Untitled Flashcards Set

• Opioid overdose deaths rose after 2010 after Purdue took oxycontin off the market, introduced a new pill with different coating. Patent was about to expire, many users switched to street drugs like heroin

• Marketing

  • Vital signs

    • 4 traditional vital signs

      • Temperature

      • Pulse

      • Respiration

      • Blood pressure

    • Can all be objectively measured

    • Sacklers launched a campaign to add pain which cannot be measured objectively as the 5th vital sign

      • 1980 letter in New England Journal of Medicine

        • Short letter speaking of low incidence of addiction

        • Letter, not journal article

        • Evidence used in letter was tested only in hospital

        • If you are in pain, oxycontin is not addictive

  • "opiophobia" fear of opioids

  • Pseudoaddiction

    • Not addiction, simply in pain and need dose increased

  • Curtis Wright

    • FDA official

    • Met with Purdue officials and let them help write memo for licensing oxycontin

      • Delayed coating made drug safe

    • 1995 FDA approved oxycontin

    • 1997 Wright took a job with Purdue paying $300,000

  • Target doctors

    • Sales reps

    • Trips

    • Lunch

    • Free samples

    • Ghost writing, fees to med school authors

    • Weak FDA oversight, DEA

• Dangers of oxycontin

  • Time release coating allowed for more drug

• Controlling the regulatory environment

  • Hire regulators to industry

  • Donations to members of congress

  • Write questions for members of congress

  • Members of congress target individual officials

  • Astroturf groups (looked like grassroots, secretly funded

    • American pain foundation (90% funded by Purdue Pharma)

Study of opiate users in US

• 2.5 million had opiate use disorder

• 22% got medications; methadone, nalextrone, buprenorphine

• More than 80,000 people dying every year

• white adults 14 times more likely to receive medications than black adults

• Black people more likely to be prescribed methadone than suboxone

  • Methadone often taken in person in clinic in morning

Suboxone

• Can't mix alcohol, valium, other opioids, antidepressants

• Tooth decay

• Sacklers tried to buy into suboxone

• Purdue tried to buy suboxone; could not

Settlement

• In years before case concluded, $10.4 billion transferred from Purdue to Sacklers in a way that was hard to trace

• Purdue declared bankruptcy in 2019

• Sacklers owned other companies in 40 countries, including Mundipharma

  • Biggest seller oxycontin

  • Looking at emerging countries with wealth

    • India, China

• $6 billion over 18 years in turn for complete indemnity (cannot be in trouble for anything else) (overruled)

• Sacklers left with $10.8 billion

Sackler art galleries

• Guggenheim, MET, Louvre, Harvard

• Nan Goldin's campaig

  

  n persuaded many major museums, art galleries to remove the Sackler name