Purdue Pharma

Based on Wikipedia: Purdue Pharma

The Family Business That Killed Half a Million Americans

In 2017, consultants from McKinsey & Company made a remarkable suggestion to the Sackler family: pay pharmaceutical distributors a rebate for every overdose attributed to their pills. Not for every prescription. Not for every bottle sold. For every overdose.

The Sacklers pushed forward with the promotion. Sales soared. More than 450,000 people died.

This is the story of how a family of doctors turned a small pharmaceutical company into a machine that generated thirty-five billion dollars in revenue—and one of the worst public health catastrophes in American history.

A Tonic Made of Sherry and Glycerin

The company that would become Purdue Pharma started innocuously enough. In 1892, two medical doctors named John Purdue Gray and George Frederick Bingham founded the Purdue Frederick Company in New York City. Their product? A tonic compound made with sherry and glycerin—the kind of thing Victorian-era pharmacists sold alongside patent medicines and snake oil.

For sixty years, the company remained a modest operation. Then, in 1952, three brothers bought it.

Arthur, Mortimer, and Raymond Sackler were psychiatrists. Arthur was the business mind, a pioneer in pharmaceutical advertising who understood something crucial: you don't sell drugs to patients. You sell them to doctors. The brothers relocated the business to Yonkers, New York, and each took a one-third share.

When Arthur died in 1987, his share passed to his brothers. Mortimer died in 2010, Raymond in 2017. But by then, the Sackler name had become synonymous with something far darker than medical innovation.

The Birth of OxyContin

In 1991, the company reincorporated as Purdue Pharma L.P. and pivoted hard toward pain management. They called themselves "pioneers in developing medications for reducing pain, a principal cause of human suffering."

The sentiment was noble. The execution would prove catastrophic.

Purdue had already found success with MS Contin, an extended-release morphine formulation released in 1984. But their real breakthrough came in 1996 with a new drug: OxyContin, an extended-release version of oxycodone.

The timing was perfect. Around the same period, the American Pain Society launched its "pain as fifth vital sign" campaign, arguing that pain was being undertreated in American medicine. The Veterans Health Administration adopted this as national strategy. Suddenly, doctors across the country were being encouraged to take pain more seriously—and pharmaceutical companies were ready with solutions.

But there was a problem. Opioids are addictive. Everyone in medicine knew this. The question was whether OxyContin was somehow different.

The One Percent Lie

To get OxyContin to market, Purdue needed approval from the Food and Drug Administration, commonly known as the FDA. This is the federal agency responsible for ensuring that drugs are safe and effective before Americans can take them.

What happened next would later be described by the FDA commissioner at the time, David Kessler, as "one of the worst medical mistakes, a major mistake."

The medical review officer for OxyContin was a man named Curtis Wright IV. According to documents reviewed by the Justice Department, Wright met with Purdue representatives in a hotel room near FDA offices in Rockville, Maryland, in early 1995. He allowed the company to help draft his official review of the drug—including approving specific language for OxyContin's package insert.

That language would prove crucial. The label stated that the drug's "delayed absorption is believed to reduce the abuse liability." Notice the hedge: "is believed to reduce." Not "reduces." Not "has been proven to reduce." Just... believed.

Wright resigned from the FDA a year later. He was subsequently hired as a consultant at Purdue with a substantially higher salary.

With FDA approval secured, Purdue trained its sales representatives to tell doctors that the risk of addiction from OxyContin was "less than one percent."

This was not true.

Marketing Misery

Purdue didn't just misrepresent their drug's addictive potential. They built an entire marketing apparatus designed to push OxyContin into the hands of as many patients as possible.

The traditional market for powerful opioids was cancer patients—people suffering such severe pain that addiction was a secondary concern. But cancer patients were a limited market. Purdue wanted more.

They identified what they called the "non-malignant pain market": people with chronic back pain, arthritis, sports injuries, headaches. This market was enormous—in 1999, it made up 86 percent of all opioid prescriptions. If Purdue could convince doctors that OxyContin was safe enough for these patients, they would have access to millions of potential customers.

So they got to work.

Purdue flew more than 5,000 physicians, pharmacists, and nurses to all-expenses-paid "pain-management seminars" at vacation destinations. These weren't really educational conferences. They were recruiting events for Purdue's national speaker bureau—doctors who would then be paid to promote OxyContin to their peers.

The company enlisted McKinsey & Company, one of the world's most prestigious consulting firms, to design their marketing strategy. McKinsey suggested focusing sales representative visits on the highest-prescribing doctors—the ones already writing the most opioid prescriptions, who might be convinced to write even more.

The results were staggering. Prescriptions for OxyContin to treat non-cancer pain increased nearly tenfold between 1997 and 2002, from about 670,000 to 6.2 million.

Between 1995 and 2001, OxyContin brought in 2.8 billion dollars in revenue. By 2016, cumulative revenues had reached 31 billion. By 2017, 35 billion. Every dollar of profit went to Sackler family trusts and entities.

The Twelve-Hour Lie

OxyContin's central marketing claim was that one dose provided twelve hours of pain relief—more than twice as long as generic medications. Purdue advertised "smooth and sustained pain control all day and all night."

There was just one problem: for most patients, it didn't last twelve hours.

A 2016 investigation by the Los Angeles Times found that many patients experienced pain returning after eight hours or less. When OxyContin wears off, patients don't just feel their original pain returning. They also experience the beginning stages of acute withdrawal—a constellation of symptoms including intense craving for more of the drug.

Theodore Cicero, a neuropharmacologist at Washington University School of Medicine, explained the implications: "That becomes a very powerful motivator for people to take more drugs."

Purdue knew about this problem before OxyContin even went to market. Internal documents showed the company was well aware that the drug didn't provide twelve hours of relief for most patients.

But they held fast to the claim anyway.

Why? Because OxyContin's market dominance and its high price—up to hundreds of dollars per bottle—depended on that twelve-hour duration. If doctors prescribed smaller doses more frequently, they might switch to cheaper generics. Instead, Purdue advised doctors to keep patients on the twelve-hour cycle but prescribe stronger doses.

This meant patients were getting more powerful opioids, which made them more physically dependent, which made withdrawal more severe, which made them more desperate for their next dose.

It was a perfect machine for creating addiction.

The Reckoning Begins

Reports of OxyContin abuse began surfacing in 2000. By 2003, the Drug Enforcement Administration—the federal agency responsible for combating drug trafficking—concluded that Purdue's "aggressive methods" had "very much exacerbated OxyContin's widespread abuse."

In 2007, Purdue paid one of the largest fines ever levied against a pharmaceutical company: they pleaded guilty to federal charges of misleading the public about OxyContin's addictive potential. The company was criminally convicted of misbranding—essentially, lying on their drug's label.

But the fine was a speed bump, not a roadblock.

Purdue responded by developing "abuse-deterrent" formulations—pills designed to be harder to crush or dissolve for snorting or injection. But they continued marketing and selling opioids. They continued fighting lawsuits. They continued making money.

Meanwhile, a study published in The New England Journal of Medicine in 2012 found that 76 percent of people seeking help for heroin addiction had begun by abusing pharmaceutical opioids—primarily OxyContin. The connection was direct: Purdue's marketing had created a generation of addicts, and when OxyContin became harder to obtain or afford, many switched to heroin.

The Philanthropic Shield

Throughout this period, the Sackler family cultivated a different public image entirely.

They gave money to museums, universities, and cultural institutions around the world. The Sackler name adorned wings of the Metropolitan Museum of Art, galleries at the Louvre and British Museum, medical schools at multiple universities. In 2016, Forbes listed them as one of the twenty wealthiest families in America, with a collective net worth of thirteen billion dollars.

But here's the remarkable thing: Purdue's own website barely mentioned the Sacklers or their ownership of the company. The family seemed to want the prestige of philanthropy without the scrutiny that came with their source of wealth.

Allen Frances, former chair of psychiatry at Duke University School of Medicine, put it bluntly: "Their name has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they've earned this fortune at the expense of millions of people who are addicted. It's shocking how they have gotten away with it."

The Global Expansion

Even as lawsuits mounted in the United States, the Sacklers were building an international opioid empire.

Purdue had sister companies: Napp Pharmaceuticals in the United Kingdom, Mundipharma selling opioids globally, and Rhodes Pharmaceuticals in Rhode Island—one of the largest producers of generic opioids in America. New drugs were developed under different company names like Adlon Therapeutics and Imbrium, though both operated from the same building as Purdue in Stamford, Connecticut, and shared employees.

The structure was like a hydra: cut off one head, and others kept operating.

The Collapse

On September 15, 2019, Purdue Pharma filed for Chapter 11 bankruptcy protection. This was not an admission of failure—it was a legal strategy.

Chapter 11 bankruptcy allows a company to reorganize while protected from creditors. It also allows for settlement negotiations that can discharge liability for related parties. The Sacklers were trying to escape personal accountability.

In October 2020, Purdue reached a settlement potentially worth 8.3 billion dollars. The company admitted that it "knowingly and intentionally conspired and agreed with others to aid and abet" doctors dispensing medication "without a legitimate medical purpose." Members of the Sackler family would pay an additional 225 million dollars, and the company would close.

But state attorneys general protested the plan—particularly provisions that would grant Sackler family members legal immunity from future opioid-related lawsuits. In March 2021, the House of Representatives introduced a bill to stop the bankruptcy judge from granting such immunity. The bill was referred to a subcommittee, where it languished until the end of the congressional session in January 2023.

Meanwhile, Purdue announced it would rebrand itself as Knoa Pharma. A new name, perhaps, for a company trying to escape its past.

As of August 2023, the case remained unresolved, pending a Department of Justice appeal to the Supreme Court.

The Cultural Reckoning

The story of Purdue Pharma has been told and retold in American culture. The 2021 Hulu miniseries Dopesick dramatized the company's rise and the devastation it caused. HBO's documentary The Crime of the Century and Netflix's 2023 series Painkiller covered similar ground. Books and documentaries continue to appear.

There's a reason this story resonates. It's not just about corporate greed—though there's plenty of that. It's about how institutions we trust to protect us can be corrupted. The FDA approved the drug. Doctors prescribed it. Insurance companies paid for it. Regulators were slow to act. Consultants from elite firms optimized the destruction.

The Sacklers weren't street-corner drug dealers. They were a respectable family whose name graced some of the world's most prestigious cultural institutions. Their company employed hundreds of sales representatives, conducted clinical trials, submitted regulatory filings. Everything had the veneer of legitimacy.

And that's perhaps the most disturbing lesson: the difference between legitimate business and criminal enterprise can sometimes come down to marketing and legal strategy.

A Note on Names

One final detail worth mentioning: Purdue Pharma has no connection whatsoever to Purdue University or the Purdue University College of Pharmacy. The university has made this clear on multiple occasions, apparently tired of being associated with the company's legacy.

The name is a coincidence. The only thing they share is a word.

The devastation, on the other hand, is Purdue Pharma's alone.