Opioid Lawsuit Massachusetts

This Aug. 17, 2018 file photo show demonstrators who have lost loved ones to OxyContin and opioid overdoses protesting outside Purdue Pharma headquarters in Stamford, Conn. The attorney general's office in Massachusetts is suing Connecticut-based Purdue Pharma, along with some company executives and members of the family that owns it in an effort to hold them accountable for the toll of the drug crisis in the state.  (AP Photo/Jessica Hill, File)

A new slogan on the American political left — “every billionaire is a policy failure” — links economic inequality to governmental error.

Whether the claim is true is a good question. Billionaires include everyone from Harry Potter’s creator, J.K. Rowling, to the wizard of Omaha, Warren Buffett.

Then again, the ranks of the superwealthy include one Richard Sackler and his family, whose assets, shared among 20 people, total $14 billion, according to a 2016 estimate by Forbes magazine. This fortune’s foundation is billions of dollars in sales of OxyContin, the prescription opioid notorious for helping to trigger the nation’s epidemic of addiction beginning two decades ago.

Sackler has been in the news because of revelations about his previously undisclosed personal role in the marketing of OxyContin pills, which first became available in 1996. Some of the details appear in a Massachusetts state lawsuit accusing him and other Sacklers of “illegal deceit” in the promotion of OxyContin. Also, journalists at ProPublica and STAT recently published records from a 2015 Kentucky lawsuit suggesting that Sackler knew Purdue Pharma representatives were misleading physicians to help boost OxyContin sales.

The focus on Sackler’s alleged individual responsibility is long overdue — and causing the universities and museums the Sacklers have supported to reassess the family’s charity. It remains important, however, to understand the policy errors, large and small, that made the business model of their company, Purdue Pharma, possible. These mistakes include the decision by governmental and nongovernmental medical institutions to emphasize pain as a “fifth vital sign” to be treated aggressively, including through opioids, previously shunned because of their addictive properties.

But if you had to name one policy, or practice, to blame for the OxyContin catastrophe specifically, it might be the large role that the direct marketing of drugs to physicians by for-profit pharmaceutical companies plays in our health-care system.

Though direct-to-consumer advertising dominates the internet and the airwaves, by far the majority of drug company marketing money — $24 billion out of a total of $27 billion in 2012 — is spent pitching health-care providers, the gatekeepers of the system. Richard Sackler’s uncle Arthur Sackler, who died in 1987, pioneered direct-to-physician marketing in the 1960s, aggressively selling drugs such as the tranquilizer Valium, which became the first pill ever to generate $100 million in annual sales.

One way to understand what Purdue Pharma did with OxyContin under Richard Sackler is as an attempted update of his uncle’s success with Valium. Purdue’s pitches conditioned doctors to overcome cautious attitudes toward prescribing opioids, according to the ProPublica/STAT report. Direct-to-physician marketing is susceptible to other forms of abuse; companies often pay speaking fees and make gifts to doctors who prescribe their drugs. In 2007, Purdue pleaded guilty, as a corporation, to a felony related to false marketing of OxyContin, and paid $635 million. Three top executives also accepted guilt and paid fines. The Massachusetts lawsuit alleges that the company’s deceptive marketing continued in subsequent years, until Purdue ceased marketing OxyContin last year.

Obamacare reformed direct-to-physician marketing by requiring drug manufacturers to disclose annual data on payments and “transfers of value” to health-care providers. The industry has its own set of voluntary ethical guidelines. Still, the system remains basically intact, premised on the theory that patients ultimately benefit from a free flow of information between those who make medications and those who prescribe them.

Charles Lane is a columnist with The Washington Post.