We go from artistic highs to moral lows on this episode of Waypoints! Rob, Danielle, and Natalie have been watching Alfonso Cuarón's Roma, his sweeping-yet-intimate historical drama produced for Netflix. The gang is savoring the fim's beauty, technique, and sensitivity as well as some terrific performances from cast. At the other extreme, Rob has been reading about new information that's come to light about how Oxycontin was marketed, and what Purdue Pharma executives knew about its role in the escalating opioid epidemic, and all the people that enabled their recklessness.

Useful Resources

Looking at the role of major pharmaceutical firms in the opioid epidemic, and especially at how much was known about the risks and harms as far back as the 1990s and early 2000s, is probably some of the most upsetting reading you can do. It's worth doing, though, because it drives home how much malfeasance takes place in the open, without the need for diabolical conspiracy or coverups.

The Charleston Gazette-Mail did a tremendous series looking at how the opioid epidemic hit West Virginia, which has some of the highest overdose rates in the country. A lot of this goes beyond Purdue Pharma: by 2007, a lot of drug firms were flooding West Virginia with opioids. Per Gazette-Mail reporter Eric Eyre: "In 2011, AmerisourceBergen, which shipped to Westside Pharmacy in Oceana, had a list of 'pain doctors' who were writing the bulk of the store’s prescriptions. Five of the six had been convicted of federal charges or are under investigation." From the same report: “The companies ignored federal laws that require them to report pharmacies that ordered a questionable number of prescription pain pills. Between 2006 and 2012, McKesson shipped 162.6 million hydrocodone and oxycodone pills to West Virginia, but didn’t send any suspicious-order reports to the DEA. During the next four years, McKesson submitted 10,000 such reports.”

The New Yorker published a terrific profile of the Sackler family in 2017 that argues this is a family whose immense personal fortune, their transition from the rich to the mega-rich, is basically down to the manufacture and marketing of Oxycontin.

A listener reached out and let us know about this article from the Huffington Post, which gives you another side of this story: the experience of chronic pain sufferers who were given a medication that they badly needed, and were in turn demonized and then increasingly cut-off as the government belatedly reacted to the epidemic of opioid abuse.

Here are some details about Purdue's 2007 settlement with the Justice Department, in a case led by US Attorney John Brownlee. The $634 million fine was considered enormous at the time, but it's worth noting that in the New Yorker article on the Sacklers, Oxycontin is estimated to have brought in 35 billion dollars in revenue for the company.

Later, Brownlee joined the massive law firm of Holland & Knight. From their press release announcing his hiring: "He served as lead counsel for the United States in two cases that gained national attention: one involving violations of the ITAR regulations, and another involving intentional misleading and false advertising by a drug manufacturer."

Here's Holland & Knight defending another pharmaceutical firm in a ton of opioid lawsuits.

An hilarious “well actually” from Purdue here showing that opioid prescriptions barely have anything to do with them… if you only consider the time period from Oct 2017 to now.

Purdue is looking at promoting a new medication of theirs, one for treating opioid addiction

Here's a useful timeline of some key events laid-out in the articles cited above. 1995: FDA approves OxyContin. It allows Purdue Pharma to claim that the new synthetic opioid was “believed to reduce” the addictiveness of the pills. 1996, Purdue brings Oxycontin to market. They aggressively market the drug to doctors, and mislead them about the pill’s addictiveness. 1999: Richard Sackler becomes CEO of Purdue and drastically increases the size of the marketing operation. 2001: significant numbers of people are beginning to die of overdoses. Sackler writes: “This is not too bad. It could have been far worse.” He also suggests a messaging strategy of demonizing addicts. 2007: Federal prosecutors suing the company secure a settlement. Three executives plead guilty to federal misdemeanor charges, and the company pays 634.5 million in fines. As part of the agreement, the Purdue board signed a compliance agreement promising the company would not violate the law in the future. 2007-2016: Purdue’s sales force increases from 300 to 700 per requests from the Sacklers. 2011: Richard Sackler is asking to shadow pharma reps on their sales rounds. June 2018: Maura Healey sues 8 Sacklers, as well as the company and its executives.

of some key events laid-out in the articles cited above.