Over the past decade, more people have died of drug overdose in the United States than from drugs. In the rust belt of cities abandoned by the times, the painkiller OxyContin became an underground "currency". Some people have become rich because of it, some people have lost their lives for it, and the medicine that should alleviate people's illness has become a guide to hell.
The three Sackler brothers
In 1913, Arthur Sackler, born in Brooklyn, New York, to Jewish immigrant parents, who made a living as a grocery store, established himself in a foreign country, arthur's two brothers Mortimer and Raymond were born.
As adults, all three of the Sackler brothers chose medicine. Arthur Sackler specialized in psychiatry, and after graduating from medical school, he worked as a psychiatrist in New York, where he wrote more than 150 psychiatric papers.
Arthur experienced a period of rapid medical development after World War II, when various life-changing antibiotics and vaccines were developed. To its disproportionate was the backward, tedious medical advertising that Arthur Sackler saw as a huge opportunity. In his thirties he joined an obscure pharmaceutical advertising agency called William Douglas McAdams.
In 1951, at the age of 39, Arthur met the most important customer of his life, Charles Pfizer, the world's largest producer of vitamin C at the time.
Pfizer Corporation
In 1849, Charles Fizer founded the Charles Pfizer Company, specializing in the production of chemical products. During the Civil War, Charles Pfizer provided a large number of drugs to the Confederate Army, made a "windfall", and since then included the drugs into the scope of business.
In 1928, when penicillin was discovered, Charles Pfizer began to produce antibiotics, and then gradually shifted its focus to the field of antibiotics, and thus achieved business expansion during World War II.
In 1951, Charles Pfizer successfully developed the broad-spectrum antibiotic oxytetracycline, which was experimentally proven to be effective against more than 50 diseases, including pneumonia. Arthur Sackler told Pfizer's sales director, "Just give me enough budget to make Charles Pfizer's name unknown." ”
Pfizer was moved, they gave Arthur an unprecedented budget, and an overwhelming advertising campaign began.
Arthur's purpose was to make the drug available to doctors everywhere.
He ran large color ads in medical journals, hired copywriters to write thousands of postcards, and sent them to family doctors, pediatricians, and even surgeons across the Country. He also "made a move" on the address of the letter, making it appear to have been sent from all over the world, "oxytetracycline cures Maltese milk production fever" and "oxytetracycline cures Australian colegen".
After the postcards were delivered, the salesperson broke through the hospital's threshold, Arthur wanted to make sure every doctor who had prescribed the drug received promotional materials, and he stuffed an 8-page booklet, Pfizer, into the Journal of the American Medical Association, to which doctors subscribed.
After some modern marketing operations, coupled with the efficacy of the drug itself, oxytetracycline reached $45 million in sales in 1952, and Charles Pfizer's reputation followed suit, expanding the business to 13 countries and officially renaming it Pfizer.
The success of Pfizer also laid the groundwork for its launch four decades later, "Viagra," a drug that is taken four times a second, making it the largest pharmaceutical company in the United States.
With the fame of Oxytetracycline, Arthur Sackler pioneered modern pharmaceutical advertising, buying his own William Douglas McAdams Company and becoming the boss. Later, the three brothers bought a pharmaceutical company that mainly sold preservatives, laxatives and earwax removers, Purdue Frederick Pharmaceuticals.
Founded in 1892, Purdue Pharmaceuticals has always been decent in business, and Arthur Sackler wanted to turn stones into gold and build a giant with his own new model.
In 1963, Arthur was licensed to sell a new tranquilizer called "Anda."
He played his marketing genius again, having salespeople get acquainted with doctors with free samples, then setting up booths at major medical conferences and, of course, full-color advertisements for medical journals.
In the publicity of the public, Arthur first chose to "start" the majority of mothers, because the stable advertisement is "relieve pain, relieve stress", once the child is sick or where the discomfort, the most nervous must be the mother.
In fact, this is even more true for doctors, Arthur knows that every doctor will encounter patients who are anxious for various reasons, "Doctor, I have difficulty sleeping", "Doctor, my son has gone to the army", etc., and stability is to convince doctors and the public through repeated advertising, "This medicine can definitely calm patients down, although a small number of people will be a little addictive, but the drug is effective...", and finally add a sentence, "Just one pill can solve any difficult disease." ”
Arthur was once again a great success, surpassing oxytetracycline to become the first drug in the pharmaceutical industry to sell more than 100 million, and later the first to sell $1 billion.
It wasn't until the 1970s that people discovered that tranquility was addictive, and even in the street trade, roche, whose producer, Roche, was accused of not giving the drug its proper warnings about its addictiveness.
Since then, Arthur Sackler has become the world's top collector, while continuing to fund medical education, founding the "Medical Tribune", attracting doctors' resources for his own use, while donating to museums and art galleries around the world, tying his name to famous paintings, masters, and schools, but his biggest "work" is still the use of direct sales and intensive advertising to promote the pharmaceutical advertising industry.
Arthur Sackler
In May 1987, arthur Sackler died of a heart attack at the age of 73, but his story did not end.
Nine years later, he became one of the first five candidates to be inducted into the Medical Advertising Hall of Fame, and Purdue Pharmaceuticals used the modern pharmaceutical advertising marketing strategy he left behind to launch a new opioid painkiller, OxyContin.
"Not addictive"
Before the protagonist OxyContin appears, let's talk about the origin of opioids.
The history of human cultivation of the poppy can be traced back to the formation of agricultural civilization in the Two Rivers Valley, when the Assyrians living in West Asia invented the method of cutting the poppy to extract opium juice, and the Hieroglyphs used by the Sumerians to represent the poppy translated as "happy grass".
The ancient Egyptian city of Thebes, once the center of poppy production, where people made opium into medicine, and later through the hands of Arab merchants, the medicine spread all over the world, in addition to alleviating pain and sorrow, people also found its deadly toxicity.
At the beginning of the 19th century, the German pharmacist Frederick Setuna isolated a hypnotic component from opium that could act directly on the central nervous system and change the body's feelings about pain, and he named morphine after Morpheus, the god of dreams and sleep in Greek mythology, which was more effective in suppressing pain than opium smoking.
Throughout the 19th century, more than 300 wars broke out around the world, leaving tens of thousands of wounded morphine-addicted soldiers in the American Civil War alone, as well as poppy plantations throughout the states.
In 1853, the Scottish physician Alexander Wood invented the subcutaneous syringe needle, which greatly improved the accuracy of the dosage.
Many doctors, including Wood, believe that needles eliminate patients' desire to take medication, but Wood's wife proved this theory untenable, and she herself became the first person on record to die from an overdose of opioids.
After the advent of morphine, fewer people smoked opium, sales of patented drugs containing morphine began to soar, and doctors everywhere were looking for so-called "non-addictive" morphine.
In 1874, the British physician Alder Wright heated morphine and acetic anhydride to obtain diacetylmorphine. After being injected into the small white rabbit in the trial, there were signs of panic, thirst, dilated pupils, a lot of saliva and vomiting, accompanied by symptoms such as a weakened heartbeat, and Wright stopped studying.
In 1897, Dreiser, a chemist at Bayer Laboratory in Germany, synthesized diacetylmorphine again, and after human testing, Bayer's staff described themselves as having a "heroic" feeling, so they named it "heroic" in German, which is transliterated as "heroin".
Yes, heroin, which today sells 50 grams, can be sentenced to death, which was initially considered non-addictive and sold as a pill to treat cough.
Bayer advertising
At that time, tuberculosis was becoming more and more popular, and doctors did not have any specific drugs in their hands, so Bayer's advertising slogan for heroin was "non-addictive oral cough suppressants".
However, the number of cases of addiction is increasing, public opinion is boiling, the government legislates to control opioids, arrest the doctors who prescribe opioids to addicts, and soon, no one dares to try the law, heroin has become a "commodity" for the mafia to make huge profits, and has spawned outlaw drug lords in Mexico, Colombia and other places.
After the end of the heroin medical story, American doctors have spent decades overcorrecting painkillers, and even if they encounter patients who are deeply suffering from pain, they will not easily take opioids, and addicts are shaped by social culture as outliers.
Pain or addiction
In the 1970s, Sanders, a British nurse, opened a hospice hospital. In her daily work, Sanders was exposed to a large number of patients who were tortured to death by pain, and she began to think about this question:
"The patient's personality cannot be destroyed in order not to become addicted, and if the person is dying, isn't it more important to let him go away with dignity than to prevent addiction?"
In her hospice hospital, patients with advanced cancer had access to opioid treatment, whether they felt pain or not, and Sanders was knighted by the Queen.
Sanders' explorations have influenced the medical community's perception of pain, with the World Health Organization publishing a book that explains the steps of pain treatment in more than 20 languages and claims that getting rid of pain is a fundamental human right.
In 1972, Rappel Pharmaceuticals, a subsidiary of Purdue Pharmaceuticals, developed a timed, sustained-release morphine pill that was used to treat dying diseases.
In 1984, on the basis of NAPP, Purdue Pharmaceuticals released morphine extended-release tablets meschcontin, which is mainly used in cancer patients and postoperative patients.
Advances in medicine have prolonged the lives of cancer patients, who endure the pain of treatment during these months to years of survival, and Mestrondine is a "new drug" in response to sanders and WHO's call.
One day in 1989, Salt Lake City's Holy Cross Hospital underwent a lung surgery with a patient named Dorothy. During the surgery, doctors inserted an epidural catheter into Dorothy's back and continued to inject small doses of opioid painkillers, which had previously been used in pregnant women during childbirth.
After the operation, Dorothy's performance shocked the doctors, she was not at all as weak as the typical postoperative patient, but stood up and raised her hand to ask for a cup of coffee, when all the doctors and nurses were watching her drink coffee, "no nausea, consciousness is also very clear." ”
This surgery is arguably a milestone event in pain management in the United States, where opioids are no longer seen as a flood beast, and through innovations by pharmaceutical companies, timed-release drugs can continue to relieve pain.
Doctors no longer have to bear great psychological pressure when dealing with patients with advanced or postoperative disease, and what they can provide has changed from comfort to real "hope".
Since then, the medical community's view of opioids has been reversed again: "Since opioids can be prescribed to patients with advanced cancer, they can also treat patients who are deeply affected by chronic pain." ”
In the late 1980s, the medical journal Pain published a famous paper called "Declaration of Independence for Opioids for Chronic Pain."
"Through a survey of 38 cancer patients who used opioid painkillers, only two had addiction problems, and they all had drug experience," the paper said. As a result, not every patient who takes opioid painkillers becomes addictive. ”
The paper sparked the anger of some doctors who were taught to:
"It is absolutely not necessary to overdose the drug, to prescribe the smallest dose of medicine to the patient within the longest course of treatment, and not to make the patient addicted to the drug."
On the other hand, the authors of the paper are also regarded by some people as fighters for the righteous voices of patients and pioneers in breaking the anti-drug dogma, and they refute the opponents with living cases:
"What do you do with arthritis, a non-alcoholic grandmother, a tattooed big brother who smokes marijuana, a construction worker with a family of old and a young man — ordinary people who are tormented by chronic grief need opioids?"
In 1990, the American Society of Pain Management and Nursing was founded, and the society's slogan was that "pain is the fifth vital sign", which immediately received a response from the U.S. Veterans Health Administration, which set pain as the fifth measure of patient health after pulse, blood pressure, body temperature, and breathing.
The Joint Council on Accreditation of Healthcare Institutions in the United States also acknowledged this determination, in which the California Pharmaceutical Society assured its members that "studies indicate that opioids are used correctly and the likelihood of abuse is extremely low." ”
Addictive dosage
After more than two decades of "game" between pain and addiction, Purdue Pharmaceuticals launched the analgesic OxyContin in 1996.
The drug contains only one drug ingredient: oxycodone, derived from the synthesis of opioid derivatives of tibaine, which is similar in molecular structure to heroin and surpasses meschcontin released in 1984 in dose.
OxyContin contains high doses of oxycodone, generally 40 and 80 mg, combined with sustained-release formulations, delivered to the body within a few hours, and has a significant effect on patients with pain.
The company that promotes OxyContin is the birthplace of Purdue's pharmaceutical bosses, the McAdams Pharmaceutical Advertising Agency. Unlike other painkillers that need to be taken every two hours by staring at the clock, OxyContin's main selling point is: "Two capsules a day to help you get back to a normal life." ”
When sent to the U.S. Food and Drug Administration, the FDA, the previous year, Dr. Curtis, the FDA director in charge of the review, gave this opinion:
"OxyContin is likely to have the side effects of addiction, but it has the benefit of reducing the number of pills that patients must take every day, and care should be taken to limit competitive promotional practices."
After leaving the FDA, Dr. Curtis joined Purdue Pharmaceuticals.
In 1995, the FDA approved OxyContin in 10, 20, and 40 mg doses, followed by 80 and 160 mg, and the FDA approved such a high dose of oxycodone drugs on the grounds that "by reducing the sharp increase in pleasure, OxyContin is not so addictive." ”
Looking at manufacturers of Class II regulated drugs nationwide, only OxyContin is allowed to attach such labels on the outer packaging, "sustained-release formulations, delayed absorption, and less likely to be abused than other oxycodone drugs."
This label has become the basis for the hype of OxyContin's marketing, and more ironically, the label with a warning effect also "reveals" the method of abuse to addicts, which prompts patients in the instructions, "Do not crush the tablets, otherwise it will release potentially toxic drugs." ”
Moreover, the FDA did not realize in the review that OxyContin dissolved in water for injection, which became a "way to take" addicts.
At a fair held by Purdue Pharmaceuticals, they asked salespeople to highlight the safety of OxyContin, and a former sales manager of Purdue said:
"They told me that the drug was almost non-addictive and told the doctor that it was proven by research, but there was no need to show it to them." If you had to describe the risk of drug addiction, "the correct answer is less than 1%."
In this way, OxyContin has become a "gospel" for 30 to 40 million patients with back pain in the United States. In addition to normal uses, it has become a "drug currency" for underground trade, with doctors in small clinics "getting rich", addicted patients exchanging it for money, and drug dealers making it a bridge between normal patients and drug addicts, "first Oxycontin, then heroin." ”
Since OxyContin went public in 1996, more than 7 million Americans have become addicted after use, and more than 200,000 have died from overdoses, resulting in an average of 130 deaths per day. It has been said that "every grain of OxyContin is stained with the blood of the patient".
Victims of the drug have filed lawsuits against Purdue Pharmaceuticals, totaling more than 2,600 cases.
Purdue approached a judge who was willing to help and passed a $4.5 billion bankruptcy settlement in an attempt to exonerate himself. But last year, the agreement was overturned by a federal judge for the Southern District of New York, "the Bankruptcy Code does not authorize such non-debtor immunity without mutual consent."
What Purdue and Sackler face is likely to be $2.2 trillion — a sky-high compensation of 9 percent of U.S. GDP last year.
But no amount of money can bring the lives that have passed back to life.
An American doctor said to people who are addicted to drugs: "We can't go to college without "smart drugs"; we can't fit without testosterone; we can't maintain intimacy without Viagra. Now, forget about that, you're your own medicine.
END
Some references:
1. Dream Addiction: The Truth About the Opioid Epidemic in the United States, By Sam Quinos, Shanghai Translation Publishing House
2、The Family That Built an Empire of Pain,Patrick Radden Keefe, Newyorker
3、U.S. states seek $2.2 trillion from OxyContin maker Purdue Pharma: filings,Mike Spector,Reuters