Dopesick

by Beth Macy

  For a town with a population of just eight thousand, Abingdon had also nurtured a surplus of lawyers over the years, who were able to walk from their historic homes to both the federal and the state courthouse, passing statues of Confederate soldiers and historical Daniel Boone markers along the way.

  The lawyers and coal-mine operators who lived here were more accustomed to fine dining and theater than rallies or protests. But in a steady rain that fell over the small mountain town, families who’d lost relatives to OxyContin converged on July 20, 2007, to speak their piece and to watch Udell, Friedman, and Goldenheim squirm in their federal courthouse seats.

  Barbara Van Rooyan had flown in from her home in California. She wore the same blue floral sundress and white sandals that she’d worn to her son’s celebration of life and carried a sign she’d made that read ONE PILL KILLS.

  Sister Beth Davies had driven in from Pennington Gap and marched, in her raincoat, with a sign of her own. It featured a picture of Ed Bisch’s ruddy-cheeked son, Eddie, in his prom tux.

  Van Zee had an out-of-state family commitment (his octogenarian father’s birthday) and couldn’t make it to Abingdon. But he left behind detailed notes for Sister Beth about everything from the sound system for the rally to bottled water for participants, plus talking points for follow-up letters to the editor.

  He and Sue Ella were now attending funerals weekly, many of them his former patients’, sometimes at a rate of two a day. He had even written a poem about one, titled “OxyContin,” published in Annals of Internal Medicine:

  It might have been easier

  If OxyContin swallowed the mountains,

  and took

  The promises of tens of thousands

  of young lives

  Slowly, like ever-encroaching kudzu.

  Instead,

  It engulfed us,

  Gently as napalm

  Would a school-yard.

  Mama said

  As hard as it was to bury Papa

  after the top fell

  in the mine up Caney Creek,

  it was harder yet

  to find Sis that morning

  cold and blue,

  with a needle stuck up her arm.

  Top of her class,

  with nothing but promise ahead

  until hi-jacked by

  the torment of needle and spoon.

  Ed Bisch and Lee Nuss had driven up together from her home in Florida, recycling the same signs they’d carried to the Orlando protest, only a little rumpled from the Caribe Royale sprinkler assault.

  It fell to Bisch to lead the parade of fifty grieving relatives from a small park to the courthouse. His sign read OXY KILL$ in big block letters.

  Nuss, a tiny redhead, was dwarfed by a larger-than-life photograph of her son, Randy, handsome and olive-skinned. It matched the giant magnet she’d plastered on her car—at the suggestion of her grief counselor—meant to warn other families wherever she drove: IN LOVE AND MEMORY OF RANDALL NUSS AND OTHERS.

  More than a decade later, as journalists and policy makers tried to pinpoint where and how the opioid crisis began, images from the rainy rally in Abingdon would get recycled in news accounts, the prescient parents marching with their signs, and next to them Sister Beth standing defiant, a look on her face that projected equal parts anger for what had happened and worry for what was coming next.

  The Purdue executives had flown in on a private jet from Connecticut the night before for the sentencing hearing, staying at the elegant, historic Martha Washington Inn, conveniently located next to the courthouse. To avoid the protesters, their attorneys had asked the judge for permission to enter the two-story courthouse by a back door.

  But Judge James Jones, a straight shooter with a booming voice, had watched his docket be overtaken by OxyContin-related crime.

  No, Judge Jones ordered, the executives would enter through the front door of the courthouse just like everyone else.

  Barry Meier stood off to the side, taking it all in. He’d been to Abingdon once before, in May, when Udell, Goldenheim, and Friedman made their first visit, to deliver their guilty pleas. Meier wanted to witness that occasion so badly that he’d arrived the night before, staying in a motel on the outskirts of Abingdon. And he wanted his appearance to be a surprise. He and a freelance photographer the New York Times hired from Roanoke would hide out near the front of the hotel, ducked between parked cars, staking out the executives.

  Meier had interviewed the men many times before in their corporate offices and on the phone, but he wanted to witness their Appalachian reckoning firsthand.

  It was his fifty-eighth birthday, and the veteran journalist could not have been happier with his gift.

  “Everything I’d written was now justified,” he told me.

  As he and the photographer stood up, Udell, Goldenheim, and Friedman seemed stunned to see them, Meier recalled. Goldenheim, the scientist, stared steely-eyed toward the camera while Udell and Friedman glanced quickly away.

  In a rally before the sentencing hearing, the parents took turns reading the names of the dead. Bisch had printed them out from his message board memorials, now so numerous that the document was more than fifty pages long. Their voices broke periodically as they choked out the names.

  Bobby Lee Ashcraft Jr., aged nineteen

  Paul Aboata, twenty-two

  Heather Marie Goslinowski, fifteen

  Nicole Notaro, nineteen

  They got through only ten pages before the hearing began.

  In a photograph that ran in the next day’s New York Times, two moms in matching rain scarves held each other, one clutching a poster of her seventeen-year-old daughter: IN LOVING MEMORY OF SARAH NICOLE. HER LIFE WAS A LIFE WORTH LIVING. Behind them stood Van Rooyan in her sundress—blue, for her son’s favorite color—holding her prepared remarks.

  Before the day was over, the executives would hear themselves described as corporate drug lords and marketing tricksters, on a par with Colombian cartels and P. T. Barnum. They would be asked to imagine themselves in the shoes of a parent of a college junior: “What if it was your son or daughter you saw in the morgue when we went there, and he was autopsied, sliced and diced?”

  The executives would have their integrity questioned and their futures threatened. “I will reach out to any organization that Mr. Friedman speaks to about having a member of his family survive the Holocaust, and contact that group and say to them that Friedman is no better than Adolf Hitler, who killed and destroyed countless lives; Hitler through death and torture, Friedman through death and addiction,” said Marianne Skolek, who lost her twenty-nine-year-old daughter, Jill. Skolek brought along her grandson, Brian, who was six years old when his mother died of an overdose of prescribed OxyContin in 2002.

  “Brian is here in the courtroom with me today because he needed to see that bad things do happen to bad people,” Skolek said.

  But not bad enough, the parents told the judge. The plea agreement called for no jail time, and many beseeched Judge Jones to reconsider incarceration for the three.

  “I think jail is too good for you guys,” said Lynn Locascio from Palm Harbor, Florida. Her son was still struggling with addiction, having been prescribed OxyContin after surgery resulting from a car accident. “I think you should go spend some time in a rehab facility like my son did and watch that. Maybe you’ll change your minds.”

  Lawyers for the executives argued that the shame of criminal charges was punishment enough. They reiterated, over and over, that the men—the top corporate executives who had directed the company’s legal, financial, and pharmaceutical divisions—had personally done nothing wrong. Representing Udell, attorney Mary Jo White called the company’s head lawyer “the moral compass of the company,” pointing out that Purdue, at Udell’s urging, had voluntarily taken the 160-milligram pill off the market after safety concerns became known. Udell had championed prescription monitoring programs when most others in the industry were opposed, and he was behind the
suspension of shipments of OxyContin to Mexico when it became clear Americans were traveling there to bring back the drug.

  Calling the case “a personal tragedy for Mr. Udell,” White said most people would wrongly equate the strict liability misdemeanor he pleaded guilty to with criminal wrongdoing. Jail time, she added, “would unjustifiably and needlessly compound the stigma and punishment for an offense and facts that are without personal wrongdoing.”

  Likewise, Goldenheim, the firm’s former chief scientist and medical director, was in “agony” about the charge, his lawyer said. He’d been labeled “a criminal, and that is horrendously harsh punishment for someone who has done so much good, and under the agreed statement of facts has done nothing wrong.”

  Friedman’s lawyer pointed out that the company distributed antidiversion brochures and antifraud prescription pads; created a law enforcement liaison unit within Purdue; funded local law enforcement programs; and, eventually, altered sales-representative compensation so the system would not lend itself to abuse. While other Purdue employees “made statements about OxyContin that were inconsistent with company policy and that should not have been made…Michael Friedman did not participate in that misconduct.” Without proof that he committed a criminal act, to jail him would be virtually unprecedented under American law, his lawyer said.

  In other words, the lawyers did exactly what Ramseyer predicted they would do in his remarks: They refused to take responsibility for the death and destruction caused by the drug—to the point of reiterating, again in court, that “the enormous benefits of OxyContin far outweigh its risks, even taking into account the grief from those we’ve heard about today.”

  Calling it “unprecedented” to hold pharmaceutical corporate officers criminally liable in such a case, Ramseyer noted that Udell, Friedman, and Goldenheim, in accepting the plea, were conceding that they had not been “powerless to prevent the crime. As corporate officers, these men had a duty to ensure that misbranding did not occur.” He predicted that Purdue’s next public-relations campaign would begin the moment he sat down from making his remarks: “They will attempt to minimize the crimes to which they pled guilty.”

  And while that is exactly what their lawyers did, Ramseyer later said the men seemed distressed throughout the proceedings. “They were very unhappy,” he told me. “We do cases in court where people get sentenced to twenty or thirty years in prison, and they didn’t seem as unhappy as those three guys.”

  Ramseyer remained loath to say much more about the case, although the fact that he’d been diagnosed with cancer while working on it—and had to take a break midway through the case for treatment—seemed to sear it in his mind as both a personal challenge and a professional high mark. He hoped the case had a chilling effect on pharmaceutical companies and overprescribing doctors alike, but he wasn’t sure. He’d read recently that enough opioid painkillers had been prescribed in 2010 to medicate every American adult around the clock for a month. “And it’s worse now,” he told me in 2016.

  The problem was so widespread that Super Bowl ads now targeted relievers of opioid-caused constipation. “Purdue had a laxative they marketed, too,” Ramseyer said, of Senokot. In fact, according to the rep-call notes subpoenaed for the case, OxyContin and Senokot were routinely recommended hand in hand. “So they got you on both ends!” Ramseyer said.

  Conspicuously absent from the courthouse drama was the family that owned the company and its 214 affiliates worldwide—and benefited the most from the drug’s sale. Purdue had earned over $2.8 billion from the drug by 2007, including $595 million in earnings in 2006 alone. Unlike a public company that answers to shareholders, privately held Purdue answered only to the Sacklers.

  In 2015, the family would earn its way onto Forbes’s “America’s Richest Families” list. With an estimated net worth of $14 billion, the OxyContin clan would edge out such storied families as the Busches, Mellons, and Rockefellers. Having gone from selling earwax remover and laxatives to the most lucrative drug in the world, the family had museum wings and college institutes named for it from Boston to Tel Aviv.

  Mortimer Sackler even had a pink climbing rose named after him, courtesy of his gardener wife. The official description of this flower, the Rosa Mortimer Sackler, reminded her of her husband, she said: “The blooms give the impression of delicacy and softness but are, in fact, very tough and little affected by bad weather.”

  Mortimer may have inherited his toughness from his older brother, Arthur, who’d put himself and his two brothers through medical school by selling student newspaper ads and delivering flowers, sometimes with holes in his shoes.

  The Don Draper of American pharmaceutical marketing, Arthur pioneered the idea of showering doctors with favors and funding experts to back drugmakers’ claims in the 1960s. It was his marketing genius that fueled the emergence of pills as a quick fix, his marketing prowess that delivered Valium and Librium, dubbed Mother’s Little Helper by the Rolling Stones, to countless nightstands.

  Realizing the importance of controlling his company’s message, Arthur had launched both a medical advertising agency and a medical newsmagazine before buying Purdue Frederick with his brothers. It was under his direction that preliminary and inevitably flawed scientific studies were first used to buttress the wonders of whatever drug he was hawking; no wonder his brothers thought nothing of excavating the flimsy and outdated letter heralding the “less than 1 percent” addiction rate nearly a decade after Arthur’s death.

  What in fact was the addiction rate among those prescribed opioids for chronic nonmalignant pain? More recent studies—not letters to the editor penned in 1980—put the figure as high as 56 percent. At the time of his death, in 1987, Arthur was lionized for his entrepreneurial vision and boundless obsession for collecting things. Especially art. He once talked the Met into letting him reimburse the museum for four major works that the museum already owned just so he could have them displayed with his name as the donor.

  Still, he had not been fully embraced by the Upper East Side society to which he aspired—not until his memorial service, held at the storied Temple of Dendur, inside the Met’s Sackler Wing, at which New York mayor Ed Koch remarked: “I don’t know why, but Jews aren’t buried in synagogues. Well, Arthur built his own temple.”

  Arthur Sackler hated not just bad press but any press that was not of his own directing, a Vanity Fair writer observed shortly after his death. As obsessive about secrecy as he was about moneymaking and art, he would have abhorred everything about the Abingdon hearing.

  At the courthouse, testifying before the judge, the relatives of the dead argued repeatedly for jail time. As did Public Citizen, a consumer advocacy group that vented: “Why have three wealthy Purdue executives, who have pleaded guilty to orchestrating this dangerous promotional campaign, escaped jail time, and why are they paying merely $34.5 million in penalties?” Even a fellow prosecutor in Brownlee’s office felt Purdue’s punishment was too light: “The dividends may go slightly down, but nobody cares because nobody who made the product goes to jail. If the government were serious, they’d put people in jail, and [others would be] fearful,” said Assistant U.S. Attorney Andrew Bassford, who would spend most of the next decade prosecuting heroin dealers as a direct consequence of the OxyContin epidemic, down the hall from the office where Brownlee worked. “But you can’t put a corporation in jail; you just take their money, and it’s not really their money anyway.

  “The corporation feels no pain.”

  Van Zee and Sister Beth viewed the settlement with both satisfaction and regret. Though the executives were placed on probation for three years and ordered to perform four hundred hours of community service in a drug abuse or drug treatment program, Van Zee and Sister Beth were furious that the Purdue fine would not be allocated to provide drug treatment in the medically underserved region. “This little county was left with nothing, even though we’ve been disproportionately impacted” by the drug, Sister Beth said.

  T
he $634.5 million fine was instead divided among law enforcement, state, and federal Medicaid programs (to reimburse it for claims resulting from the misbranding); to create Virginia’s Prescription Monitoring Program; and to settle $130 million in civil claims.

  The only thing the Lee County sheriff’s office got from Purdue was placebo OxyContin pills for use in drug stings.

  Many anti-opioid activists were mad, too, that technically it was Purdue Frederick, Purdue Pharma’s holding company, that was banned from participating in the federal insurance programs Medicaid, Medicare, and Tricare as part of its five-year probation—rather than Purdue Pharma itself, which was still permitted to participate, and therefore to continue selling OxyContin. (“They are independent, associated companies,” a spokesman explained.) The executives were likewise banned from doing business with federal health programs, a decision they repeatedly appealed in intervening years and lost, leading one federal district judge to scold: “Plaintiffs appear to misunderstand or misstate the basic elements of their conviction.”

  “It’s very typical for these companies to have an entity that is a shell company, basically, set up to plead guilty to the crime, rather than the actual corporate entity taking the fall,” Meier said.

  Flanked by state and federal flags, Judge Jones admitted that the lack of jail time frustrated him. But the Abingdon federal judge’s hands were tied by the plea agreement struck between Purdue and the prosecutors, he said. He would have preferred that parts of the fine be funneled into treatment, adding that prosecutors were reluctant to “direct treatment funds in a manner beyond their expertise and possibly contrary to national policy.”