Billions and Billions –

Oct. 4, 2020 – With the launch of OxyContin, in 1995, Purdue unleashed an unprecedented marketing blitz, pushing the use of powerful opioids for a huge range of ailments and asserting that its product led to addiction in “fewer than one percent” of patients. This strategy was a spectacular commercial success: according to Purdue, OxyContin has since generated approximately thirty billion dollars in revenue, making the Sacklers (whom I wrote about for the magazine, in 2017, and about whom I will publish a book next year) one of America’s richest families.

But OxyContin’s success also sparked a deadly crisis of addiction. Other pharmaceutical companies followed Purdue’s lead, introducing competing products; eventually, millions of Americans were struggling with opioid-use disorders. Many people who were addicted but couldn’t afford or access prescription drugs transitioned to heroin and black-market fentanyl. According to a recent analysis by the Wall Street Journal, the disruptions associated with the coronavirus have only intensified the opioid epidemic, and overdose deaths are accelerating. For all the complexity of this public-health crisis, there is now widespread agreement that its origins are relatively straightforward. New York’s attorney general, Letitia James, has described OxyContin as the “taproot” of the epidemic. A recent study, by a team of economists from the Wharton School, Notre Dame, and rand, reviewed overdose statistics in five states where Purdue opted, because of local regulations, to concentrate fewer resources in promoting its drug. The scholars found that, in those states, overdose rates—even from heroin and fentanyl—are markedly lower than in states where Purdue did the full marketing push. The study concludes that “the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.”

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