Capitalism’s Costly Prescription: The Opioid Epidemic

-Tanmayi P, SYBSc Economics

Source: Opioid Overdoses published June 7, 2017 by Jimmy Margulies courtesy of

How did one family’s ruthless ambition and greed lead to the death of over 500,000 Americans?

Enter the Sacklers—an immigrant family from Brooklyn—whose name has adorned the facades of cultural and educational institutes around the world. From The Guggenheim to Harvard University, the Sacklers have engaged in a swathe of philanthropy over the years, in efforts to deflect scrutiny of their role in the opioid crisis.

The family owns Purdue Pharma, a pharmaceutical company that makes the highly addictive opioid ‘OxyContin’. Approved by the FDA in 1995, this drug would soon trigger one of the worst health crises in history, claiming the lives of the ones addicted, and ravaging those of countless others. 

Before the introduction of OxyContin, pain management primarily focused on cancer and end-of-life care. Patients who suffered from chronic pain but did not have a terminal illness were excluded from long-term therapy with opioids, based on care providers’ fears of the risk of severe addiction (Melzack, 1990).

Though not much more efficient than the drugs prescribed at the time, OxyContin would witness a meteoric rise in popularity and use in the years to follow. By 2013, it represented approximately 30% of the opioid painkiller market—largely due to aggressive and misleading marketing tactics. Purdue’s marketing strategy led to the widespread acceptance and utilisation of highly addictive opioids for the treatment of moderate and chronic pain, across a broad spectrum of medical conditions. By 2003, nearly half of all physicians prescribing OxyContin were primary care physicians, marking a significant shift in prescribing patterns influenced by Purdue’s actions. 

In 2001, Purdue Pharma invested $200 million in marketing OxyContin, a move that led to sales exceeding $1.5 billion by 2002. By 2004, OxyContin had become the leading drug of abuse in the United States. In 1996, during its debut year on the market, OxyContin accounted for $45 million in sales for Purdue. By 2010, the profits from OxyContin skyrocketed to an astonishing $3.1 billion, marking a period of immense financial success for the company. In 2013, OxyContin claimed a staggering 30% share of the opioid painkiller market. However, this surge in sales was accompanied by a significant rise in abuse and addiction. 

In their efforts to maximise profits from OxyContin sales, the Sacklers were aided by McKinsey & Co, a Big 4 consulting firm with “narcotics expertise”. The firm’s involvement extended far beyond typical consulting services, as it utilised extensive data and proprietary tools to shape strategies for pharmaceutical companies. McKinsey advised on corporate strategies, developed tactics to deal with regulators, and even helped gain approval for new opioid products.

The most concerning aspect of McKinsey’s involvement was its contribution to the adoption of more aggressive sales strategies. The firm went as far as profiling and targeting physicians, with the intent of influencing their prescribing habits, a practice that federal officials later warned heightened the risk of overdose. When the government initiated a crackdown on opioid prescriptions due to the growing crisis, McKinsey adapted its tactics to maintain and even increase sales.

Unfortunately, extensive donations and strategic reputation laundering will only get you so far. 

As evidence of OxyContin’s lethal nature mounted, Purdue was subject to increasing public scrutiny. Several states filed lawsuits against the company alleging drug abuse, with the company finally pleading guilty to misrepresenting the addictive nature of OxyContin, in 2007. In the years since, almost all 50 states have sued Purdue for its role in getting a generation of Americans addicted to the notorious opioid. In May 2007, Purdue Pharma pleaded guilty to criminal charges regarding the misrepresentation of OxyContin’s addiction risks. The company was forced to pay $634 million in penalties, a mere fraction of the staggering, nearly $35 billion in sales accumulated over the last two decades.

McKinsey & Co agreed to a $230 million settlement to address lawsuits filed by numerous U.S. local governments and school districts, accusing the consulting firm of contributing to an opioid addiction epidemic through its work with Purdue Pharma and other pharmaceutical companies. 

The opioid epidemic is a chilling example of how the pursuit of financial gain within the healthcare industry can have devastating consequences, creating a ripple effect in society. The for-profit healthcare model often prioritises financial success over patient well-being, evident in the pharmaceutical industry’s aggressive marketing of opioid pain medications. Profits frequently take precedence over ethical considerations, leading to the promotion of prescription opioids for an ever-widening range of conditions. This profit-driven approach disregarded the risks of addiction and overdose, fostering a culture of over-prescription as pharmaceutical companies capitalised on the profitability of pain management.

The capitalist mindset in the pharmaceutical sector exacerbated the opioid crisis, promoting mass production and marketing of opioids and influencing healthcare providers’ prescribing habits. The relentless pursuit of financial gain led to frequent prescriptions of potent opioids for chronic and moderate pain, contributing to widespread misuse and addiction. This illustrates how the capitalist ethos can result in negative externalities, exacting a significant human toll.

The impact of pharmaceutical companies’ profit-driven strategies on policymakers and regulatory bodies is significant. With vast resources at their disposal, these corporations exerted substantial pressure and engaged in lobbying efforts to shape healthcare policies and regulations favourably. The consequence was a regulatory environment that inadequately safeguarded against the opioid crisis, prioritising economic interests over public health and safety.

From 1999 to 2021, almost 645,000 people in the United States lost their lives to opioid-related overdoses, encompassing both prescription and illicit opioids, as reported by the U.S. Centers for Disease Control and Prevention.  The for-profit healthcare model and the capitalist mindset, prioritising financial gain over public welfare, played pivotal roles in contributing to the widespread misuse of opioids, thereby perpetuating the epidemic.

As the opioid epidemic was worsening, the Sackler family had withdrawn more than 10 billion dollars from Purdue between 2008 and 2018, channelling it into offshore accounts and trusts, effectively shielding it from scrutiny by the American public. In 2015, Forbes estimated their collective family wealth at $14 billion. The immunity granted by the appeals court shields the Sacklers from civil suits, and the controversial $6 billion settlement exposes the complex interplay between wealth, legal protection, and the far-reaching impact of the opioid epidemic.

Despite attempts to distance themselves, the Sacklers and their destructive creation, OxyContin, remain inseparable. Driven by insatiable greed, they had created—an “Empire of Pain,” as aptly termed by Patrick Radden Keefe. Their legacy is one of unparalleled harm to America’s social fabric, marked by an immense human cost, which no amount of donations can erase.


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Radford, B. A. (2023, May 31). Sackler family wins immunity from opioid lawsuits. BBC News.

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