Who Profits from Opioid Crisis?

This week, President Donald Trump’s nominee for drug czar, Republican Congressmember Tom Marino, had to withdraw from consideration after a Washington Post/”60 Minutes” investigation found he led a drug industry-backed effort to pass a law that weakened the U.S. Drug Enforcement Administration’s ability to crack down on addictive opioids. Meanwhile, calls are growing to look at the major pharmaceutical companies that have fueled the opioid crisis. A new investigation by Esquire magazine reveals how the secretive Sackler family, owners of the company that invented OxyContin, downplayed the risks of addiction and exploited doctors’ confusion over the drug’s strength. We speak with Christopher Glazek, the Esquire reporter behind the story.

NERMEEN SHAIKH: We turn now to look at America’s staggering opioid epidemic, the secretive family making billions from the crisis, and how Congress undermined efforts to restrict the flow of pain pills that have led to tens of thousands of deaths. President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis has said, quote, “America is enduring a death toll equal to September 11th every three weeks.”

But this week, his nominee for drug czar, Republican Congressmember Tom Marino, had to withdraw from consideration, after a Washington Post/60 Minutes investigation found he led a drug industry-backed effort to pass a law that weakened the U.S. Drug Enforcement Administration’s ability to crack down on addictive opioids and keep them off the black market. The Ensuring Patient Access and Effective Drug Enforcement Act passed in 2016. It made it nearly impossible for the Drug Enforcement Administration to intervene in cases where large, suspicious shipments of opioids are delivered to pharmacies bound for the black market. The drug industry lobbied heavily to win passage of the bill, contributing $1.5 million to its 23 congressional co-sponsors. Marino alone accepted nearly $100,000 in campaign cash from the industry.

This is Joe Rannazzisi, who ran the DEA’s Office of Diversion Control, which regulates and investigates the pharmaceutical industry, speaking to 60 Minutes about the measure.

JOE RANNAZZISI: If I was going to write a book about how to harm the United States with pharmaceuticals, the only thing I could think of that would immediately harm is to take the authority away from the investigative agency that is trying to enforce the Controlled Substances Act and the regulations implemented under the act. And that’s what this bill did.

BILL WHITAKER: The bill, introduced in the House by Pennsylvania Congressman Tom Marino and Congresswoman Marsha Blackburn of Tennessee, was promoted as a way to ensure that patients had access to the pain medication they needed.

AMY GOODMAN: Congressman Marino has said he’s proud of his work on the 2016 law, which passed without opposition in the House and Senate, was signed by President Obama.

Meanwhile, calls are growing to look at the major pharmaceutical companies who fueled the opioid crisis. A new investigation by Esquire magazine reveals how the Sackler family, owners of the company that invented OxyContin, downplayed the risks of the drug’s addiction and exploited doctors’ confusion over the drug’s strength. The piece in Esquire is headlined “The Secretive Family Making Billions from the Opioid Crisis.” It begins, “You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?”

For more, we’re joined by Christopher Glazek, the reporter behind the investigation.

Christopher, welcome to Democracy Now!


AMY GOODMAN: So, the name Sackler is famous in the art world, because it’s hard to go into a museum where you don’t see an atrium named, whether we’re talking about the museum—the Metropolitan Museum, the Tate in London—I mean, all over. Why don’t you explain how we know the name, and how we don’t know the name when it comes to OxyContin, and how significant OxyContin is when it comes to the opioid epidemic?

CHRISTOPHER GLAZEK: Yeah, well, the Sackler family is very interesting, because, in some ways, it’s extremely public, and then, in other ways, it’s extremely private. So, you’ll see their name on university campuses. Almost every Ivy League school has an institute or a museum named for the Sacklers. As you mentioned, there’s—

AMY GOODMAN: Like where, in universities?

CHRISTOPHER GLAZEK: Oh, like at Yale, at Tufts, at Columbia, at NYU, at Cornell, at King’s College London, at Edinburgh, at Sussex. I mean, the list really goes on and on and on. And in the museum world, too. I mean, there’s named rooms or wings for the Sacklers at the Guggenheim, at the Louvre, at the Tate, at the Met. You know, so people know the Sackler name. But the Sacklers themselves are rarely interviewed. They basically never give interviews. They’re rarely seen in public. And almost nobody in the world, in the art world or in the world of higher education, understands that the major source of their fortune is OxyContin. And one reason for that is that the Sacklers never put their name on their company, never put their name on their product.

So, you know, as you mentioned, I mean, the reason I wanted to do the piece, we have an opioid crisis in this country, and more than 200,000 people have died from prescription drugs since OxyContin was released in 1996, and w have an accountability crisis also. You know, we tend to think of big social problems, like drug epidemics, as the product of these large, impersonal forces that are hard to understand. And there’s some truth to that. But that can also distract from the fact that a lot of social problems also have their origins in actions taken by individuals. So, that was something I wanted to shine a light on.

NERMEEN SHAIKH: Well, how did you learn, come to learn, of the Sacklers’ involvement in this?

CHRISTOPHER GLAZEK: Well, it’s very interesting. So, you know, I had read quite a bit about Purdue Pharma, which had manufactured OxyContin and which, in 2007, had to plead guilty to criminal charges for what was called criminally misbranding a prescription drug. And they had to pay a huge fine, and three of their top executives went down. And there had been a ton of writing about that, but almost no writing about the fact that the company was actually 100 percent owned by one family, and that family filled more than half of the board seats and actually supplied top executives for the company.

You know, one thing that kind of emerged is that when they signed onto this huge settlement, which got a ton of press in 2007, it seemed like the top leaders of the company took the fall, because the CEO at the time had to plead guilty to a misdemeanor. But he wasn’t the CEO during the period covered by the settlement or during the crucial period of OxyContin’s promotion and marketing. During that period, the top executive was actually a member of the Sackler family who owned the company. And yet the Sackler name appeared nowhere in the guilty plea. It was like a hundred pages. It appeared all over this other document that was attached, which was a nonprosecution agreement. And so, basically, the government said, “We’re not going to prosecute any of these 200 entities related to the Sackler family.”

AMY GOODMAN: So, Christopher Glazek, tell us the story of the Sackler family, their rise, the rise of OxyContin. Go back decades.

CHRISTOPHER GLAZEK: Sure. So, the Sacklers were basically three brothers from Brooklyn who were—came from a Jewish immigrant family. And they got their start, really—I mean, the eldest brother, Arthur Sackler—in medical advertising. So he was a really important pioneer in the field of medical, and specifically pharmaceutical, advertising. He was one of the first people ever inducted into the Medical Advertising Hall of Fame, actually.

So, basically, when he came on the scene in the ’40s, there really wasn’t much pharmaceutical advertising. There were these door-to-door salesmen. They were called “detail men,” and they would basically try to push their drugs on doctors. What Arthur realized is that you could use print advertising to reach a much larger number of doctors more efficiently. And he was actually the first person to convince the Journal of American Medicine to insert a color brochure advertising a particular drug, which, at that time, was an antibiotic—and then actually got involved in this big scandal about overprescription of antibiotics, you know, another public health problem. His big, huge first influx of cash came with Valium, because he was the one who designed the marketing campaign for Roche, which was the manufacturer, and he made Valium the most widely prescribed drug in America.

AMY GOODMAN: What was his trick there?

CHRISTOPHER GLAZEK: So the trick, basically, was that, you know, Valium—there was another drug that had already been on the market that was the same as Valium. It was called Librium. I mean, almost indistinguishable. And so it was like this big question: Well, how are we going to market this one? Librium had been marketed pretty narrowly for a specific anxiety function. His idea was to take Valium, a new drug with a new name, and market it for every kind of problem. And so he kind of—they played with this concept called “psychic tension,” which was purported to be the source of indigestion, of depression, of sleep problems, of restless leg syndrome. And so—

AMY GOODMAN: It was the word before “stress.”

CHRISTOPHER GLAZEK: Yes, right. It was kind of like what we now think of maybe as stress. You know, so he was, in this way, able to vastly expand the range of potential patients and indications, and, in that way, made the first $100 million drug.

NERMEEN SHAIKH: And what kind of use did Valium have versus Librium?

CHRISTOPHER GLAZEK: So, I mean, it was used by people who were suffering kind of what are called “somatic problems,” so different kind of physical manifestations which may or may not have their root in something related to anxiety. Valium was just narrowly targeted—or, sorry, Librium was narrowly targeted to people who had like a specific kind of anxiety issue, which at that time was not quite the thing that it is today.

NERMEEN SHAIKH: So Valium was prescribed much, much more than Librium—


NERMEEN SHAIKH: —or Librium.

CHRISTOPHER GLAZEK: Yeah, way, way, way more. And it became, actually, the most prescribed medication of all time, you know, at that time.

AMY GOODMAN: And so, move on from there.

CHRISTOPHER GLAZEK: Right. So, Arthur also became a huge art collector, kind of established the family’s foothold in the art world. And throughout his entire life, he had actually passed on jobs and businesses to his younger brothers. So he was involved in the purchase of this really tiny pharmaceutical company in 1952 which was called Purdue Pharma, which was on its last legs. It had basically been a kind of patent medicine peddler. It had this drink called Gray’s Glycerin Tonic, which was—you know, in the patent medicine era, it was also marketed for all kinds of purposes—if you have a headache, if you have sex problems, if you have whatever problem. So, they bought this kind of shell, financially troubled shell.

And for years and years, Purdue Pharma didn’t really—wasn’t a major player in the pharmaceutical world. It had one really good product, which was Betadine, which it acquired in the ’60s, which was a disinfectant. And they kind of had this great fortune of acquiring the rights to Betadine just as the Vietnam War was amping up. So the government had bought huge quantities of Betadine to treat wounded soldiers. But still, you know, a midget in the pharma scene.

Then they got into the pain business, and that’s when the real money started flowing in. And they developed—you know, so the kind of company lore is that there was a doctor in London—because some of the family members moved to London—and who was associated with the hospice movement. And they said, “You have a time-release asthma pill that isn’t really selling very much. What if you made a time-release morphine pill?” And they said, “You know, we have these hospice patients who have these IVs, and it’s hard to give them enough pain medication to sleep through the night.” And so, he said, you know, “A time-release morphine pill could really be transformational.” So they made this, and it came out in the United States in 1984 as MS-Contint, which is kind of the predecessor of OxyContin. And it was targeted exclusively at the cancer market. And really, it was an amazing drug. It helped cancer patients sleep through the night without needing to redose. And, you know, addiction didn’t matter if you’re a terminal cancer patient.

There was a problem with MS-Contin: Its patent was going to expire in the ’90s, and the company didn’t have anything to replace, and that was really the company’s, you know, golden goose. So, basically, younger relatives of Arthur’s at the company, other executives at the company were brainstorming: What can we do about MS-Contin having its patent expire? And they said, “Well, what if we created a new time-release pain pill, but we don’t use morphine, we use another derivative of the poppy plant, oxycodone, and we create a time-release oxycodone pill, and instead of marketing it to cancer patients, we market it to 30 million back pain patients, we market it to people with menstrual problems, we market it to people with toothaches? So, what if we take this powerful drug that we know works for this one purpose, but then kind of give it to everybody?” And that was the billion-dollar idea, the $14 billion idea, that gave the Sacklers what is likely the largest fortune in pharmaceutical history.

NERMEEN SHAIKH: Well, I mean, one of the problems with the term—I mean, I realized, myself, when I was reading your piece, that there’s a lot of confusion between oxycodeine, oxycodone and the OxyContin. So, could you explain what that distinction is and whether the name itself was chosen so that precisely this confusion could be created?

CHRISTOPHER GLAZEK: Exactly. So, you know, I talked to employees at the company, you know, and there’s some reference to this also in some internal company documents. OxyContin and MS-Contin—one’s morphine, one’s oxycodone—they’re basically the same. They’re kind of—like Librium and Valium, they’re virtually indistinguishable. But morphine had a stigma, which is that people thought if you’re on morphine, that means you’re dying. And ordinary doctors, general practitioners, family practitioners, they weren’t going to prescribe morphine. Like that sounded like some really serious stuff. Oxycodone, though, had a very different brand, because it was in Percocet and Percodan. And so, thousands of doctors, you know, ordinary doctors, general practitioners, would prescribe Percocet for injuries. And so they were familiar with it, and they were comfortable with it. But Percocet has a very small dose of oxycodone in it.

As you allude to, there was another confusion: People thought that “oxycodone” sounded like “codeine.” And codeine is another weak opioid. Doesn’t sound like morphine. Morphine sounds strong. So, they were basically playing on this misconception that doctors had, and they acknowledged this when they had to plead guilty, that doctors thought that oxycodone was weak, even though it’s actually more powerful than morphine.

AMY GOODMAN: So let’s turn to a joint investigation between 60 Minutes and The Washington Post on the opioid crisis. This is Joe Rannazzisi, who ran the DEA’s Office of Diversion Control, which regulates and investigates the pharmaceutical industry, speaking with CBS correspondent Bill Whitaker.

JOE RANNAZZISI: That’s out of control. What they want to do is do what they want to do and not worry about what the law is. And if they don’t follow the law in drug supply, people die. That’s just it. People die. … This is an industry that allowed millions and millions of drugs to go into bad pharmacies and doctors’ offices, that distributed them out to people who had no legitimate need for those drugs.

BILL WHITAKER: Who are these distributors?

JOE RANNAZZISI: The three largest distributors are Cardinal Health, McKesson and AmerisourceBergen. They control probably 85 or 90 percent of the drugs going downstream.

BILL WHITAKER: You know the implication of what you’re saying, that these big companies knew that they were pumping drugs into American communities that were killing people.

JOE RANNAZZISI: That’s not an implication, that’s a fact. That’s exactly what they did.

AMY GOODMAN: Whistleblower Joe Rannazzisi, speaking with CBS correspondent Bill Whitaker. In another part of the interview, he talks about pain clinics.

JOE RANNAZZISI: Pain clinics, overnight, popping up off an entrance ramp or an exit ramp on an interstate. Then, all of a sudden, there’s a pain clinic there.

BILL WHITAKER: Had you ever seen anything like that before?

JOE RANNAZZISI: Never. In fact, it was my opinion that this made the whole crack epidemic look like nothing. These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.

BILL WHITAKER: You know what a chilling picture that paints?

JOE RANNAZZISI: I do, because I watched them get arrested, and I was the one who approved the cases.

AMY GOODMAN: So, that is Joe Rannazzisi, who ran the Drug Enforcement Administration, the DEA’s Office of Diversion Control, which regulates and investigates the pharmaceutical industry, speaking with CBS correspondent Bill Whitaker. Of course, he became a whistleblower. Christopher Glazek, talk about the significance of what this man said.

CHRISTOPHER GLAZEK: Well, you know, the opioid epidemic has many different actors in different parts of the chain. And this investigation focused on the distributors, who are basically the people who carry the opioid pills from the manufacturer and give it to specific pharmacies. And there’s been a lot of litigation focused on them. Some thought that, you know, they knew, that they had had reason to know, that certain pharmacies maybe were involved in diversion. And they have this ongoing struggle with the DEA about what’s appropriate to seize and under what circumstances.

In my view, what you want to do when you look at the opioid crisis is look at where the real profits are. And it’s actually not with the distributors. It’s really with the manufacturers. And, you know, people kind of think they’re following the money. And McKesson and Cardinal are these huge, giant companies. But you really want to follow the margin, because that’s going to tell you who’s controlling a market and who’s kind of like a minor toll taker. And the fact is that the manufacturer, Purdue Pharma, which really created this market, created all this business for Cardinal and McKesson, etc., they had much more detailed information about where pills were going. They knew down to the prescription level, you know, what doctors were prescribing what. The distributors didn’t know that. The distributors—all distributors knew was about pharmacies. So they really are just one part of this giant chain. But Purdue had the aerial vision of the entire thing. And they—

AMY GOODMAN: Where is Purdue based?

CHRISTOPHER GLAZEK: It’s based in Stamford, Connecticut.



NERMEEN SHAIKH: Well, one of the things that you point out in the piece is that part of the money, the money that the Sacklers made from Purdue and selling OxyContin, in a foundation they have called the Richard and Beth Sackler Foundation—could you talk about where they chose to donate some of that, the money from that foundation?

CHRISTOPHER GLAZEK: For sure. You know, we live in a billionaire democracy, and billionaires exert tremendous control not only over business, but also over the arts and higher education and over politics. And, you know, different members of the Sackler family have very different political leanings. Richard Sackler, who was the top executive during the time that OxyContin was mainly promoted, has given money to a variety of anti-Muslim groups. He’s actually given money to several groups designated hate groups by the Southern Poverty Law Center. He’s also given money to this organization called True the Vote, which was the original source for Trump’s claim that 3 million illegal immigrants voted in the election. You know, if you go what appears to be his Facebook page or his YouTube page, he seems to have some affection for Geert Wilders in the Netherlands and kind of Brexit types, so a lot of kind of—he also seems to be a gold bug, very concerned about inflation and things like that. Other members of the Sackler family are not right-leaning. Some are them are quite left-leaning, actually. But Richard’s foundation, you know, and the money that came from OxyContin has gone to a number of causes that raise some eyebrows.

AMY GOODMAN: So, what is happening with OxyContin now? Talk about the number of deaths a day. Talk about the bill that passed last year and was signed off on by the president—not by President Trump, but by President Obama—that now has led to Congressman Marino, who was the choice to be the drug czar, having to withdraw, under Trump.

CHRISTOPHER GLAZEK: Right. So, basically, what that legislation did is it hampered the ability of the DEA to seize suspicious shipments. And, you know, I actually—it’s quite a complex issue. Whether it really is the most important aspect of the opioid crisis is something that one could debate. It does seem pretty galling, though, that Trump nominated Marino, who was so involved in this legislation, to be the drug czar. Like you don’t want the fox guarding the chicken coop. So, that did seem pretty outrageous, and it’s a great thing that that has been exposed and brought to light.

But the key point about the opioid crisis is that what triggers addiction—you know, people talk a lot about diversion, the black market, drug dealers. That’s part of it. It’s kind of a small part. Most people become addicted to OxyContin by just taking it as prescribed. So, really, it’s the number of prescriptions, who is driving the prescriptions, and the total volume of opioid that’s circulating through the market.

NERMEEN SHAIKH: Well, one of the—you cite a piece, an L.A. Times investigative piece, which concludes that the American market for OxyContin is actually diminishing.


NERMEEN SHAIKH: So could you explain why that is, and then how this drug is now being marketed, quite successfully, abroad?

CHRISTOPHER GLAZEK: Yes, exactly. So, you know, OxyContin has run into a lot of regulatory problems in the United States and a lot of bad press. And, you know, kind of borrowing from the Big Tobacco playbook, it’s like when you run into problems in your home market and you’ve got all these lawsuits, maybe it’s time now to go abroad. And that seems to be what the Sackler family is doing. They have all these international companies that are related to Purdue which sell pain products abroad.

And, you know, the CDC, in this country, actually issued this warning last year, basically saying that we’re not sure that opioids are good for long-term pain at all, that maybe opioid use is not an effective treatment for chronic pain, because it changes your pain threshold and, over time, it becomes less and less effective. So, I mean, this was like a really—you know, a kind of death blow for the chronic pain market here. But now you have the company going abroad, kind of reprising all of its greatest hits from the ’90s. They released a study in Colombia saying that we believe that more than 40 percent of the population suffers from chronic pain.

AMY GOODMAN: In May, a dozen members of Congress sent a bipartisan letter to the World Health Organization that warned the Sackler-owned drug companies were preparing to flood foreign countries with legal narcotics. The letter mentions the Sacklers by name, notes they own Purdue Pharma, and reads, quote, “Purdue began the opioid crisis that has devastated American communities. … Today, Mundipharma is using many of the same deceptive and reckless practices to sell OxyContin abroad.” Mundipharma, owned by the Sacklers. And the L.A. Times reporting the company circulated a press release in Colombia that suggested 47 percent of the population suffered from chronic pain. Your final comment on all of this, Christopher Glazek, and where it goes now?

CHRISTOPHER GLAZEK: Well, the big question is complicity, and it’s a really tricky question. You know, is Tufts University complicit in the opioid epidemic because they’ve taken huge amounts of money from the Sacklers? You know, is a third-generation Sackler heir, who maybe is a documentary filmmaker or restaurateur—do they have some burden or complicity to address here? And I think that’s a complicated question. But the solution to complexity is not secrecy. And what we’ve seen again and again is that people who have taken Sackler money, and the Sacklers themselves, have concealed their connection to OxyContin. And that cannot be the solution to the problem.

AMY GOODMAN: We’re going to leave it there, Christopher Glazek, journalist, editor, whose new exposé was just published in Esquire—we will link to it—”The Secretive Family Making Billions from the Opioid Crisis.”

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