$7.4B Disaster: How The Sacklers Killed 800,000 Americans

A bathroom floor in Huntington, West Virginia. Eleven forty-seven in the evening. A twenty-three-year-old woman, slumped against the tub, an orange prescription bottle still clutched in her right hand. The label says OxyContin, eighty milligrams. The paramedics arriving in four minutes will not bring her back. She is one of roughly two hundred Americans who will die of an opioid overdose tonight. Eight hundred thousand are already dead since this pill went on sale in nineteen ninety-six. In November twenty twenty-five a federal bankruptcy judge approved a seven point four billion dollar settlement that releases the family who built it. Not one of them goes to prison. This is how three brothers from Brooklyn turned a sleepy laxative company into the deadliest pharmaceutical empire in American history, and how the United States Supreme Court tried to stop them and only half succeeded.

This is how three brothers from Brooklyn turned a sleepy laxative company into the deadliest pharmaceutical empire in American history. How they used Madison Avenue advertising and McKinsey consultants to push a Schedule Two narcotic onto the kitchen tables of small-town America. How the Supreme Court of the United States tried to stop them in twenty twenty-four and only half succeeded.

By the time the bankruptcy judge approved the deal in November twenty twenty-five, the Sacklers had personally extracted more than ten billion dollars in cash from the company. They built wings of the Metropolitan Museum, the Louvre, the Tate, and Harvard. They paid the lawyers who held off two thousand six hundred lawsuits for six years. They never spent a night in jail.

The story begins in Brooklyn in nineteen thirteen. Three brothers, the sons of Polish-Jewish immigrants from Galicia — Arthur, Mortimer, and Raymond Sackler — grew up above a grocery store in Flatbush during the Depression. American medical schools at the time held strict Jewish quotas. Mortimer and Raymond were forced to take their medical training in Glasgow, Scotland. All three came home and trained as psychiatrists at Creedmoor State Hospital in Queens, treating schizophrenia and manic-depressive psychosis when those conditions were still managed with insulin comas and electroshock. They were brilliant. They were ambitious. They never forgot what it felt like to be told they did not belong. And the oldest brother, Arthur, had a second talent that would change American medicine more than any drug he ever prescribed.

Arthur Sackler was the first pharmaceutical advertising man on Madison Avenue. In nineteen forty-seven he bought a small medical-advertising firm called William Douglas McAdams. He invented what we now call pharma marketing — full-page color ads in medical journals, free samples flooded to physician offices, sponsored physician-education seminars dressed up as continuing medical education. He founded his own weekly newspaper for doctors, the Medical Tribune, which carried roughly half a million copies into American medical offices every week and which became the most efficient single channel for placing drug advertising into the hands of prescribers ever devised. His first major campaign, for Pfizer's antibiotic Terramycin, grew Pfizer's sales force from eight people to two thousand inside seven years. His second campaign was for Roche, and the product was a tranquilizer called Valium. Valium became the first prescription drug in history to gross one hundred million dollars a year. By the early seventies it was the most prescribed drug in the Western world, dispensed to American housewives by the millions for what the ads called the everyday anxieties of modern life.

In nineteen fifty-two, Arthur arranged the financing for his brothers to buy a small patent-medicine company in Greenwich Village. The company was called Purdue Frederick. It made laxatives and earwax remover. The Sacklers held it for forty years and built nothing remarkable. Arthur died in nineteen eighty-seven, and Mortimer and Raymond bought out his estate's stake. They were sitting on a sleepy family business.

Then Richard Sackler — the son of Raymond, a physician in his own right, head of research and marketing at Purdue — found the molecule that would change everything. It was already in the public domain. It had been used in German medicine since nineteen seventeen. Its name was oxycodone.

In December nineteen ninety-five, the Food and Drug Administration approved Purdue's new pill — a controlled-release oxycodone tablet they called OxyContin. The label allowed it to be prescribed not just for cancer pain or end-of-life care, but for, quote, moderate to severe pain where use of an opioid analgesic is appropriate for more than a few days. That single phrase opened the entire chronic-pain market in America to a Schedule Two narcotic.

The FDA medical officer who shepherded the approval, a man named Curtis Wright, left the agency two years later and went to work for Purdue. His first-year compensation was roughly three times his FDA salary.

The pill was launched commercially in nineteen ninety-six. In January of that year a historic blizzard shut down the East Coast. Richard Sackler arrived late to the launch sales meeting because his flight had been grounded. He stepped to the microphone and said this. The launch of OxyContin Tablets will be followed by a blizzard of prescriptions that will bury the competition. The prescription blizzard will be so deep, so dense, and so white. That sentence would surface twenty-three years later in a Massachusetts attorney general filing.

Purdue trained roughly one thousand sales representatives and gave them a single talking point. The risk of addiction with OxyContin, they were told to tell doctors, was less than one percent. The claim had no clinical basis. It was traced back to a five-sentence letter to the New England Journal of Medicine from nineteen eighty, which had looked at hospitalized patients receiving short courses of opioids under nursing supervision. It said nothing about chronic outpatient use. Purdue's sales reps cited it anyway, in tens of thousands of physician offices, for two decades.

The reps targeted high-volume prescribers. Family doctors in Appalachia. General practitioners in the Rust Belt. The pill mills of South Florida, where a single storefront clinic could write more OxyContin scripts in a week than the entire state of Wyoming filled in a year. They handed out branded swag — fishing hats, golf balls, plush toys, a music CD called Get In The Swing With OxyContin. They sent doctors on all-expenses-paid pain management seminars in Boca Raton and Scottsdale. They paid prescribing physicians thousands of dollars to deliver promotional talks to their colleagues. By two thousand and one, OxyContin was a one billion dollar drug. By two thousand and ten, it was a three point one billion dollar drug — one third of all painkiller revenue in the United States that year. In that same year, American pharmacists filled two hundred and fifty-four million opioid prescriptions, enough for every adult in the country to have a bottle of their own.

Cumulative revenue by twenty seventeen: roughly thirty-five billion dollars.

By nineteen ninety-nine, emergency room doctors in Maine, in rural Virginia, in eastern Kentucky, were filing reports about a new pattern of overdoses. People were crushing the controlled-release tablet on kitchen counters and snorting the powder, or dissolving it and injecting it. The entire twelve-hour dose hit the bloodstream in seconds. It was heroin in a prescription bottle. Coroners in the coalfields of West Virginia began stacking the death certificates in separate folders just to keep count. Funeral homes in towns of four hundred people were running two services a week.

Purdue's internal documents show they understood the abuse pattern in real time. In February two thousand and one, Richard Sackler wrote an email to a Purdue executive about the rising body count in West Virginia. We have to hammer on the abusers in every way possible, he wrote. They are the culprits and the problem. They are reckless criminals. The dead and dying were the problem. Not the pill.

In May two thousand and seven, in a federal courthouse in Abingdon, Virginia, Purdue pleaded guilty to felony misbranding. Three executives — the chief executive Michael Friedman, the general counsel Howard Udell, and the chief medical officer Paul Goldenheim — pleaded to misdemeanor charges. The total fine was six hundred and thirty-four point five million dollars. Each executive was sentenced to three years probation and four hundred hours of community service related to drug abuse prevention. None of them served a day in prison. No member of the Sackler family was charged.

The company kept selling OxyContin. And between two thousand and eight and two thousand and seventeen, according to a forensic report by Purdue's own bankruptcy advisors, the Sackler family extracted approximately ten point four billion dollars in cash distributions from the company they owned. Four point one billion in dividends. Four point seven billion to pay the taxes on those dividends. The pace of extraction accelerated roughly eight-fold after the guilty plea.

To turbocharge the sales, Purdue brought in McKinsey and Company. McKinsey advised the company on how to target the highest-volume prescribers, how to circumvent emerging pharmacy restrictions on high-dose prescriptions, how to push past the warning signs. The relationship ran from roughly two thousand and seven through two thousand and eighteen. In February twenty twenty-one, McKinsey settled with forty-seven state attorneys general for five hundred and seventy-three million dollars. In December twenty twenty-four, the firm settled federal criminal charges for an additional six hundred and fifty million dollars. A former senior partner pleaded guilty to obstruction of justice for destroying records. It was the first criminal resolution ever obtained against a major management consultancy in the United States.

By twenty nineteen, Purdue was facing roughly two thousand six hundred lawsuits from states, cities, tribes, and individual families. On September fifteenth, twenty nineteen, the company filed for Chapter Eleven bankruptcy in White Plains, New York. The filing was tactical. It would freeze every lawsuit in the country, consolidate every claim into one proceeding, and let the family negotiate a single grand bargain on its own terms.

The bargain the Sacklers proposed was extraordinary. They would contribute four and a half billion dollars over nine years. They would surrender ownership of Purdue. And in exchange, every member of the family — none of whom had personally filed for bankruptcy, all of whom remained billionaires — would receive lifetime immunity from every civil opioid lawsuit, in every state, forever. The bankruptcy judge approved the deal in twenty twenty-one. The United States Trustee, the federal bankruptcy watchdog named William Harrington, refused to accept it. He appealed. The case went to the Supreme Court of the United States.

On June twenty-seventh, twenty twenty-four, the Supreme Court ruled five to four in Harrington versus Purdue Pharma. Justice Neil Gorsuch wrote the majority opinion. The bankruptcy code, he wrote, does not authorize the discharge of claims against non-debtors without the consent of the affected claimants. The Sacklers were not in bankruptcy. They could not buy immunity through someone else's. The vote crossed every ideological line on the court — Gorsuch was joined by Thomas, Alito, Barrett, and Justice Ketanji Brown Jackson. Justice Brett Kavanaugh, writing for the four dissenters, called the ruling devastating for more than one hundred thousand opioid victims and their families. The deal was dead. The family was back on the hook for every lawsuit they had spent five years trying to extinguish.

For six months the case sat in limbo. Then in January twenty twenty-five, with new pressure from the state attorneys general and the threat of personal depositions hanging over the family, the Sacklers came back to the table. The revised settlement was announced in mid-June twenty twenty-five. The total figure was seven point four billion dollars. The Sacklers would pay up to six point five billion over fifteen years. Purdue would pay an additional nine hundred million dollars in cash at plan effectiveness.

On November eighteenth, twenty twenty-five, Judge Sean Lane approved the plan from the bench in the federal bankruptcy courtroom in White Plains. Purdue Pharma was dissolved. In its place rose a new public-benefit company called Knoa Pharma, with no Sackler on the board, barred from marketing opioids, owned by an independent foundation that would direct future profits to opioid abatement programs.

The Sacklers were barred from selling opioids in the United States. They were not barred from selling them anywhere else. Their international arm, called Mundipharma, continues to operate across Europe, Asia, Latin America, and the Middle East, selling oxycodone formulations including OxyContin under different names. Between twenty twenty and twenty twenty-two, Mundipharma is estimated to have generated roughly two and a half billion dollars in international opioid sales.

The Centers for Disease Control and Prevention count approximately eight hundred and six thousand opioid overdose deaths in the United States between nineteen ninety-nine and twenty twenty-three. OxyContin did not kill all of them. It lit the fuse. The first wave was prescription pills. The second wave, after Purdue reformulated OxyContin in twenty ten to be harder to crush, was heroin — millions of dependent patients cut off from their prescriptions and routed to the street supply. The third wave, the one still killing roughly two hundred Americans a day, is fentanyl.

Before the settlement, the Sackler family's net worth was estimated by Forbes at roughly thirteen billion dollars. After paying out the six and a half billion over fifteen years, their remaining wealth is estimated to be greater than six billion dollars. The payment schedule is heavily back-loaded. The family is permitted to keep its art, its real estate, its yachts, its trusts in Switzerland and the Channel Islands. The first installment is due at plan effectiveness. The last installment is not due until the year twenty forty.

Their names still appear, in some places, etched in stone on the walls of the world's great museums. In other places — at Harvard, at the Louvre, at the Metropolitan, at the Tate, at the Smithsonian — the letters have been quietly chiseled off. Curators describe the work as patching. The shadows of the original lettering, in raking light, are still faintly visible.

The number of Sacklers personally indicted for crimes related to the opioid epidemic is zero. The number who have served a single day in prison is zero. The drug they invented sits, today, in tens of millions of medicine cabinets in America. The orange bottle on the kitchen table in eastern Kentucky is, statistically, still being refilled.

In the cemeteries of Mingo County, of Cabell County, of Scioto County in Ohio, the headstones from this century are crowded close. Some of them are children. Some of them are grandmothers. Many of them carry only one date — the year they were born and the year they died, separated by no more than three decades. None of those headstones carry the name Sackler.

The blizzard of prescriptions that Richard Sackler promised in nineteen ninety-six arrived. It buried a generation. And the family that called it down walks free.