Danny Hakim, Roni Caryn Rabin and William K. Rashbaum

It was 2014, and the company the family had controlled for two generations, Purdue Pharma, had been hit with years of investigations and lawsuits over its marketing of the highly addictive opioid painkiller OxyContin, at one point pleading guilty to a federal felony and paying more than $600 million in criminal and civil penalties.

But as the country’s addiction crisis worsened, the Sacklers spied another business opportunity. They could increase their profits by selling treatments for the very problem their company had helped to create: addiction to opioids.

Details of the effort, named Project Tango, have come to light in lawsuits filed by the attorneys general of Massachusetts and New York. Together, the cases lay out the extensive involvement of a family that has largely escaped personal legal consequences for Purdue Pharma’s role in an epidemic that has led to hundreds of thousands of overdose deaths in the past two decades.

The filings cite numerous records, emails and other documents showing that members of the family continued to push aggressively to expand the market for OxyContin and other opioids for years after the company admitted in a 2007 plea deal that it had misrepresented the drug’s addictive qualities and potential for abuse.

The business potential of adding addiction treatment to the mix was illustrated in internal company charts and diagrams.

“Pain treatment and addiction are naturally linked,” one Project Tango document, included in the New York complaint, said. It depicted a big blue funnel. The fat end was labeled “pain treatment”; the narrow end was labeled “opioid addiction treatment.”

The company, the document said, could make money at both ends of the funnel as an “end-to-end pain provider.” Dr. Kathe Sackler, one of the eight family members sitting on Purdue’s board, instructed employees to devote “immediate attention” to the effort, according to an email included in the Massachusetts filing.

The two lawsuits are part of a burst of recent litigation that has taken aim at the Sacklers, a far-flung billionaire family that has a network of trusts and companies in the United States and abroad. Their philanthropic gifts have built namesake wings housing the Temple of Dendur at the Metropolitan Museum of Art in New York and oriental antiquities at the Louvre in Paris, as well as a library at the University of Oxford and a scientific institute at Columbia University.

In addition to New York and Massachusetts, Connecticut, Rhode Island and Utah have filed suit against members of the family. Last month, a coalition of more than 500 counties, cities and Native American tribes named the Sacklers in a case in the Southern District of New York, bringing the family into a bundle of 1,600 opioids cases being overseen by a federal court judge in Cleveland.

(The various legal claims also identify many other manufacturers, distributors and pharmacy chains as bearing responsibility for the epidemic.)

Calling the Shots

The suits are not only an effort to get at the Sacklers’ personal fortunes — estimated by Forbes to be $13 billion — but to expose the extent to which the Sacklers themselves have been calling the shots.

“If these allegations against the Sacklers are proven to be correct, that could dramatically change the potential reach of where the litigation goes to collect funds on behalf of the cities and states that are so desperately trying to get money to deal with the opioid crisis,” said Adam Zimmerman, an expert on complex litigation at Loyola Law School in Los Angeles.

In a joint statement to The New York Times, representatives of the eight Sackler family members named as defendants in the New York and Massachusetts cases said the lawsuits were “filled with claims that are demonstrably false and unsupportable by the actual facts.” The statement also contended that the claims would be refuted by the family’s response this week to the Massachusetts lawsuit.

The statement said the lawsuits “ignore the fact that the Sackler family has long been committed to initiatives that prevent abuse and addiction,” citing what it characterized as a philanthropic donation from the family to an addiction research and treatment center in Tulsa, Oklahoma. In fact, the $75 million contribution, to be made over five years, was a condition of the court-approved settlement of an opioid lawsuit brought by the Oklahoma attorney general against Purdue.

Regarding Project Tango, a separate statement from some of the Sacklers named in the suits said that “no board member proposed Tango, or authored any documents in support of it.”

Purdue, for its part, said in a court filing in Massachusetts this year that it “neither created nor caused the opioid epidemic” there and in a statement last week said the company and its former directors “vigorously deny” the New York claims.

Prescription opioids are Food and Drug Administration-approved medications that have legitimate uses for certain patients with advanced cancer or short-term severely acute pain, and are still prescribed, despite limited evidence, for some patients with chronic pain.

A central concern of the investigations and legal cases against Purdue Pharma over the years, including the 2007 federal investigation, has been whether the company, its executives and owners were aware in the late 1990s that OxyContin was being abused. The new lawsuits are notable for the detail they provide about the family’s own continued push to sell opioids in more recent years, as the opioid epidemic became a full-blown national crisis.

In 2009, two years after the federal guilty plea, Mortimer D.A. Sackler, a board member, demanded to know why the company was not selling more opioids, email traffic cited by Massachusetts prosecutors showed.

In 2011, as states looked for ways to curb opioid prescriptions, family members peppered the sales staff with questions about how to expand the market for the drugs. Mortimer asked if they could sell a generic version of OxyContin in order to “capture more cost sensitive patients,” according to one email. Kathe, his half sister, suggested studying patients who had switched to OxyContin to see if they could find patterns that could help them win new customers, according to court filings in Massachusetts.

The family’s statement said they were just acting as responsible board members, raising questions about “business issues that were highly relevant to doctors and patients.”

In July 2011, Mortimer and Kathe’s cousin Dr. Richard Sackler, who had stepped down as Purdue’s president several years earlier but remained an influential board member, went into the field with a sales representative to promote opioids to doctors, though some in the company were concerned that his involvement could run afoul of regulators, according to documents in the Massachusetts case.

When he returned, he argued in an email to Purdue’s vice president for sales that a legally required warning about opioids was not needed, and that it “implies a danger of untoward reactions and hazards that simply aren’t there.”

(The family’s statement disputed that, saying that Richard supported accurate labeling, and merely questioned where on the label the warning should appear. The statement also said he had not been out in the field with sales representatives since well before the launch of OxyContin, in 1996.)

In 2014, Raymond Sackler, now deceased, sent three other family members a confidential memo about Purdue’s strategy for placing patients on high doses of opioids for extended periods of time. The memo noted that doctors had argued against the practice, but that Purdue had beaten back efforts to impose caps on doses, according to the Massachusetts complaint.

The next year, Jonathan Sackler, then a board member, sought information about how public health campaigns to curb opioid addiction would affect OxyContin sales. In 2017, he pushed to develop a new opioid, and asked the staff to present a plan at the next Purdue board meeting.

From Laxatives to Painkillers

It was Arthur Sackler, a psychiatrist and pharmaceutical marketing guru who helped pioneer the infomercial, who started the family business dynasty. In 1952, he and his two younger brothers, Mortimer and Raymond (who were also psychiatrists and who have since died), bought a small company called Purdue Frederick. Their first products included laxatives and a prescription earwax remover, as recounted in the book “Pain Killer” by Barry Meier, a former New York Times reporter.

The sprawling family today is hardly monolithic. Arthur’s branch has not been involved in Purdue for many years, and one of his children, Elizabeth A. Sackler, has called Purdue Pharma’s role in the opioid crisis “morally abhorrent.” But reporting published last year by ProPublica and The Atlantic suggested that Arthur’s side of the family may have reaped some financial benefit from Purdue after OxyContin hit the market.

The lawsuits brought by the attorneys general of New York and Massachusetts, Letitia James and Maura Healey, named eight Sackler family members: Kathe, Mortimer, Richard, Jonathan and Ilene Sackler Lefcourt — children of either Mortimer or Raymond Sackler — along with Theresa Sackler, the elder Mortimer’s widow; Beverly Sackler, Raymond’s widow; and David Sackler, a grandson of Raymond.

Purdue’s business was fundamentally changed after the FDA approved OxyContin in 1995. The company marketed the drug as a long-acting painkiller that was less addictive than shorter-acting rivals like Percocet and Vicodin, a strategy aimed at reducing the stigma attached to opioids among doctors.

The court filings detailed a multipronged approach used by the pharmaceutical industry at that time to reshape public perceptions about pain and chip away at physicians’ reluctance to prescribe opioids, long known to be addictive, by describing an “epidemic” of untreated pain affecting 100 million Americans.

Manufacturers funded “front groups” that were “disguised as ‘unbiased’ sources of cutting-edge medical research and information,” according to the New York attorney general’s office, ostensibly to educate the public about chronic pain and the benefits of opioids. Physicians were paid as consultants to further spread their message. The companies claimed that opioids were safer than high doses of acetaminophen and other anti-inflammatory agents and that there was a minuscule risk of addiction.

At Purdue, sales representatives focused on doctors who were high-volume opioid prescribers, as well as inexperienced providers and primary care physicians who knew little about pain management, encouraging them to prescribe higher and higher doses for longer stretches of time, according to the court filings. Sales representatives could earn tens of thousands of dollars in bonuses and were rewarded with trips to tropical islands.

200,000 Deaths From Opioids

Since OxyContin came on the market, more than 200,000 Americans have died of overdoses related to prescription opioids. As reports of overdoses grew, Richard Sackler urged the company to blame the patients. “We have to hammer on abusers in every way possible,” he wrote in a 2001 email disclosed in documents filed in the Massachusetts case. “They are the culprits and the problem. They are reckless criminals.”

That year, after a federal prosecutor highlighted 59 OxyContin-related deaths in one state, Richard Sackler wrote: “This is not too bad. It could have been far worse.”

The same year Purdue lawyers negotiated the federal guilty plea, the Sacklers quietly formed a new company to sell generic opioids, called Rhodes, according to the New York lawsuit.

“Rhodes was set up as a ‘landing pad’ for the Sackler family in 2007, to prepare for the possibility that they would need to start afresh following the crisis then engulfing OxyContin,” the suit quotes a former senior manager at Purdue as saying.

The Sacklers were intimately involved in overseeing and approving Rhodes’ activities, court records show. They saw the agendas for board of directors meetings and the financial statements. In the years that followed, Theresa, Kathe and Jonathan Sackler would serve on Rhodes’ governance committee, according to the New York lawsuit, while Kathe, Jonathan, Mortimer and David served on its business development committee.

The business operations of Rhodes, based in Rhode Island, and Purdue, based in Connecticut, were closely enmeshed. Rhodes relied on Purdue to oversee its compliance with government regulations, ensuring the quality and safety of its products, the New York lawsuit says, providing, for example, statistics and data to Rhodes’ compliance committee for review.

Rhodes made monetary distributions to two companies that were ultimately owned by trusts set up for the Sacklers: the Rosebay Medical Co. and the Beacon Co.

While the Sacklers “have reduced Purdue’s operations and size, Rhodes continues to grow and sell opioids for the benefit of the Sackler families,” the New York suit contends.

By 2016, Rhodes, though little known to the public, had a greater share of the U.S. prescription opioid market than Purdue, according to a Financial Times analysis. Together, the companies ranked seventh in terms of the market share of opioids.

Purdue temporarily abandoned plans to pursue Project Tango in 2014, but revived the idea two years later, this time pursuing a plan to sell naloxone, an overdose-reversing drug, according to the Massachusetts filing. A few months later, in December 2016, Richard, Jonathan and Mortimer Sackler discussed buying a company that used implantable drug pumps to treat opioid addiction.

In recent years, the Sacklers and their companies have been developing products for opioid and overdose treatment on various tracks. Last year, Richard Sackler was awarded a patent for a version of buprenorphine, a drug that blocks opioid receptors, administered by mouth in a thin film. In March, the FDA fast tracked the company’s application for an injectable drug for emergency treatment of overdoses.

Purdue has said it is taking charitable steps to curb opioid addiction, and last year donated $3.4 million to a nonprofit developing a nasal spray that uses the drug naloxone to treat opioid overdoses.

But the funnel that Purdue once described is full, and overflowing at both ends. David Sackler spent a reported $22.5 million on a Bel Air mansion last year. Mortimer’s Amagansett spread has been featured in Vogue. Theresa Sackler was made a dame and is a trustee of the Victoria and Albert Museum in London.

Last week, three Democratic senators from states hit hard by the opioid epidemic, Edward J. Markey of Massachusetts, Sheldon Whitehouse of Rhode Island and Joe Manchin of West Virginia, sent a letter to Purdue, insisting that it make a more formal commitment not to make money from the treatments.

“Indeed,” they wrote, “it is a maxim of the common law in this country that no one should be allowed to profit from his own wrongdoing.”

This article originally appeared in <a id="23279517-c595-488b-b11e-8cc338f802b7" href="https://www.nytimes.com/2019/03/31/health/lawsuits-lay-bare-sackler-familys-role-in-opioid-crisis.html">The New York Times</a>.

Lawsuits Lay Bare Sackler Family's Role in Opioid Crisis

The Sacklers had a new plan.

Lawsuits lay bare Sackler family's role in opioid crisis

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Danny Hakim, Roni Caryn Rabin and William K. Rashbaum

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Lawsuits lay bare Sackler family's role in opioid crisis