Purdue Pharma pitches $10 billion plan to treat opioid crisis

As an addiction psychiatrist in Washington state, Dr. Mark Duncan sees patients struggling with opioid addiction every week. He described a recent patient who began overusing opioid painkillers because of an aortic dissection—a serious condition in which blood vessels tear near the heart. The patient’s provider stopped prescribing the drugs, so the man bought any opioids he could find off the street to manage his withdrawals and anxiety. His missed work and poor performance caused him to lose jobs, and he lost relationships as he tried and failed at treatment. Over the next decade, he misused other substances, as well, including alcohol and methamphetamines.

When Duncan first met this patient, he had accidentally overdosed on the anesthesia drug Ketamine, and his parents found him unconscious in his bedroom. “This was his wake-up call to get help,” Duncan said.

In the past two decades, about 470,000 opioid users have died before answering that call. Now, one of the major pharmaceutical companies whose drugs fueled the opioid epidemic has offered $10 billion to fight addiction and its harmful effects on families and communities. Purdue Pharma, the maker of OxyContin, filed a revised bankruptcy plan this month that would include a payment of $4 billion directly from the company’s owners, the Sackler family. The plan focuses on easing the opioid crisis, but critics say it should do more to fund recovery and hold the Sacklers accountable.

Purdue Pharma first released OxyContin in 1996, claiming the time-release opioid tablets were less likely to cause addiction because patients needed fewer doses. But abusers crushed the tablets to access the active ingredient all at once, leading to increasing overdose deaths. Company representatives and members of the Sackler family continued to aggressively market the drug to pharmacies and doctors, who overprescribed it. The excess amounts quickly reached the streets.

A 2007 federal investigation produced criminal charges against three Purdue Pharma executives for deceiving the public about the risks of OxyContin. The company paid more than $600 million in fines. Purdue also paid $19.5 million to settle with 26 states and the District of Columbia. In January 2019, Massachusetts Attorney General Maura Healy filed a lawsuit against members of the Sackler family, and other states, counties, tribes, and families joined in. In September 2019, the company filed for bankruptcy with nearly 3,000 lawsuits looming.

The bankruptcy plan involves Purdue paying $500 million to settle injury claims and the Sacklers paying $4.2 billion to the U.S. government over the next nine years. All of the assets of Purdue Pharma would go into a new company that will manufacture drugs to treat opioid addiction and reverse overdoses. All profits from that company would go into a trust to fund efforts to combat the opioid crisis. The Sackler family may not be involved with the new company and must sell its overseas pharmaceutical businesses within seven years. Covenants will dictate how the new company can market and distribute its products, and a monitor will ensure its compliance.

Some stakeholders approved the plan, including Texas Attorney General Ken Paxton. “We hope that communities can begin turning Purdue dollars into new treatment facilities, educational programs, foster homes, and much more by the start of 2022,” he wrote.

But 24 other attorneys general expressed disappointment. The plan did not provide enough money, they said—the Sacklers have reportedly received $12 to $13 billion from Purdue Pharma. Some activists have also objected that the plan shields the Sacklers from future litigation.

Duncan agrees Purdue played a significant role in the opioid epidemic, and he believes holding companies accountable is important “to help push back on the influence of profit and greed that can cause people and companies to completely disregard the impact their decisions may have on human lives.” But he pointed out additional factors caused the opioid crisis, including insurance companies’ unwillingness to pay for safer pain treatments and doctors not doing their research on medicines.

The past few years have brought a shift in the epidemic: More addicts are using heroin or illicitly manufactured synthetic opioids like Fentanyl than prescription opioids like OxyContin. States must focus on bringing to justice not only drugmakers like Purdue but also those making and selling illegal drugs.

In 2019, Dr. Charles Horton suggested one part of a solution: “Let’s replace our society’s current addiction to rules and guidelines with a commonsense understanding that life after the Fall can’t be entirely devoid of pain any more than corporate funding can be entirely without strings. Let’s bring back the idea of doctors and patients knowing each other, as individuals, and of doctors using that relationship to help encourage patients as they manage their pain, one day at a time.”