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In May 1997, a year after Purdue Pharma launched OxyContin, its sales and marketing manager sought the advice of Dr. Richard Sackler, a member of the billionaire family who founded and controlled the company. Michael Friedman told Sackler that he did not want to correct the false impression of doctors that OxyContin was weaker than morphine, because the myth was increasing prescription sales.
"It would be extremely dangerous at this early stage of the product," Friedman told Sackler, "to make doctors believe that the drug is stronger or equal to morphine …. We are well aware of the point of view of many doctors: oxycodone [the active ingredient in OxyContin] is weaker than morphine. I do not plan to do anything about it.
"I agree with you," Sackler replied. "Is there a general agreement or is there resistance?"
Ten years later, Purdue pleaded guilty in federal court for underestimating the risk of OxyContin addiction, including failing to warn doctors that it was a stronger painkiller than Morphine, and agreed to pay $ 600 million in fines and penalties. But Sackler's support for the decision to disguise OxyContin's strength to doctors – in e-mails with Friedman and another company executive – has not been made public.
The discussion threads were disclosed in a sealed court document obtained by ProPublica: a Richard Sackler statement of August 28, 2015. Taken in the context of a lawsuit brought by the State of Kentucky against Purdue , this statement would be the only case where a member of the Sackler family would have been questioned under oath about the illegal marketing of OxyContin and what family members knew about it. Purdue has waged a three-year legal battle to keep the deposition and hundreds of other secret documents, in a case brought by STAT, a Boston-based health and medicine news organization; the case is currently before the Kentucky Supreme Court.
Meanwhile, interest in the content of the testimony has intensified as hundreds of cities, counties, states and tribes have sued Purdue and other opioid manufacturers and distributors. A committee of the House asked the document at Purdue last summer as part of a survey of pharmaceutical companies' marketing practices.
In a statement, Purdue stands behind Sackler's testimony in his testimony. Sackler, he said, "argues that the company has accurately disclosed the power of OxyContin to health care providers". He "is careful to explain" that the drug's label "clearly indicated that OxyContin is twice as potent as morphine," said Purdue.
Mr Purdue nonetheless acknowledged that he had taken the "determination to avoid making OxyContin a potent pain cancer drug," out of fear "that non-cancer patients are reluctant to take an anti-cancer drug ".
The company, which said it also spoke for Sackler, lamented what it called the "intentional leak of testimony" to ProPublica, calling it "a clear violation of the court's decision" and "regrettable".
The 337 pages of Sackler's testimony focused on Purdue's marketing of OxyContin, particularly during the first five years following its launch in 1996. Some badysts criticize OxyContin's aggressive commercialization of fostering a national crisis that has resulted in 200,000 overdose deaths related to prescription opioids since 1999.
Taken at the same time as a lawsuit filed in Mbadachusetts and made public last month against Purdue and eight Sacklers, including Richard, the evidence underscores the essential role of the family in shaping the business strategy of the company. OxyContin and the decision to recruit an expanded sales force to implement a drug sales plan. at ever higher doses. The documents show that Richard Sackler was particularly involved in the company's efforts to commercialize the drug and had pushed staff to continue deregulating OxyContin in Germany. Son of a co-founder of Purdue, he began working at Purdue in 1971 and has been the company's president and co-chair of the board of directors several times.
In a 1996 e-mail submission, Sackler is pleased with the rapid success of OxyContin. "It's clear that this strategy has exceeded our expectations, our market research and our most cherished dreams," he wrote. Three years later, he wrote to a Purdue executive: "You will not believe how determined I am to make OxyContin a huge success. It's almost that I've spent my life there. After the initial launch phase, I will have to resume my private life. "
During his testimony, Sackler defended the company's marketing strategies – some of which had already been found inadequate by Purdue – and offered a benevolent interpretation of emails that appeared to show Purdue executives or sales representatives to minimize the risks badociated with the company. OxyContin and its euphoric effects. He denied any attempt to trick physicians into the power of OxyContin and argued that Kentucky's lawyers misinterpreted terms such as "stronger" and "weaker" used in the threads.
The word "stronger" in Friedman's e-mail, Sackler said, "meant more threatening, more frightening.This has no purpose or effect to make doctors forget that he was twice as powerful. "
The e-mails introduced in the evidence show Sackler's hidden role in the key aspects of the 2007 federal case in which Purdue pleaded guilty. A 19-page factual statement that Purdue admitted as part of the plea agreement and which, according to prosecutors, contained the "major violations of the law revealed by the government's criminal investigation", made reference to the email sent by Friedman to Sackler in May 1997 bad impression stand. He did not identify any men by name, attributing the statements to "some supervisors and employees of Purdue".
Friedman, who was then president and chief executive officer, was one of Purdue's three leaders who pleaded guilty to a misdemeanor of "OxyContin." No members of the Sackler family have been charged or named under the plea agreement. The lawsuit in Mbadachusetts alleges that Purdue's board of directors, controlled by Sackler, ruled that the three rulers, but no family member, should plead guilty as individuals. Once the case was over, the Sacklers were concerned about maintaining the allegiance of Friedman and another of the leaders, according to the lawsuit filed in Mbadachusetts. To protect the family, Purdue paid the two leaders at least $ 8 million, according to this lawsuit.
"The Sacklers spent millions of dollars to keep the loyalty of people who knew the truth," says the Mbadachusetts Attorney General's complaint.
The content of Kentucky's evidence is likely to fuel the growing protests against the Sacklers, including lobbying for the family name to be stricken from the cultural and educational institutions it has donated. The family has been active in philanthropy for decades and has donated hundreds of millions of dollars. But the source of its wealth has not attracted much attention until the last few years, partly because of the lack of public information about what the family knew about Purdue's abusive marketing of OxyContin. false allegations concerning the addictive nature of the drug.
Although Purdue has been pursued hundreds of times for its marketing, OxyContin has addressed many of these cases and has almost never gone to trial. As a condition of settlement, Purdue often required a confidentiality agreement, protecting millions of documents from public view.
That's what happened in Kentucky. In December 2015, the state settled its lawsuit against Purdue, alleging that the company had created a "public nuisance" by inappropriately marketing OxyContin for $ 24 million. The settlement required the state Attorney General to "completely destroy" the documents in his possession from Purdue. But this condition did not apply to documents sealed by the circuit court where the case had been closed. In March 2016, STAT filed a motion to publish these documents, including Sackler's statement. Last year, the Kentucky Court of Appeal upheld a lower court ruling ordering that the evidence and other sealed documents be made public. Purdue asked the state Supreme Court to review the decision, and both parties have recently filed briefs. Protesters outside the capital of Kentucky last week waved placards urging the court to release the statement.
The Sackler family has long been the majority of Purdue's board of directors, and the profits of the company go to trusts that benefit the extended family. During his testimony, which lasted more than 11 hours at a law firm in Louisville, Kentucky, Richard Sackler said, "I do not know" more than 100 times, including when asked how much his family had pulled sales of OxyContin. He acknowledged that it was more than $ 1 billion, but when they were asked if they had earned more than $ 5 billion, he replied, "I do not know." Asked about $ 10 billion he replied, "I do not think so then."
In 2006, OxyContin's "contribution" to Purdue was $ 4.7 billion, according to a document read in the testimony. According to the lawsuit filed in Mbadachusetts, the Sackler family received more than $ 4 billion in payments from Purdue between 2007 and 2018.
During the testimony, Sackler was confronted with e-mails with company officials about Purdue's decision not to correct the misconception of many physicians that OxyContin was weaker than morphine. The company saw this news as good news, as the softer image of the drug helped boost sales in the lucrative market of treating diseases such as back pain and arthritis, according to the documents products at the show deposit.
Designed to gradually release medication into the blood, OxyContin allows patients to take fewer pills than they would with other faster-acting painkillers, and its effects last longer. But to achieve these goals, an OxyContin pill contains more narcotics than competing products. The attackers quickly understood how to crush the pills and extract the large amount of narcotics. They would usually sniff or dissolve the liquid form to be injected.
The pending lawsuit against Purdue in Mbadachusetts accuses Sackler and other company executives of "the doctors had the crucial misconception that OxyContin was weaker than morphine, which led them to prescribe much more often OxyContin ". tell the truth to doctors, "for fear of reducing sales. But that does not reveal the content of the e-mail exchange with Friedman, the link between this conversation and the 2007 plea agreement, and the back and forth in the testimony.
A few days after the e-mail exchange with Friedman in 1997, Sackler had an email conversation with another company executive, Michael Cullen, according to the statement. "Since oxycodone is perceived as a weaker opioid than morphine, it has resulted that OxyContin is used much earlier for the treatment of noncancer pain," Cullen wrote to Sackler. "Doctors are positioning this product where Percocet, hydrocodone, and Tylenol with codeine are used traditionally." Cullen then added, "It's important to be careful not to change physicians' perceptions about of oxycodone in the development of promotional items, colloquia, journals, studies, and so on. "
"I think you have this problem well in hand," replied Sackler.
Friedman and Cullen could not be reached for comment.
Asked during his testimony on the exchanges with Friedman and Cullen, Sackler did not dispute the authenticity of the emails. He added that the company feared that OxyContin would be stigmatized as morphine, which he said was only perceived as an "end-of-life" drug that scares people.
"Meanwhile, it seems that people have become accustomed to signifying less frightening, less threatening, more patient, more acceptable, more or less frightening, less acceptable and less desirable and less desirable or stronger. Sackler said during his testimony. "But we knew that the word" weaker "did not mean less powerful. We knew that the word "stronger" did not mean more powerful. He called these words "very unhappy".
He added that Purdue did not want OxyContin to be polluted by all the bad badociations that patients and caregivers had with morphine.
In his testimony, Sackler also defended sales representatives who, according to the Facts 2007 Advocacy Statement, had falsely stated to physicians during the period 1996-2001 that he was not the only one in the world. OxyContin did not cause euphoria or was less likely to do so than other opioids. . This euphoric effect felt by some patients is part of what can make an addiction to OxyContin. Yet, questioned on a 1998 note written by a Purdue salesman, which indicated that he had "spoken of less euphoria" when he was promoting OxyContin to a doctor, Sackler replied that it was not necessarily moved.
"It was in 1998, well before the common statement of facts," he said.
The state attorney asked Sackler, "What difference does it make? If it is not correct in 2007, would it not be in 1998? "
"Not necessarily," Sackler replied.
In another sales note, in which a Purdue representative claimed to have told a doctor "that there might be less euphoria" with OxyContin, Sackler replied, "We really do not know what has been told. " After further interrogation, Sackler said perhaps less euphoria "could be true, and I do not see the harm."
The same problem arose with a note written by a Purdue sales representative about a doctor: "You have to convince him to advise patients that they will not be buzzed as they will with painkillers. short-acting opioids. Sackler also defended these comments. "Well, what is written here is that they will not be heard. And I do not think that saying to a patient: "I do not think you're going to have a buzz" is harmful, "he said.
Sackler added that the representative's comments to the doctor "might actually be helpful because a lot of patients will not be heard, and if he wanted to know if they were doing it, he might have had a good one. medical reason for wanting to know this. "
Sackler stated that he did not believe that the vendors of the company working in Kentucky engaged in the improper conduct described in the federal plea agreement. "I have no facts to tell me otherwise," he said.
Purdue said that Sackler's statements in his statement "fully acknowledge the wrongful acts committed by some Purdue employees prior to 2002," as stated in the 2007 Advocacy Agreement. The company and Sackler "completely disagree" with the facts in this case, Purdue said.
The statement also reveals that Sackler has pushed company officials to determine whether German officials could be persuaded to relax restrictions on the sale of OxyContin. In most countries, narcotic badgesics are regulated as "controlled" substances because of their potential for abuse. Sackler and other Purdue executives discussed the possibility of persuading the German authorities to clbadify OxyContin as an uncontrolled drug, which would probably make it easier for doctors to prescribe it – for example, without seeing a patient. Fewer rules are expected to result in increased sales, according to company documents disclosed at the time of filing.
A Purdue official warned Sackler and others that it was a bad idea. Robert Kaiko, who developed OxyContin for Purdue, wrote to Sackler: "If OxyContin is not controlled in Germany, it is highly likely that it will eventually be abused there, and then controlled."
Nevertheless, Sackler asked a Purdue executive in Germany for sales forecasts with and without controls. He also wondered whether, if a country in the European Union relaxed controls on drugs, others could do the same. When he was finally informed that German officials had decided that the drug would be controlled like other narcotics, Sackler asked by email if the company could appeal. Saying that was not possible, he told a German official: "When we are together, we should talk about how this idea was raised and why it was not been realized. I thought it was a good idea if it could be done. "
When asked about this comment during the testimony, Sackler replied, "That's what I said, but I did not think so. I just wanted to be encouraging. "He said that he" was really not in favor of "loosening the regulation on OxyContin and that he was just" polite "and" caring "at the same time. in respect of his own employee.
Toward the end of the testimony – after showing Sackler dozens of emails, memos and other documents regarding the marketing of OxyContin – a Kentucky lawyer asked a fundamental question.
"Sitting here today, after all you've learned as a witness, do you believe that Purdue's leadership in marketing and promoting OxyContin in Kentucky caused the One of the addiction problems of prescription drugs now rife in the Commonwealth? "
Sackler replied, "I do not think so."
This story is a collaboration between ProPublica and STAT.
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