Pain

5 Aug 2014

The pills

When her son Jeff hurt his knee in high school football, Alexis Pleus says, the doctor told the family he should take his pain pills every four hours. She does not name the drug. Jeff told her he was afraid he was starting to like the pills a little too much; years later she learned he had struggled with addiction in silence for seven years. He died of an overdose on 5 August 2014, 20 months into recovery. Six months later she founded Truth Pharm.

1980

Five sentences

In 1980 the New England Journal of Medicine printed a one-paragraph letter titled “Addiction rare in patients treated with narcotics.” A 2017 study in the same journal notes that the letter gave no evidence, and counted 439 of its 608 citations (72.2 percent) using it to say addiction was rare in patients treated with opioids; 491 (80.8 percent) did not note that its patients were in hospital. Its authors “believe” this citation pattern contributed to the crisis. That is their conclusion, not a court’s finding.

608 citationsHow often a five-sentence 1980 letter had been cited by March 2017, in a New England Journal of Medicine count

1996

A family company

Purdue’s headquarters were in Stamford, Connecticut. The Purdue Frederick Company, a federal prosecutor told the Senate, was “created in 1892 and purchased by its current owners in 1952.” The Supreme Court wrote that Sackler family members served as president and chief executive, dominated the board, “pushed sales targets” and went on ride-along visits with sales representatives. David Sackler told Congress the board “also included outside directors who were highly credentialed and prominent professionals from beyond our family.”

1996

A blizzard

Purdue began marketing OxyContin in January 1996. The Massachusetts attorney general’s complaint says Richard Sackler, then the senior vice president responsible for sales, told the launch party that a “blizzard of prescriptions” would follow. That is the state’s account of a speech, not a finding. Prosecutor John Brownlee told the Senate that prescriptions rose from about 300,000 in 1996 to nearly 6 million in 2001, “in part” because of Purdue’s “aggressive and misleading marketing campaign.” The FDA’s approval and label for OxyContin are told in User Fees; this story judges neither.

1 Feb 2001

“Reckless criminals.”

On 1 February 2001, the complaint’s footnotes show, Richard Sackler, whom it says had been Purdue’s CEO since 1999, wrote that email about people who became addicted. In December 2020 members of Congress read such emails to Kathe and David Sackler. Asked if she shared the view, Kathe Sackler answered, “Correct,” meaning she did not. Asked if he agreed with his father’s words that people struggling with addiction are criminals, David Sackler said, “No, I don’t,” and that “I know my father has both apologized for these words.” This story found no statement by Richard Sackler himself on the emails.

14 Feb 2001

Early 2001

The complaint quotes Purdue’s own emails. On 26 January a sales representative told Richard Sackler of a high-school meeting where mothers whose children had died said “the only difference between heroin and OxyContin is that you can get OxyContin from a doctor.” On 8 February a federal prosecutor reported 59 deaths in one state, and Sackler replied: “This is not too bad. It could have been far worse.” On 14 February a mother wrote the letter above; a Purdue staff member noted: “I see a liability issue here. Any suggestions?” These are the state’s allegations from company files. David Sackler told Congress in 2020 that his family denies liability.

10 May 2007

Abingdon, 2007

In federal court in Abingdon, Virginia, the Purdue Frederick Company pleaded guilty to a felony, and its president Michael Friedman, chief legal officer Howard Udell and former medical chief Paul Goldenheim to a misdemeanor. The U.S. Attorney said all four admitted that Purdue fraudulently marketed OxyContin as less addictive, less subject to abuse and less likely to cause withdrawal than other pain medications, with no medical research behind it. Company and executives agreed to pay $634,515,475; the three men’s shares were $19 million, $8 million and $7.5 million. The judge accepted the pleas on 20 July and gave the executives three years’ probation; their misdemeanor, Brownlee told the Senate, “requires no proof of intent or actual knowledge.” The Massachusetts complaint alleges the Sacklers voted that these three, “but no member of the Sackler family,” should plead.

Mar 2001

What Purdue told doctors

The statement of facts says Purdue’s sales representatives falsely told health care providers that OxyContin had less euphoric effect and less abuse potential than short-acting opioids, and “could be used to “weed out” addicts and drug seekers.” Brownlee told the Senate “the company knew its claims were false.” Purdue’s own study showed an abuser could pull about 68 percent of the oxycodone from a 10 mg tablet by crushing it and drawing it through cotton into a syringe, yet supervisors trained sales staff to say it was harder to extract. In March 2001, after reports of possible withdrawal symptoms in study patients, supervisors and employees “decided not to write up the findings” for fear of adding to “the current negative press.”

31 Jul 2007

The families

Brownlee named Marianne Skolek, whose daughter Jill died from OxyContin on 29 April 2002 and who, he said, had raised concerns about Purdue for years, and noted “complex legal questions about the relationship between Purdue’s crimes and the events that have led to such harm.” He said the pleas confirmed what such families believed, “that the marketing of OxyContin was deceptive and criminal.” Critics came from both sides: Dr. Sally Satel wrote that the prosecution would make it harder for pain patients to get treatment, and others asked why no executive went to prison. Brownlee answered that the misdemeanor was strict liability, the guideline range was 0 to 6 months, and a prison sentence “would be unusual.”

17 May 2007

After the plea

Before 2007, the Supreme Court writes, Purdue paid the Sacklers under 15 percent of its yearly revenue; afterwards as much as 70 percent, about $11 billion from 2008 to 2016, much of it sent to overseas trusts and family-owned companies. The Court says the family acted knowing the litigation “would eventually impact them directly” and that one member called it a “milking” program. In Congress David Sackler agreed the family took out about $10 billion in 2008 to 2018 and said “about half was paid in taxes,” that the suits he feared in his 2007 email were settled by then, and that “milking” was “badly taken out of context.” A 2020 Justice Department settlement resolves allegations that transfers were made to hinder creditors: allegations only.

Aug 2013

“Turbocharge.”

McKinsey worked for Purdue on 75 engagements between 2004 and 2019. In May 2013 Purdue retained it for Evolve to Excellence, which, the Justice Department says, included advice on how to “turbocharge” the OxyContin sales pipeline by intensifying marketing to High Value Prescribers, among them “prescribers who were writing opioid prescriptions for uses that were unsafe, ineffective, and medically unnecessary.” In August, it says, McKinsey presented to family members on Purdue’s board; one partner reported they “gave a ringing endorsement of ‘moving forward fast.’” The 2020 Sackler settlement alleges the five Named Sacklers (Richard, David, Kathe, Mortimer D. A. and Jonathan) approved the program; it records no determination of liability.

24 Nov 2020

Newark, 2020

Purdue Pharma LP, the affiliate that kept selling OxyContin after the Purdue Frederick plea, pleaded guilty to three felonies. It admitted that from May 2007 through at least March 2017, a conspiracy that began the month of the Abingdon pleas, it told the Drug Enforcement Administration it kept an effective anti-diversion program while marketing to more than 100 health care providers it had good reason to think were diverting opioids, and reported misleading data to boost its manufacturing quotas.

24 Nov 2020

Doctors and penalties

It also admitted paying two doctors through its speaker program from June 2009 and paying the records company Practice Fusion in 2016 for referrals. The Justice Department called the $3.544 billion fine and $2 billion forfeiture the largest penalties ever levied against a drug maker; IndustryWeek noted that because the fine sits inside the bankruptcy, “it’s unlikely that all of that money will be collected,” and Connecticut’s attorney general called the deal “a mere mirage of justice.” It added a $2.8 billion civil claim, and the department said no individual, Sacklers included, was released from criminal liability.

17 Dec 2020

Under oath

Two months after the family agreed to pay $225 million to resolve the government’s civil allegations, David and Kathe Sackler and Purdue’s chief executive Craig Landau testified by video; Richard Sackler was not a witness. Kathe Sackler said, “I am so terribly sorry for your pain and loss,” and that she “acted honestly, conscientiously, and in good faith.” David Sackler said his family denies liability, that Purdue spent “more than a billion dollars on anti-abuse and diversion initiatives,” and that he is “deeply and profoundly sorry that OxyContin has played a role in any addiction and death.” Landau said of the 2020 pleas: “we’re taking full accountability and responsibility for those crimes.” Chairwoman Carolyn Maloney told Kathe Sackler her answer was not the apology the committee was looking for.

Jul 2021

The distributors

Wholesalers and a drug maker faced their own claims, apart from Purdue’s. In July 2021 McKesson, Cardinal Health, AmerisourceBergen and Johnson & Johnson agreed with 52 states and territories to a package worth about $26 billion, in New York’s count. New York’s attorney general says the deals were over the companies’ role in creating and fueling the crisis. Its release does not say whether the companies admitted anything, and this story did not read the agreements or the companies’ answers.

$26 billionApproximate value of the settlements with Johnson & Johnson and the three major drug distributors, by New York’s count

Sep 2021

The release

Purdue filed for bankruptcy in 2019; the Sacklers did not. Purdue’s plan carried the family’s terms: $4.325 billion of the $11 billion they had taken out, paid over a decade, for a release from all opioid claims, fraud included. Victims would get $3,500 to $48,000 before lawyers’ fees. Fewer than 20 percent of eligible creditors voted; the dissent says more than 95 percent of those who did approved, while thousands of victims, eight states, D.C. and Seattle objected. Alexis Pleus told a House hearing the Sacklers walk away “uncharged for mass murder,” her accusation, not a finding. The bankruptcy court confirmed the plan in 2021, a district court vacated it, and the Second Circuit revived it after the family offered $1.175 to $1.675 billion more.

10 Mar 2022

The Sacklers listen

On 10 March 2022 a court required the Sacklers to hear from people who say Purdue destroyed their lives. Cheryl Juaire held up photographs of her sons Corey and Sean, who died of overdoses: “they never want their child to be forgotten.” Kara Trainor, who was addicted to OxyContin, said of her son, born opioid dependent: “It has impacted me, and now it’s impacting my son.” NPR reports that David Sackler and Theresa Sackler were on screen and silent, that Richard Sackler was not visible, and that the Sacklers “have long maintained they did nothing wrong.” These are the speakers’ accusations and grief, not findings.

27 Jun 2024

The Supreme Court

The U.S. Trustee, the Justice Department’s bankruptcy officer, joined the objectors, and in Harrington v. Purdue Pharma the Court ruled 5 to 4 on 27 June 2024 that bankruptcy law does not allow that release without claimants’ consent: the Sacklers sought it without putting “anything close to all their assets on the table” and, the Court said, “seek to pay less than the code ordinarily requires and receive more than it normally permits.” It said it was not deciding anything about consensual releases. Justice Kavanaugh, dissenting for four, said the plan would have built an estate of about $7 billion with $5.5 to $6 billion from the Sacklers, and that victims “are now deprived of the substantial monetary recovery that they long fought for.” The ruling is about bankruptcy law. It does not decide whether any Sackler is liable.

13 Dec 2024

McKinsey pays

In February 2021 McKinsey agreed to pay $573 million to state attorneys general (NPR counts nearly 50 states plus D.C. and territories; North Carolina counts 53 attorneys general), admitting no wrongdoing; its global managing partner said, “We deeply regret that we did not adequately acknowledge the tragic consequences of the epidemic unfolding in our communities.” The states alleged it advised Purdue on “targeting high-volume opioid prescribers.”

13 Dec 2024

December 2024

On 13 December 2024 it agreed to pay $650 million: a five-year deferred prosecution agreement on a felony count of destroying records and a misdemeanor count of conspiring to aid and abet misbranding, against its U.S. subsidiary, with a 71-page agreed statement of facts, plus a civil settlement of over $323 million. Martin Elling, a former senior partner whose July 2018 email asked about “eliminating all our documents and emails,” pleaded guilty in January 2025 and was sentenced to six months in prison. The department calls the civil resolution allegations; this story did not read McKinsey’s own statement on the 2024 deal.

1 May 2026

After the ruling

Purdue’s lawyers say a year of mediation produced a plan with a bigger Sackler contribution and releases “on a consensual basis,” supported by more than 99 percent of voting creditors. They say Judge Sean Lane confirmed it on 18 November 2025 and it took effect on 1 May 2026: the Sacklers paying up to $6.5 to $7 billion, of which $1.5 billion on the effective date and the rest over several years, individual victims up to $865 million, and operations moved to Knoa Pharma, which may keep making opioid medicines but may not promote them. Connecticut’s attorney general says more than 30 million documents are to be released. This story did not read the plan, and found no trial of any Sackler, which the objectors had demanded; figures are Purdue’s lawyers’.

$7.4 billionCash the new plan delivers to creditors, in Purdue’s lawyers’ account

2024

The count

CDC counts nearly 727,000 opioid overdose deaths from 1999 to 2022, prescription and illegal opioids together, and in 2022 nearly 108,000 overdose deaths, about 82,000 involving opioids. It describes three waves: prescription opioids from the 1990s, heroin from 2010, illegally made fentanyl from 2013; Alexis Pleus describes young people “moving on to heroin when they could no longer afford the pills.” The Supreme Court cites about 247,000 prescription-opioid deaths for 1999 to 2019 and says Purdue “sits at the center of these events”; Massachusetts alleges hundreds of its patients died after taking Purdue’s drugs. No source read says what share of all these deaths is OxyContin’s. CDC’s provisional 2024 count is 80,391 overdose deaths, 54,743 involving opioids, down from 110,037 and 83,140 in 2023.