The Sackler family name is ubiquitous, spanning from an exclusive wing at the Metropolitan Museum of Art to establishments at renowned educational centers like Oxford and Columbia. Hailing from Brooklyn, the trio of brothers—Arthur, Mortimer, and Raymond—gained prominence in the medical realm as physicians and frequently made substantial donations to various institutions. These institutions, in gratitude, prominently showcased the Sackler family name as a gesture of recognition. Their philanthropic efforts did not stop there as they “endowed professorships” and “underwritten medical research,” ultimately cultivating an image of a family dedicated to relentless service and creating a better world. Despite the Sacklers’ active engagement in conversations about their philanthropy, there is a conspicuous silence surrounding the roots of their family enterprise—Purdue Pharmaceuticals, the very company behind the prescription painkiller OxyContin that wrought havoc on countless lives and played a significant role in the opioid crisis

After declaring bankruptcy in September 2019, Purdue Pharma reached a $8 billion settlement while the Sackler family finalized a $6 billion settlement that also would “block future opioid lawsuits targeting them.” However, the Supreme Court of the U.S. have decided to block the settlement agreement this month and review the provision that protects the Sackler family from liability for lawsuits. The legal ramifications for this decision is vital as it would determine “whether the bankruptcy court had the authority to release the Sackler family members from the claims being made by opioid victims.” In the landscape of our time, where the opioid crisis stands as a profoundly destructive public health catastrophe, attention is sharply focused on the Supreme Court’s decision over the Sackler family’s shield from accountability.

The origins of the Sackler wealth

One of the Sackler brothers, Arthur Sackler, had shaped the pharmaceuticals industry through his extreme push on marketing and was attributed to many current pharmaceutical companies’ successes to the point where he was inducted into the Medical Advertising Hall of Fame. Even though he was not involved in the manufacturing of pharmaceuticals, he catapulted them into prominence from his decision to not advertise to consumers, but directly to doctors. He often liked to say: “I would rather place myself and my family at the judgment and mercy of a fellow physician than that of the state.” Consequently, he would opt for campaigns that primarily appealed to doctors and conspicuous advertisements in medical journals to promote his products. Sackler also leveraged his understanding that physicians were primarily swayed by their colleagues, enlisting renowned doctors to endorse his products and referencing scientific research (frequently funded by the pharmaceutical companies themselves). John Kallier had worked under Sackler at McAdams for 10 years, characterizing that his ads “had a very serious, clinical look—a physician talking to a physician… [But] it was advertising.” The legacy Arthur Sackler left behind for advertising can be described as a dual-ended sword in how Allen Frances attributed him for “[m]ost of the questionable practices that propelled the pharmaceutical industry into the scourge it is today.” 

One of Arthur’s marketing techniques included putting the tagline “More and more physicians find Sigmamycin the antibiotic therapy of choice” next to a series of doctors’ business cards for a new Pfizer antibiotic. When an investigation reporter tried to contact some of the named doctors from the advertisement in 1959, they “did not exist.” Another marketing technique of Sackler’s was for Valium in a medical journal where he indicated that a college student’s “sense of lost anxiety” could be remedied with tranquilizers. He even went as far as promoting Valium to patients with “no psychiatric symptoms” to the point in which a physician asked “When do we not use this drug?” in the 1965 journal Psychosomatics. Even though Valium’s creator, Roche, did not conduct studies of its addictiveness, it did not matter to Sackler’s ad agency as it was focused on ensuring that the drug was distributed and promoted everywhere. One former employee, Win Gerson, told journalist Sam Quinones that “[Valium] kind of made junkies of people, but that drug worked,” attributing the Valium campaign’s success to the drug’s effectiveness.  

Beyond advertising, Arthur launched a biweekly newspaper, the Medical Tribune, with a readership of 600,000 physicians. When questions arose regarding a conflict of interest between his position as the leader of a pharmaceutical-advertising company and his role as a publisher for doctors, he quickly dismissed those questions. In 1959, it came to light that a company associated with Sackler had engaged in bribery, offering around $300,000 to Henry Welch, the head of the antibiotics division at the FDA. This payment was intended to boost the promotion of specific drugs. However, Welch would also throw in some of Sackler’s advertising taglines for some drugs into his speeches. After the discovery of the bribe, Welch quickly resigned. However, throughout Arthur Sackler’s promotions, there was a constant emphasis on how “the drugs were effective in a huge range of conditions, had no side effects, and were not additive.”

By the mid-1970s, more than 100 million tranquilizers were written by American doctors annually and soon prompted the U.S. Senate to hold hearings on “a nightmare of dependence and addiction.” It was Arthur Sackler’s marketing techniques that enabled the Sackler brothers to donate millions to museums, art galleries, universities, and other institutions on the condition that their name was included. This also was noted to be a tactic in which there was a distinction between the Sackler brothers and their companies, dividing the two as separate entities rather than one. 

Purdue Pharma and the opioid crisis

And so, the next step for the Sackler brothers was to buy a small patient-medicine company in 1952, originally named “Purdue Frederick.” Court documents indicated that each brother would control a third of the company, but Arthur played a much more passive role due to his focus on publishing and advertising. However, things took a turn once Purdue Pharma had the idea of a “controlled-release opioid”—namely OxyContin. OxyContin’s sole active ingredient is “oxycodone,” understood as a “chemical cousin of heroin which is up to twice as powerful as morphine.” In the past, doctors were quite reluctant to resort to opioids—synthetic drugs made from opium—like morphine and heroin and solely used them for “acute cancer pain and end-of-life palliative care” due to the long-standing fear about their infamous addictive properties and the previous centuries’ opioid crises.   

To be released to the public and have revenue for a new drug, there are two primary considerations for the pharmaceutical company: FDA and the patent. The patent grants the pharmaceutical company the right to be the sole manufacturer of the drug for roughly 20 years, giving them a specific amount of time to make profits before competitors are allowed to make cheaper, generic versions of the same drug. During this patenting process, the FDA would take numerous years to license and review the drug’s effectiveness due to the government’s limited budget, ultimately having the pharmaceutical companies pay for the costly trials in the end. The FDA assigned Curtis Wright as the medical reviewer and chief inquisitor for OxyContin’s review where Empire of Pain’s author, Patric Keefe, noted that “Wright had given up his role as an impartial federal regulator and became a sort of in-house advocate for Purdue.” Purdue Pharma stated that the slow-release method of OxyContin would make the patient “less likely to succumb to addiction” with misrepresented and unclear data, making this the very foundation of its marketing strategies for doctors.

Wright also approved of a “low-risk package insert” that stated that addiction to opioids used to manage is “very rare,” joining Purdue Pharma in actively misguiding pain patients that there “was little to no risk of opioid dependency, as long as they were taking OxyContin as prescribed.” Even though OxyContin should have been only recommended for “acute cancer pain and end-of-life palliative care,” Wright decided to approve the drug for chronic to moderate pain which granted Purdue Pharma the ability to expand its market beyond the terminally ill. Within a mere 11 months, Wright approved OxyContin as safe and non-addictive to the public as the FDA representative, stating that OxyContin “is believed to reduce the abuse liability of the drug.”

Recognizing that FDA approval was not enough to increase OxyContin’s popularity among the American public, Richard Sackler, Raymond’s son, and the rest of the Sackler family on the Purdue board returned to Arthur’s advertising tactics. One particular tactic of Arthur Sackler’s was to have a renowned doctor endorse his product. For OxyContin’s case, Purdue Pharma enlisted the aid of Dr. Russell Portenoy, a famous doctor that gained recognition for being one of the first doctors to focus primarily on pain. As the topic of pain was an unreliable and subjective area in medicine, Portenoy aimed to fight that stigma: “Opioids bared an unfair taint because of concerns about their addictive properties and this had discouraged generations of doctors from employing what might be the best and most effective therapy for the treatment of pain.” Portenoy held leadership positions at prestigious medical institutions such as Memorial Sloan-Kettering Cancer Center and Mount Sinai Beth Israel, dubbed as the “King of Pain” by Forbes in the 1990s, and president of the American Pain Society and the American Pain Foundation. He was seen in conferences promoting the use of OxyContin to his fellow physicians and featured in training videos sponsored by Purdue Pharma, ultimately “erod[ing the] longstanding caution within the medical profession over prescribing opioids because of addition fears.” Portenoy even co-authored a paper in Pain, a medical journal in 1986, in which he claimed that a study of cancer patients demonstrated how opioids should not be feared. The results were inconclusive and “lacked the standard scientific rigor of control groups,” but deeply resonated with a group of younger doctors as they sought to provide any relief to their patients who were experiencing a substantial amount of pain. Years following the paper’s publication, Portenoy admitted that his paper was based on “weak, weak, weak data” and his campaigning for opioids “was the wrong thing to do.” 

In April 2019, Portenoy agreed to testify against Purdue Pharma and accused pharmaceutical companies like Purdue Pharma of “underplaying the dangers of opioids and of pushing them on patients who did not need them.” He also acknowledged the contracts and grants he had with numerous pharmaceutical companies, but denied that “drug company payments influenced his public statements on opioids.” Furthermore, Portenoy mentioned that the pharmaceutical companies’ funding of his research was specifically allocated to areas that would aid in the promotion of the drugs and so, they “selectively quoted his work to highlight the positives about opioids.”  

One other aspect that led to OxyContin’s rise in popularity was the use of sales representatives, attempting to capitalize on doctors’ sense of duty and preference for their previous opioid, MS Contin. Before Purdue Pharma’s national campaign for OxyContin, many pharmaceutical companies would not directly reach out to primary physicians and encouraged them to prescribe opioids to patients. However, the FDA approval of OxyContin for non-cancer pain gave these sales representatives the free reign to call doctors about alleviating any amount of pain. Consequently, sales reps were given clearance to reiterate the information from the package insert approved by Wright to doctors, aggressively promoting the opioid to all levels of pain. Purdue Pharma also gave the sales reps “millions of dollars” to buy doctors “lunch and send them free Purdue Pharma merchandise” as incentives for both parties. Rather than implementing a sales bonus ceiling for these sales reps, Purdue uncapped the sales bonuses to encourage them to “sell as much OxyContin to doctors as possible” where Purdue paid $40 million in 2001 in employee bonuses. 

Purdue even resorted to holding more than 40 symposiums at luxury resorts in California, Arizona, and Florida, where more than 5,000 doctors and nurses attended for free from 1996 to 2001. The only catch was that they would only have to set “a few hours aside to attend a promotional conference for OyxContin.” When concerned doctors asked about OxyContin’s potential for addiction, Purdue’s representative asserted that the slow-release of oxycodone into the bloodstream prohibits the “peaks and troughs of euphoria and therefore addiction.” However, there was no actual scientific evidence illustrating the correlation between peaks and troughs and addiction. When patients became addicts to OxyContin and came to Purdue for explanations, Purdue told them that “only persons with an ‘addictive personality’ became addicts.”

The aftermath of the opioid crisis

As the opioid crisis continued to escalate and public awareness became more prevalent, the U.S. General Accounting Office had a discussion with the DEA, FDA, and Purdue Pharma over the increase in OxyContin addiction and diversion in December 2003. The DEA reported numerous instances of “diversion,” where OxyContin was “tampered with and also had a high potential for black market use.” The FDA also noted that many of Purdue’s advertisements in medical journals were not approved to be displayed; one of these was a promotional video for OxyContin, “I Got My Life Back: Patients in Pain Tell Their Story” that had 15,000 copies sent to physicians. Despite these clear violations, the FDA and DEA did not give Purdue a harsh sentence and implemented minor changes like retracting statements and updating the package insert for OxyContin. 

As for the Sackler family’s involvement with Purdue during the opioid crisis, it was evident that they “felt no pressure to be the public head of the business” and sent representatives to defend Purdue on their behalf. Even though Richard Sackler was the one spearheading OxyContin’s launch into the public, he “has never given an on-the-record interview about the drug.” One long-term critic of Purdue admitted that even though he had “a lot of experience with Purdue over the years, in different settings,” he has “never even seen Richard Sackler.” It was also revealed that Purdue also maintained a contract with I.M.S, an obscure company co-founded by Arthur Sackler, that “furnished its clients with fine-grained information about the prescribing habits of individual doctors” to figure out “which doctors to target.” The very same data could be used to see whether certain doctors are abusing their prescriptions, but it was evident that Purdue did not care since overprescribing meant higher revenue. Richard Blumenthal, the Attorney General of Connecticut, even wrote to Richard Sackler about his concerns with the increasing amounts of addiction and urged him to “overhaul and reform” OxyContin’s marketing. The Sacklers ignored his recommendation and prompted Blumenthal to file a complaint, launching an investigation in which it was revealed that Purdue officials knew since 1998 that prescriptions were increasing at an alarming rate, pointing to a growth in addiction.

In 2003, New York trial lawyer Paul Hanly filed a lawsuit against Purdue Pharma and represented 5,000 patients who became addicted to OxyContin after being prescribed by a doctor. “They demonstrated that this company had set out to perpetuate a fraud on the entire medical community,” Hanly stated. The discovery process also showed that the safety guidelines “emanated from the marketing department, not the scientific department.” By 2006, Purdue settled the case for $75 million before pleading guilty in Virginia for “criminal charges of misbranding,” acknowledging that OxyContin’s marketing had “the intent to defraud or mislead.” The Sacklers were nowhere to be found as Richard Sackler resigned from his chairman position, opting to be co-chairman to avoid scrutiny. Mississippi’s former Attorney General, Mike Moore, deemed the Sacklers as the “main culprit” for the opioid crisis as they are “profiting by killing people.” Throughout the opioid crisis, Sackler family members withdrew more than $10 billion from Purdue and deposited such checks in family trusts and holding companies. These withdrawals occurred during a time in which Purdue faced intense scrutiny for its involvement in the opioid crisis, receiving a total of $10.7 billion from 2008 through 2018.

Purdue Pharma’s bankruptcy and legal ramifications

In 2019, Purdue Pharmaceuticals filed for Chapter 11 bankruptcy “to resolve thousands of lawsuits, many filed by state and local governments” due to their involvement in the opioid crisis’ 500,000+ overdose deaths. The original bankruptcy settlement approved by the 2nd U.S. Circuit Court of Appeals included a stipulation that protected the Sackler family as the owners from lawsuits in exchange for $6 billion and a lack of admission of guilt. The Court of Appeals stated that U.S. bankruptcy law granted “legal protections from non-bankrupt parties” in “extraordinary circumstances.” However, the U.S. Department of Justice asked for the court to pause its approval for a potential appeal to the U.S. Supreme Court, focusing on the lack of accountability from the Sacklers. 

By August 10, 2023, the U.S. Supreme Court agreed to hear an emergency challenge by President Biden’s administration and halted the bankruptcy settlement. The primary legal question brought by the case was “whether the bankruptcy court had the authority to release the Sackler family members from the claims being made by opioid victims.” Throughout the original bankruptcy proceedings, the Sackler family had a “separate deal with Purdue and some plaintiffs” that would give Purdue Pharma the chance to restructure their company to combat the opioid crisis. To much of Purdue’s dismay, the Supreme Court’s decision to review the case indicated that there will be a tedious process that will “delay billions of dollars in value that should be put to use for victim compensation, opioid crisis abatement for communities, and overdose rescue medicines.” 

On the other hand, the Supreme Court’s decision to review the bankruptcy deal has brought joy to activists who protested against the settlement and wanted more accountability for the Sackler family. Mike Quinn, a New York-based lawyer representing the Prescription Addiction Intervention Now, stated: “We’ve been saying that this is a misuse of the bankruptcy court, and that the Sacklers have been using it as defense because they were the ones that put Purdue into bankruptcy.” The decision that the Supreme Court made with this case is noted to have the “potential to reconcile the issue of non-debtor third party releases, and allowed the judicial system to finally decide whether non-bankrupt parties can get discharges from their liability for wrongdoing.” The Office of the U.S. Trustee stated that bankruptcy courts have no authority to force creditors to waive their legal rights if they disagree with the settlement terms. However, the Sacklers specified that for the $6 billion settlement to proceed, plaintiffs had to waive their rights. The case going to the Supreme Court “certainly puts more attention on the case,” posing the question of why third-party individuals are not being held criminally liable for their actions. 

At a minimum, the Sackler name has been expunged from various art institutions, swiftly becoming inseparable from the opioid crisis. The mysterious persona of the philanthropic Sackler family is now gone, replaced with the very much real carnage they left behind with hundreds of thousands dead in the name of greed The Supreme Court now holds the opportunity to consider a particular plaintiff in the battle against Purdue Pharmaceuticals, brought forth by Ellen Isaacs, who tragically lost her son to an overdose in 2018. “The Sacklers need to be indicted… No swanky prison, no TVs… Put an ankle monitor on them and put them out in the community to help clear up the mess,” Isaacs said in her brief against Purdue Pharma and by extension, the Sacklers.