On the one hand going after individuals for the actions of the corporations is a bit sketchy to say the least. On the other hand there is a long history in the US for people to set up corporations in ways that shields them from personal responsibility. Having said that I wonder if this is more of a ploy to bring attention to people in the hopes they will quietly cave. If that is the case then it is not a responsible way to use the legal system, but abuse of the system is a bit of a sport in the US.
 
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I'm still not clear on why the various states' regulatory authorities didn't notice something was amiss. I'm assuming that local laws restricting the supply and use of opiates include some requirements on the manufacturers and pharmacists to record and report patterns of use, so I'm wondering why the problem wasn't spotted earlier by local regulators -- who, as I've suggested, seem very willing to micromanage other areas like women's reproductive health and possible drug abuse by welfare recipients.
The regulations exist; however enforcement is very difficult because, thanks to legislative lobbying by this industry on national and state levels, drug manufacturing and distribution companies are responsible for monitoring their own compliance and self-reporting their violations to regulatory agencies. So you can tell how that tends to go.

Making matters worse are that the laws, or case precedents, setting the dollar amounts typical for settlements between states and companies found in violation (these settlements are intended to serve the same function as fines but suck at it because they are negotiable and allow the companies being "fined" to make some of their own demands on the government in exchange for agreeing to pay) tend to be very old and have not kept pace with the growth of the economy....which means that settlement amounts that may have been painful to a company back-in-the-day are so laughable and inconsequential today that drug companies can practically plan for them as just another expense when making their yearly budgets.
 

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The comments on this thread are an example of what I’ve been seeing. So it was CDC guidelines, if I now understand correctly. A lot of doctors are denying care inappropriately as a result, including large providers.