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What Is The Definition Of Justice In The Opioid Crisis

I published the essay below on December 21, 2017. Some of the numbers have changed but the story has not, so it’s being republished with the following update.

The opioid  epidemic continued to balloon with lots of lip service by politicians while the Sacklers continued to live the high life, as did the institutions that benefited from their largesse.

So, here we are two years later…will justice be served at any level with the talks just announced in the WSJ? It means that the government will receive the settlement in a public trust to dole out to states suing–aka, to attorneys. How will the victims of this crisis be served? You’ll notice a hint of outrage on my part with this question…

Will institutions that celebrated the philanthropy of the Sackler family by splashing their name across building  facades around the world walk away from the endowments? Will they do the right thing?

So, exactly, what is justice for all of these lost lives and the families who continue to suffer?

And, here’s the update

(courtesy WSJ By Sara Randazzo and Jared S. Hopkins Updated Aug. 27, 2019 7:09 pm ET)

OxyContin maker Purdue Pharma LP and its owners, the Sackler family, are in talks with state and local governments to resolve more than 2,000 opioid cases in a deal valued at between $10 billion and $12 billion, according to people familiar with the matter.

The discussions, part of a mediation to end the mounting litigation that seeks to blame Purdue for fueling the opioid crisis, have been ongoing for more than a year and remain in flux, the people said.

The latest proposal, which came out of settlement talks last week in Cleveland, would put Purdue into bankruptcy and have it emerge as a public benefit trust corporation, with proceeds going toward the governments bringing the lawsuits, the people said.

The Sackler family, which has owned the company since its founding in the 1950s, would cede ownership as part of the bankruptcy reorganization.

Sackler family members are being asked to contribute $3 billion under the current proposal, the people said. The proposal includes the sale of Mundipharma, a major international pharmaceutical operation owned by the Sacklers. Depending on the value of the sale, the Sacklers could be asked to contribute an additional amount of up to $1.5 billion.

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“Oh Holy Night, the Stars are Brightly Shining”…but not for Opioid Addicts

Published December 21, 2017

It’s that time of year when thoughts turn to celebrations of faith and family across the US. But, we have an opioid crisis on our hands that can’t be ignored.

Tragically, from 2000 to 2015 almost half a million people died from drug overdoses, with 64,000 lost just last year.  That’s 100 lives a day from opioid and heroin overdose spanning across every socioeconomic class, race, gender, religious affiliation, every city, suburbia and rural landscape. Opioids highjack the brain driving the unrelenting need for users to repeatedly experience the intense feelings of pleasure that some derive from eating, drinking and sex.Tightly knit families have been ripped apart while exhausting avenues to identify solutions.

Adding to that, in an analysis released in November by the Council of Economic Advisers, the true cost of the opioid crisis in 2015 was pegged at $504 billion, a figure more than six times larger than the most recent estimate of $78.5 billion in 2013.

This crisis brings with it the cold hard reality of rationing, a “third-rail” word rarely mentioned in the delicately constructed talking points of politicians. Tragically, it’s a real situation in communities across our country. Local budgets are stretched to the breaking point and the overwhelming strain on first responders is contributing to the stress on limited human resources. First responders are compromised each time they have to make a run to save an individual who has overdosed when another 911 call completely unrelated to the opioid epidemic rings into the station.

Let’s look at Middletown, OH. Population 49,000. Ohio’s Butler County exceeded last year’s total runs by July, making over 600 runs, sometimes a half dozen times to the same people who then required the opioid antagonist, Naloxone (Narcan).

Two doses of Evzio, the injectable form of Naloxone, cost local taxpayers $4500 for, up from $690 in 2014. The potency of some of the latest opioid drugs, which contain fentanyl and carfentanil, an elephant tranquillizer, requires the administration of multiple doses to reverse the deadly effects of these drugs. So, in the first six months of 2017, it spent $100,000 on Naloxone. That’s a tenfold increase over last year.

Their solution was to set a three time limit for receiving the drug. Does this sound heartless, leaving young people to die after repeated overdoses? Yes, on the face of it, it does. But localities have to balance budgets. Deficit spending is not an option. So, fellow drug abusers are learning CPR to help victims just in case their “three-strikes and they’re out” have expired.

In Maine, which averages almost one death per day attributed to opioid overdose, Governor LePage sparked outrage from the recovery community when he attempted to get survivors to pay for their Naloxone. His bill, which failed, would have required authorities who dispense Naloxone to “make all reasonable efforts to identify whether that individual has previously been administered an opioid antagonist” and to “make all reasonable efforts to recover the cost of the dose administered if it is not the first opioid antagonist administered to the individual,” according to the Bangor Daily News.

According to the Massachusetts Department of Public Health, in 2015 emergency personnel statewide responded to over 11,000 opioid-related incidents, up from 6,300 in 2013. Of those incidents, Naloxone was used 9,000 times, with 2,900 of those being repeat doses.

In Maryland, concerns have forced the Department of Health to ration Naloxone because of short supply, prioritizing who gets Naloxone kits. They came down on the side of needle exchanges because addicts who inject drugs are at high risk for overdosing. But is this fair? What about all of the others?

President Trump’s declaration of a National Public Health Emergency this summer will provide an opportunity to negotiate the cost of these opioid antagonist drugs that are crippling the budgets of localities. But, this only addresses the cost of rescue, not the underlying issue.

How did we get here?  In my judgment, the Sackler family who owns Purdue Pharmaceuticals, a privately held pharmaceutical company in Stamford, CT carries a significant burden. In 1995, Oxycontin launched their break-through narcotic pain reliever, touted to the medical community as non-addictive. and by 2001, it became a best seller, generating over $35 billion in revenue for the company.

Oxycontin is the major offender in the opioid crisis, providing a documented glide path toward a cheaper opioid, heroin, the drug of choicewhen prescription opioids are no longer available or too expensive to purchase on the black market. Practically speaking, neither Purdue Pharma nor the government is aggressively reducing supply leaving all of us to deal with this crisis.

According to Forbes,the Sacklers are now one of the richest families in the country, with a collective net worth of thirteen billion dollars. And what do they do with their money? They live large but are also renowned philanthropists, showcasing their names on the campuses of such elite academic institutions as Yale, Columbia, Tufts, Weill Cornell Medical College, Tel Aviv University and UC Berkeley…and more.

Unfortunately, hypocrisy oozes from these hallowed halls. As an example, Yale is renaming a residential college that was once named after John C Calhoun because of his “legacy as a white supremacist…promoted slavery” because it “fundamentally conflicts with Yale’s missions and values.” And the Sackler family’s money does not “offend” so their names still grace the facades of their revered campus? Seriously! I suggest the difference may be that the Sacklers are still alive with deep pockets while Mr. Calhoun is no longer with us. We all have a price!

Sadly, this is our societal reality, but let’s earnestly consider a point made by Allen Frances, a Duke psychiatrist. Why not petition the Sacklers to use their personal net worth to fully fund inpatient and outpatient addiction treatment and lifetime support to reduce relapse for our addicted society? They could also fund the Naloxone and necessary emergency personnel for localities across this country until this crisis is managed? They obviously have the capacity.

As Dr. Frances said of the Sacklers. “A truly philanthropic family, looking at the last twenty years, would say, ‘You know, there’s several million Americans who are addicted, directly or indirectly, because of us.’ Real philanthropy would be to contribute money to taking care of them. At this point, adding their name to a building—it rings hollow. It’s not philanthropy. It’s just a glorification of the Sackler family.”

The Sacklers are presiding over a modern day Holocaust of death and addiction. Rather than filling their days with opportunities for self-aggrandizement, why not invest in saving the lives of those whose brains have been hijacked by the drug that built their fortune?

It’s the Christmas season. In your mind’s eye, can you envision that young person who just had to administer CPR to a fellow addicted traveller? Was it your child or your parent? How will those families experience this holiday season without their loved ones?

And, how about the Sacklers? Will they be toasting their good fortune with total disregard for the epidemic that should carry their name? Rather than displaying their name on another building, maybe we should name the crisis after them…the Sackler Epidemic.

But then they do have an opportunity to do the right thing. But, the question is, will they? And, will others?

 

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