YaleNews

Last month, President Donald Trump declared the opioid epidemic a national public health emergency. Abuse of the popular narcotic OxyContin alone is estimated to cause 100,000 deaths each year, though OxyContin deaths are difficult to differentiate from total opioid-related deaths. The drug was manufactured by Purdue Pharma, a pharmaceutical company owned by members of the Sackler family that misrepresented the drug as far less dangerous than it was known to be.

The Sackler family, whose estimated $13 billion fortune is a product of the company’s success, has donated a wing at the Metropolitan Museum of Art and a library at the University of Oxford. At Yale, the Sacklers have endowed two professorships at the School of Medicine and funded the Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, among other gifts.

“There’s no doubt that we have an opioid addiction crisis in this country,” said University President Peter Salovey. “It is also clear that generosity from the Sackler family has funded issues core to Yale’s mission.”

Salovey declined to comment further on the Sacklers’ donations before he confers with relevant deans and faculty who are experts on the issue and whose research and lectureships have been funded by the Sacklers, who are not Yale alumni, except for a granddaughter who graduated in the class of 2012.

The opioid crisis is the deadliest drug crisis in American history. Some estimates place the death rate at more than 90 American lives each day. Marketing practices in the 1990s are widely believed to have contributed to the crisis, when pharmaceutical companies falsely advertised narcotics as helpful painkillers that had little risk of causing addiction.

Just a few days before Trump declared the epidemic an emergency, a story in Esquire investigated the history and philanthropy of the Sackler family. And a week later, a piece in the New Yorker similarly highlighted the contributions of Purdue Pharma to the crisis. In 1995, the company released the drug OxyContin, whose only active ingredient is the heroin-like substance oxycodone. Purdue Pharma marketed the drug as a remedy for both short-term and longer-lasting, less acute pain, such as arthritis or back pain. After two decades, the drug has produced nearly $35 billion in revenue.

But by 2003, the Drug Enforcement Administration found that Purdue Pharma had used “excessive and inappropriate” marketing that “very much exacerbated” OxyContin abuse. In 2007, Purdue Pharma and three of its executives pled guilty to federal charges of misbranding the drugs, collectively paying more than $600 million in fines. However, Richard Sackler was not charged.                                        

Prescriptions for OxyContin have dropped by almost 40 percent since 2010. But Mundipharma, a company associated with Purdue Pharma and owned by members of the Sackler family, has continued to push the drug in Asia, Latin America and the Middle East. A Los Angeles Times investigation found that Mundipharma had paid doctors to give presentations abroad on the benefits of the drug. In 2015, the company saw a $100 million increase in sales from China — a jump of 45 percent — compared to the previous year, although Mundipharma did not disclose the portion of its revenue that came from OxyContin sales alone. There, the company used cartoon videos that understated the likelihood of addiction in a campaign for opioid pain relievers. The video was later removed from the website.

By 2008, when Raymond and Beverly Sackler endowed Yale with funds for an Institute for Biological, Physical and Engineering Sciences, Purdue Pharma’s misrepresentation of the drug was commonly known — the company had already settled multiple suits.

“These are gifts that different family members made as individual family gifts. These were not gifts from the company — these were individual family gifts, so in that sense, these individuals have wealth that they gave to us, so it’s no more complicated than that when they made these gifts a number of years ago,” said Vice President for Development Joan O’Neill. “We have no reason that we wouldn’t have been excited by the generosity that they provided to Yale and that they’ve provided to institutions around the world.”

In 2009, Richard and Jonathan Sackler endowed the Richard Sackler and Jonathan Sackler Professorship, to be held by the Yale Cancer Center director, with a $3 million gift. Mark Lemmon, the co-director of the Yale Cancer Biology Institute at Yale’s West Campus, currently holds the David A. Sackler Professorship of Pharmacology. According to Dean of the School of Medicine Robert Alpern, the Sacklers have given many gifts over the years to research and lectureship at Yale.

As of July 2014, Richard S. Sackler, former co-chairman and president of Purdue Pharma, was a member of the School of Medicine dean’s council and the Yale Cancer Center director’s advisory board. That year, Alpern called Sackler a “steadfast friend of the medical school.”

In March 2014, Sackler and his children established the Richard Sackler Family Endowment in Medicine, funded by a gift of stock donated by Sackler in 2009, to support three professorships. Raymond and Beverly Sackler have given to Yale to support archaeological excavation work and the establishment of the Raymond and Beverly Sackler Visiting Professor/Lecturer at the School of Medicine.

Asked whether Yale considered the source of the Sackler family’s wealth a factor in deciding whether to accept their donations and why the University ultimately accepted them, Alpern responded that the Sackler family had been “incredibly generous” to the University as well as other organizations. He added that members of the family have always been professional and never asked for anything in return.

Indeed, the Sackler family’s philanthropy spreads across continents. Facilities at Harvard, Tufts, Cambridge and Oxford bear the family’s name. The Sackler Wing at the Louvre Museum honors the family, and members of the family also endowed the Sackler Center for Arts Education at New York City’s Guggenheim Museum. The Raymond and Beverly Sackler Fund for the arts and sciences, one of the family’s charitable organizations, has supported a Yale study on macular degeneration.

“As a physician, I can tell you that opioid painkillers, which have been made by a number of pharmaceutical companies, have been very helpful for patients with pain,” Alpern said. “While it is now clear that these drugs have been abused and there is certainly an addiction problem in our country, responsibility for it cannot be attributed to a single cause.”

According to University Vice President for Communications Eileen O’Connor, once a fund or program is named, the University is contractually and ethically bound to the terms of a gift agreement. Renaming or altering the use of the fund or direction of the program require donor consent. If the donor does not agree, relevant University management analyzes the circumstances and, if necessary, recommends to the trustees that the gift be returned or appeals to a court to alter the name, modify the purpose or determine the appropriate alternative institution.

Purdue Pharma is based in Stamford, Connecticut.

Hailey Fuchs | hailey.fuchs@yale.edu

Clarification, Nov. 15: A previous version of this article has been updated to include the fact that deaths due to Oxycontin are difficult to differentiate from total opioid-related deaths. Also, Esquire reported on the Sackler family two weeks before the New Yorker piece.

  • Nancy Morris

    This article, and much now-fashionable criticism of Big Pharma, Purdue and the Sacklers in particular regarding the current national opioid crisis, is blighted by highly selective twenty-twenty hindsight that downplays or outright ignores the central culpability of Bill Clinton’s federal regulators. That a 2003 “finding” criticized ads that prior federal regulations had actually encouraged does not establish anything beyond the fickleness of federal regulation of opioids. The history of this disaster is important to bear in mind as the nation plunges into its equally questionable legalization of recreational marijuana.

    By 1985, the Reagan FDA had set stringent rules regarding opioid ads, prohibiting claims that a specific drug could treat a specific condition. Those rules made direct advertising of opioids mostly impossible or ineffective.

    That all changed in 1996 when the Clinton FDA opened the “ask your doctor” loophole – advertising a medicine without saying what it is or what it does. Responding to the Clinton policy shift, Purdue Pharmaceuticals started marketing OxyContin as an abuse-and-addiction-resistant opioid that could be taken safely more often than the recommended twice-per-day maximum. In 1997 Clinton’s FDA relaxed its rules to allow specific-drug-for-specific-ailment claims.

    It is important to recall that Clinton’s relaxation of opioid promotion rules was motivated by powerful studies and arguments from influential quarters of the medical community at the time, not from Big Pharma, that opioid use was then too limited by regulation, resulting in too many patients experiencing unnecessary pain. Opioid ADDICTION and SIDE EFFECTS were downplayed in such studies and arguments. Bill Clinton’s oversight was so lax it permitted OxyContin to be promoted on giveaway swag like beach hats, coffee mugs and fanny packs.

    Clinton’s acts were not corrupt, they were willfully ignorant and misguided. But if one is determined to locate a pernicious link from Yale to the opioid crisis, that link runs through Bill Clinton, not Purdue or the Sacklers. Even Bill Clinton acknowledges his own culpability: “We should all acknowledge that we should have seen more of this before,” Bill Clinton recently told the Conference of Mayors.

    In 1995, Purdue Pharmaceuticals started manufacturing OxyContin, their version of oxycodone, a drug developed in Germany in 1916. The FDA approved it for sale in 1996 and the company made $45 million selling OxyContin.

    Painkiller prescriptions in the early 90s were increasing 2-3 million per year. The results of Bill Clinton’s policy shift were immediate. In 1996, painkiller prescriptions jumped by 8 million. In 1998 prescriptions jumped by 11 million. By 2000, Purdue was selling $1.1 billion in OxyContin. These rises were desired by Clinton’s federal regulators, and encouraged by them. Pain was finally being relieved!

    OxyContin is a Schedule II drug. That means that its production is strictly monitored by the Drug Enforcement Administration, particularly within a bureau called the Office of Diversion Control (ODC).

    In 1996, the first year after OxyContin was released, the Bill Clinton ODC approved a quota of just over 5,500 kilograms (kg) of oxycodone. It rose every year of Clinton’s second term, to over 35,000 kg by 2000.

    (Clinton wasn’t alone in this failure. By 2013, the quota had risen to over 153,000 kg, and this year it’s over 108,000 kg.)

    Regulatory malfeasance increased dramatically under President Obama. In a 2011 interview with Salon, DEA supervisory special agent Gary Boggs explained that DEA is required by statute to set quotas so there is “an uninterrupted supply for the legitimate medical and scientific research needs of the United States.” That alone is uncontroversial. But Boggs then explained that illegal users threatened to interrupt that supply. “What you have to understand,” Boggs told Salon, “is that you do have legitimate patients and they’re fishing from the same pond that the illegitimate patients are fishing from, so you have to be cautious not to restrict the quota to the point that when the legitimate parties go to the pool, all the fish haven’t been taken out by the illegitimate parties.”

    In other words, the Obama administration deliberately increased the national OxyContin quota to accomodate the drug’s soaring abuse, often recreational.

    Clinton’s policy shifts also hugely increased the nation’s heroin problem. By 1994, Clinton has successfully pushed Congress to pass the North American Free Trade Agreement, or NAFTA. NAFTA “has certainly attributed to increasing drug traffic over the border,” says a 2015 report from the Council on Hemispheric Relations.

    That NAFTA would increase drug trafficking was no mystery, either. In his book “Border Games: Policing the US/Mexico Divide,” author Peter Andreas explained that “pushing NAFTA through Congress… required deflecting concerns that opening the border to legal trade might unintentionally open it to illegal drugs.” Bill Clinton’s administration purposefully kept quiet about knowing NAFTA’s dark Mexican drug secret when presenting NAFTA to Congress, which passed NAFTA essentially without knowing of that likelihood.

    Bill Clinton promised to get tough on crime and signed the 1994 Crime Bill, which mandated “three strikes and you’re out” penalties and strict mandatory minimum sentences for drug trafficking.

    While the get-tough-on-drugs policies had already been started in 1986, pushed primarily by then-Democratic Senator Joe Biden, during the Clinton years the effects became more pronounced. The policies mostly cracked down on mid- and low-level dealers, who spent increasingly longer times in prison.

    More dealers in prison for longer times just opened up more drug dealing jobs for the people on the street. The revolving door from street to prison to street continued turning out people who, tarnished by the label “convicted drug dealer,” could only find work by returning to the drug trade.

    Combined with NAFTA, the Crime Bill made it possible for the Mexican drug cartels to wage increasingly violent wars south of the border for control of the lucrative border crossing routes and to build increasingly sophisticated gang networks north of the border to distribute the product.

    That product – increasingly, as marijuana legalization makes that crop less profitable – is the cheaper heroin sought by those dependent on expensive oxycodone.

    Today the true sequels to the “studies” of those that “found” oxycodone to be nonaddicting and anodyne are, ironically, “studies” purporting to “find” that access to cannabis show a great reduction in the harms from opioids, including fewer deaths from, overdoses from, addictions to, use of, and prescriptions for opioids. Just as it became fashionable in the Clinton years to ignore adverse evidence of opioid use and focus on their supposed benefits, it is now fashionable to do the same regarding cannabis.

    But however the cannabis debate is resolved, one should not forget how much of our nation’s current opioid overdose epidemic was created and enabled by Bill Clinton’s drug and crime policies.

    • muffbuster

      Interesting insights! You should take a crack at defending white supremacy and income inequality next!

  • justanaverageguy

    We have a criminal justice system that rewards those who have shrewdly
    scammed and destroyed society and been made rich in the process, when
    they should be held fully accountable as are the little people. The
    French learned how to deal with this.