Shared blame for the opioid crisis

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As the COVID-19 pandemic recedes, it is time to look back on the slow and devastating epidemic caused by the opioid crisis in the United States. Over the past 10 years, approximately 15,000 annual deaths have been attributed to prescription opioid overdoses. Add in the deaths of all opioids, whether obtained by prescription or on the black market, and the total is almost 50,000. Black market fentanyl has played a big role, along with a now notorious drug called OxyContin, which is manufactured and sold by Purdue Pharma. The dysfunctional corporate culture, combined with the complacent oversight of the Food and Drug Administration (FDA), the research community, and the medical community, has led to this perfect storm that we must learn from in order to avoid a similar tragedy in the future.

There have been many notable reports on the OxyContin saga and the role of Purdue Pharma and the Sackler family, who own and run the company. More recently, Patrick Radden Keefe wrote a compelling version of the story in his new book, Empire of Pain. The book focuses primarily on the Sacklers’ horrific trade actions, but given Keefe’s detailed reports, I asked him to help me understand why the company’s scientists and doctors couldn’t stop the crisis. earlier. One of the real quirks of this story, he told me, is the lack of whistleblowers. You would expect what you are describing precisely, for people to come forward, quit in protest, try to alert authorities and there aren’t many along the way. Keefe says that the fact that Purdue was not a public company and that there was a high premium placed on loyalty to the Sackler family were key considerations. But he also cites an idealistic belief among the company’s scientists that with OxyContin, they cracked the code on pain management. These are drugs that we’ve known for thousands of years to have significant therapeutic benefits but also very significant drawbacks, he said, and I think Purdue’s hope and ambition was that ‘they hacked it. Keefe was referring to the sustained-release aspect of OxyContin, which allowed Purdue to deliver much higher doses of opioids.

A telling episode in the company’s history involves a chemical explosion at a Purdue New Jersey manufacturing facility in 1995 that killed five people and injured dozens more. All kinds of shortcuts were cut in the interest of profits, creating danger that should have been foreseeable. Keefe said: The family that owns the business and that was behind this profit campaign accepts no responsibility. They don’t go to any funerals. They didn’t even express any regrets to me, it was in short a story of how a relentless pursuit of profit can blind people to the very dangerous consequences of some of the risks they take. This lack of safety culture at the Purdue plant has apparently spread throughout the organization.

The FDA has also not addressed the situation. Although the drug was approved in 1995, it wasn’t until 2009 that the FDA began warning of its dangerously addictive properties. David Kessler, who was the FDA commissioner when OxyContin was approved, was later cited as saying that opioid de-stigma was one of the big mistakes of modern medicine. Nonetheless, Keefe says the FDA has taken Purdue at its word both in terms of the science and the marketing of the drug. It was 14 years after the drug was approved when FDA Commissioner Margaret Hamburg finally started holding hearings and issuing warnings about the drug’s dangers. Joshua Sharfstein, who was then deputy commissioner of the FDA, told me: The FDA has to remember that this is the last line of defense against something horrible happening, and for various reasons the agency no did not play this role.

The story of OxyContin is above all a story of greed and pride. But science bears a part of the responsibility for not having manifested itself, but also for having adhered to the idea that science can solve everything. As Keefe surmised, the first three Sackler brothers in the 1950s had this, I think, very American feeling that if the chemistry is good enough, there is no human problem that cannot be solved with a pill. . For many scientists, this view can be just as intoxicating as an illicit drug.

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