The Sackler dynasty is one of the richest and most powerful in the USA. With a fortune estimated at 14,000 million dollars, their surname shares the podium with wealthy families such as the Buschs or the Rockefellers. In addition, as with other billionaires, they are also involved in philanthropic causes with a purpose that ranges from altruism to image laundering. They appear linked to art and teaching institutions or museums such as the Guggenheim in Bilbao, which has received donations of 9 million dollars over 20 years. How have they done it? By building a pharmacological empire, first by marketing Valium and then OxyContin, a powerful and revolutionary painkiller. They generated billions in revenue… and millions of addicts.
OxyContin began selling in 1996. In the quarter century after its release, opioid-related overdose deaths in the U.S. reached 450,000. They exceed those killed in traffic accidents, gunshot wounds, or American soldiers killed since World War II. This is what ended up generating the so-called opioid crisis, an epidemic of addicts created by pharmaceutical companies that still has consequences around the world today.
To shed light on this whole network of influences comes Patrick Radden Keefe (author of Don’t Say Anything), who in 2017 began an exhaustive investigation into the secrets of the Sackler family that now lands in bookstores with the title El imperio del dolor ( Reservoir Books), translated by Albino Santos, Francesc Pedrosa and Jesús Negro. The author meets us in a hotel in the heart of Madrid, early in the morning, with coffee in hand and ready to delve into one of the most perverse networks of our recent era.
The story begins with the story of three brothers of humble origins who in 1952 acquire a small pharmaceutical company to make a living. At what point does the compass of ethics break down?
It happens gradually, it’s difficult to pinpoint the moment when they crossed the line. It was a succession of smallThey were not only a good person, but they also thought of themselves as a good person every time they deviated from the right path.
What makes OxyContin different from other opiates that also cause addiction?
When it was first sold in 1996, what made it different from other drugs is that it was very potent. They could put a large dose of that opioid in a small pill, because it had a code that was designed to release it little by little.
The other difference was the way it was sold. Up to that point there was a consensus among doctors that opioids should only be used when other things hadn’t worked, because they were addictive. But when OxyContin began to be marketed, they focused their marketing campaign on saying that it was not dangerous or addictive, and it began to be used more freely.
I hope my book will serve to challenge a system that isolates the rich and prevents their bad acts from having consequences.
The silence of the Sacklers’ malpractice lasted for decades because government agencies also allowed it, such as the Food and Drug Administration. To what extent are the institutions charged with looking out for the citizen complicit?
The book is also about the history of all those institutions that allowed it, because that family’s money corrupted everything it touched. I hope it also serves to question a system that isolates the rich and prevents their bad acts from having consequences.
At a time when governments around the world are campaigning to raise awareness of vaccination against HIV/AIDS, can stories like these fuel health mistrust?
I hope my book is not read in that light. We should not be naïve about the way the world works: organizations that are in it to make money are not working for the good of humanity. This is very clear in those companies that have been asked to give up their patents, with the intention of using their drugs in resource-poor countries, and yet they have refused.
But being overly cynical about these companies is not a good thing either, because they can achieve miraculous things. It’s happened more in the US than in Spain, but many of the people who have refused to get vaccinated have been partly because of stories like the opioid crisis. The public’s trust in pharmaceuticals has been shattered, but the last thing I would want is for anyone reading my book to conclude that they don’t have to get vaccinated. I am and everyone should be.
Many of the people who have refused to vaccinate have been partly because of stories like the opioid crisis, the public’s trust in pharma has been broken.
At first it seemed that the problem was not with OxyContin, but with people because they were abusing it. It is the same logic that seems to exist in other businesses, such as the arms industry: the culprit is not the manufacturer of a gun, but the one who uses it to kill. Why is the consumer held responsible?
There are people who have a philosophy of the world in which everything depends on individual freedom and, therefore, believe that they would have the right to sell you something regardless of whether you can use it to kill yourself or others.
When the Sacklers became aware that their drug was killing a lot of people, their first reaction was to say that this was happening to addictive people with no ethical values and therefore it was not the drug’s fault. There are a lot of people in the US who have that libertarian point of view because it caught on with the population.
In the end, the pharmaceutical company went bankrupt, but after making 35 billion dollars and causing hundreds of thousands of deaths. Has justice been done?
No, not at all. This is a story of impunity, and I was already aware of that as I was writing the book. There were things I didn’t know how they were going to end, but one thing was very clear to me: that the bad guys got away with it in the end. It’s important to understand what this also tells us about the world we live in.
The Sackler dynasty has proliferated in a context such as the USA, where the privatization of health care is a priority. Would it have been so easy in another context with a more public health care culture, such as in Spain?
It would have been much more difficult, though surely not impossible. The reason the book’s story goes back to the Great Depression and not to 1996, when the drug was first marketed, is because the roots of this story are rooted in the privatization of medicine. The corruption of medicine has been mediated by private companies, and this happened long before OxyContin.
The amount of opioid painkillers consumed in Spain has increased by 53% in the last seven years. Why do you think this increase is due?
I don’t know the full context of Spain, but I do know that in that same period you mention the consumption of prescription opioids in the US decreased and many of those companies, Purdue Pharma and others tried to recoup those losses abroad. The same thing happened with the tobacco companies: when people in the West, in Europe and in the US realised that tobacco caused cancer and the companies started to lose money, they decided to focus on Africa.
The Spanish health minister, Carolina Darias, recently warned of the high consumption of opiates in Spain and launched a “preventive” plan that involves informing patients of the risks or limiting prescriptions. I know you are not a doctor, but after investigating the conflict so thoroughly… What concrete measures would a good plan to combat the high consumption of opiates have to have?
There’s something very important: that many doctors know about opioids from companies, not from use. If there is going to be a plan, it should be one in which professionals should not only be trained on how to prescribe opioids but also on how to properly stop using them.
But if opioid prescribing is limited, don’t you think that will lead to a black market for opioids?
This is happening in the US and it’s a fact. It’s one of the most diabolical aspects: that you take measures to solve one problem and end up creating another. But for the black market to be a problem you first need to have created a large community of people who depend on those drugs. If in Spain the problem does not have these dimensions, it is time to act, because then there will not be so many people dependent on these substances and therefore it will not create a market.
Practitioners would not only have to be trained on how to prescribe opioids but also on how to stop opioids appropriately.
So what would be the alternative for someone who would otherwise live in pain?
Opioids are a very powerful solution for short-term severe pain, the problem is what do you do with people who have chronic pain, because the body develops dependence and tolerance. After a while it is very difficult to see if the opioid treats the discomfort or if one has become dependent, because one of the ways in which withdrawal is expressed is through pain.
It’s a very difficult question and there are different opinions within the medical field. Many professionals think that there are alternatives, such as physical therapy, and maybe we should try that before going for opioids. The culture that whatever happens is solved with a bunch of opioid prescriptions should end.
In the 1960s, the sugar industry paid scientists to dissociate sugar as a cause of cardiovascular disease. On that occasion, as with OxyContin, the balance tipped to the side of private and economic interests. What should be done so that in the future, when faced with another similar case, it will tip to the side of public health?
The sector needs to be more regulated, the government should avoid being influenced by the industry and consumers should be informed. Just as everyone needs to be vaccinated, I think it’s also good to have some skepticism about how these companies operate and how they can influence government institutions. The little I can do in all this is to tell the truth.
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