The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth

by Sam Quinones

In 2009 Purdue hired McKinsey, the worldwide management consultant, to study how OxyContin sales might be rejuvenated. Purdue’s relationship with McKinsey dated to 2004 and would last until 2019. Through the years, McKinsey seemed to originate the idea that pushing doctors to prescribe more OxyContin and at higher doses was essential to Purdue’s profit. On Purdue’s board, Richard Sackler seemed the driving force behind this idea. He kept the pressure on, insisting that sales staff come up with tactics for “exceeding 2007 Rx numbers.” He wanted to know how sales staff would get patients to take higher doses and stay on opioids longer. How many patients had insurance reimbursement for unlimited quantities of Purdue opioids? How many were limited to sixty tablets per month? The records showed that limits on OxyContin’s use seemed to rankle him. When staff offered a plan to get pharmacies to increase their stocks of OxyContin from two bottles to three, Richard Sackler wanted to know why they couldn’t get four bottles or more. When Purdue staff noted reports of deaths due to OxyContin and a 2001 public meeting in which OxyContin was compared to heroin, Richard Sackler said that addicts and drug dealers were creating a problem, while “no one is speaking for the patients in pain.” Then in a confidential email, “We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.” “What else more can we do to energize the sale...