“Today we are facing the deadliest drug crisis in American history,” Attorney General Jeff Sessions said Thursday in West Virginia, the latest stop on his ongoing tour of places hit hardest by opioid addiction and overdose deaths.
“Talk to the police about it, and they’ll tell you many people became addicted almost the first time they tried these powerful and addictive drugs,” Sessions said.
But despite acknowledging the severity of the opioid crisis today, the rest of Sessions speech ignored the role of the corporations that have sold these pills over the years.
Thursday’s speech hit most of the same notes Sessions has struck in other appearances to discuss opioid addiction, treatment, and law enforcement. He echoed Nancy Reagan’s call to “just say no” and offered tepid praise for treatment programs. He even used the fact that treatment too often fails to save addicts’ lives as a springboard to focus on enforcement.
Sessions mentioned drug manufacturers only once — a shout-out to former pharma industry lobbyist turned West Virginia Attorney General Patrick Morrisey for suing some of the companies he used to represent — then launched into several paragraphs of detailed criticism of doctors, dealers, and gangs.
Sessions’ speech focused on users and ignored the other end of the prescription drug pipeline. Like other law enforcement figures, Sessions rarely discusses the drug approval processes that allowed companies like Purdue Pharmaceuticals to make misleading claims about their drugs, or the legal logics that keep the Sackler family that owns Purdue safe from lawsuits.
The crisis Sessions lamented Thursday began with the introduction of OxyContin in 1996. The drug’s ubiquity and high price have helped the Sacklers to amass a $14 billion fortune over the years.
OxyContin caught on because it was marketed as a wonder-drug that could wipe out extreme pain for 12 hours off of a single dose. “Unlike short-acting pain medications, which must be taken every 3 to 6 hours,” Purdue wrote in a 1996 press release, “OxyContin Tablets are taken every 12 hours, providing smooth and sustained pain control all day and all night.”
It’s by now well known that Purdue’s marketing overpromised, and the drug underdelivered. “The drug wears off hours early in many people,” the Los Angeles Times reported in a groundbreaking investigation of the company last year, “and when it doesn’t last, patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug.”
Most damningly, the Times’ expose found, Purdue knew its marketing was a lie. Its own drug trials had shown as much, the Times found, yet the company “held fast to the claim of 12-hour relief, in part to protect its revenue… Without that, it offers little advantage over less expensive painkillers.”
After the drug hit the market, more real-world evidence of OxyContin’s shortcomings began piling up atop the internal trials evidence. Purdue simply recommended upping a patient’s dose – not increasing the frequency with which a patient takes the same concentration of the heroin-lite medication, but dumping larger volumes of it into the bloodstream at the same “smooth and sustained” 12-hour clip.
Heroin and its chemical relatives have an especially pernicious effect on human brain chemistry. Unlike cannabis – Sessions’ personal bugaboo – the withdrawal of opioids from a neurology that’s become dependent upon them is violent and debilitating.
OxyContin isn’t the main murder weapon in the 60,000-plus overdose deaths in 2016 that Sessions cited on Thursday. It is more often heroin, increasingly cut with the even-more-dangerous pharmaceutical invention fentanyl.
But putting a civilian with a pain problem on OxyContin, telling them they’re going to feel fine for 12 hours, then telling them not to take any more even though their pain has resurfaced just a few hours later? That amounts to leaving patients stuck between the pill bottle warnings on one side and the lure of cheaper, harder hits of the same brain chemicals from some street dealer. It’s “the perfect recipe for addiction,” as Dr. Theodore Cicero told the Times.
Hundreds of thousands of people have died in the United States from prescription drug overdoses since OxyContin went on the market.
Purdue, meanwhile, has racked up billions in profits – thanks in part to an aggressive internal sales culture built on telling doctors the answer to problems with OxyContin was almost always more OxyContin, the Times found — and stymied every serious attempt to claw back some of that money to the victims of the epidemic.
The lawsuits started piling up fast, within the drug’s first six years on the market. But the corporate-friendly eccentricities of American liability law kept Purdue’s ill-gotten profits out of reach. Most the more than 100 lawsuits over OxyContin dosing deceptions have been dismissed because of “a legal doctrine which shields drug companies from liability when their products are prescribed by trained physicians.”
Where courtroom shields were at risk of cracking, Purdue wrote checks to make cases go away. West Virginia itself won one of the largest settlements Purdue’s ever paid, a $10 million handshake deal that the company only offered after its lawyer – future Attorney General Eric Holder – failed to convince a judge to dismiss the case before trial.
Trial records are public. Taking the fight further would mean exposing Purdue’s secrets to every other lawyer in the world, a class-action nightmare that could threaten the Sackler family’s Oxy fortune. Out came the checkbook.
To this day, the Sacklers have retained their titanic fortune. Even as official attention turns squarely to opioid users, prescribers, and distributors, the people who actually created the drugs Sessions and other government officials decry can apparently rest easy.