On December 17th, The House Committee on Oversight and Reform, chaired by Rep. Carolyn B. Maloney held “Landmark Hearings with Sackler Family Members and the Purdue Pharma CEO on their Roles in Fueling Opioid Crisis.” The desire by the committee to spend the time and resources to hear the Sackler’s testimony in their effort to address the drug crisis is understandable. It is well established that Oxycontin, developed by Purdue in the 1990’s and subsequently aggressively marketed, contributed to many of the deaths and substance use disorders that have created one of the worst public health crises in United States’ history. The crisis, which has claimed more than 400,000 lives in the past two decades, continues to ravage communities and individuals. On the morning of the hearing, the CDC made public data that deaths by drug overdose are at an all time high. Personal testimonials by individuals whose lives were devastated by opioids, further highlighted the toll of the crisis. It is anticipated that the economic and social consequences of the COVID 19 pandemic will further increase substance use and “deaths of despair”.
Unlike the multiple congressional inquiries, legal actions, presidential commissions, and media coverage that shed light into the origins of the opioid epidemic and the role of Purdue, this hearing was billed as one of the few times members of the Sackler family testify in public under oath. Testifying at the virtual livestreamed meeting were family members and former board members Dr. Kathe Sackler, David Sackler, and Dr. Craig Landau President and CEO Purdue Pharma L.P. After the prepared questions by members, mostly seeking to get the witnesses to accept personal responsibility for the crisis, the hearing didn’t seem to get more clarity about the origins of the opioid crisis than was available after a similar committee meeting hearing in 2001 and reported in an excellent article in the 2001 NYtimes article The Alchemy of OxyContin. After over three hours of “withering comments and furious questions” of the witnesses, other than establishing in a bipartisan manner that the Sackler family is evil and a bad apple, and perhaps should face criminal accountability and forfeit all the billions of dollars they earned over the years, there is not much substance to help the committee address the increasing drug related overdoses and related “deaths of despair”. And certainly not as the invite to the hearing suggested, “inform future legislative efforts to address the substance use disorder epidemic in this country.” The role of other stakeholders and the social determinants and governmental dysfunction that play a part in the initiation of the crisis and its maintenance was seldom mentioned let alone explored. Neither was consideration for the responsibility of congress for governmental oversight and reform. Because the committee is well positioned within the political ecosystem to have a substantial impact on the federal, state and local response to the drug crisis and the underlying pathology that nourishes it, this is unfortunate.
If evidence of the hearing is any indication of the focus of the committee, it is unlikely to have much impact on the drug abuse crisis. There is another way forward for the committee. The committee can transcend the current polarization and other dysfunctions that have stymied meaningfully addressing the drug overdose crisis and the larger challenge of death of despair.
As the main investigative committee in The U.S. House of Representatives, with the authority to investigate "any matter within the jurisdiction of the other standing House Committees”, could succeed where many other congressional efforts had failed in their attempts to contribute to arresting the devastation caused by the opioid and related drug crisis. With its unique subpoena power and rules that allow the Chair of the Committee to waive or modify rules in order to facilitate cooperation, this committee is better positioned to succeed. The committee leadership has the ability to establish rules for the hearings. Furthermore, the change in the committee’s leadership bodes well for its potential to achieve the important role it should serve in our democracy and for which it was established.
In particular, the committee is the authorizing committee for the Office of National Drug Control Policy (ONDCP); a component of the Executive Office of the President tasked with reducing drug use and its consequences by leading and coordinating the development, implementation, and assessment of United States drug policy. In order to achieve the stated goals, the committee will need to transcend the polarization that has hampered more divisive topics they investigated. Current circumstances, including the political environment, the new committee leadership, the COVID 19 pandemic provide an opening to address the challenges associated with the drug crisis in a bipartisan collaborative manner.
Representative Maloney, and Representative James Comer, the ranking member on the committee are at the extreme opposite when it comes to issues such as abortion, guns and religion. Furthermore they represent districts at the opposite extremes of wealth and income and have been on the front lines of the partisan battles during the past congressional term. Mr. Comer, a relatively newcomer to congress, represents Kentucky’s 1st congressional district that is among the poorest in the nation with $13,500 per capita. Representative Maloney became chairperson of the committee after the death of Elijah Cummings in 2019 , representing New York’s 12 th congressional district that included NY City. The district has per capita income in excess of $75,000, one the highest among all congressional districts in the United States. Yet, both represent districts that regardless of being blue or red, rural or urban, rich or poor, have experienced drug overdoses and other manifestations of “deaths of despair”. Although diverse in their political beliefs and most of the interests of their constituencies, both appear committed to the success of the committee and its central role within the political system in serving the American people.
Representative Comer in his previous role in Kentucky, took on the DEA and collaborated with Democrats to take on corrupt members of his own party. Upon being selected by his colleagues he posted: “I believe our role should be to seek the truth and that's what I'm going to do as ranking member and I'm blessed to have a great committee — that's a committee filled with a lot of fighters and a lot of institutional knowledge.”
In order to achieve their mission, the committee’s leadership should consider obstacles to their work and the work of congress more generally. Perhaps as importantly, done well, and seeking a true understanding of the causes and maintenance of the crisis, the committee can actually initiate a process that leads to a reckoning as well as paving a way forward for this as well as other public health crises. Dr. Landau, an anesthesiologist by training concluded his written testimony by stating correctly that , “one prescription opioid manufacturer alone cannot end this public health crisis. Any meaningful solution must involve input from the full array of stakeholders, including public health officials, other manufacturers, health insurers, distributors, academics, regulators, legislators, law enforcement, the addiction and recovery community, physicians, pain patients, and advocates for people with the disease of addiction”.
The committee would do well to reach out to the relevant stakeholder and ask the questions that can inform actions they can take to meet their responsibility to the American people. Here are a few suggestions for questions of the Sackler’s and other Purdue employees :
Dr. Kathe Sackler, David Sackler, and Dr. Craig Landau, given the experience you have had over the past 3 decades within the pain- opioid ecosystem, what have you learned that can assist us in the following:
1. The process of approval of new drugs. In particular the vulnerability of the FDA in approval of the product. How should we better monitor and respond to post approval monitoring side effects and concerns?
2. Given powerful marketing expertise and experience, how would you build a system that provides education and training for health care clinicians and patients to achieve best outcomes for pain management and substance use disorders?
3. Having been successful in dealing with the DEA, and gaming its mandate by congress to track and control substances such as opioids, please give examples where you were able to overcome the DEA’s system and what would you recommend to allow the organization to function as intended in the legislation?
4. How can your support of non for profit organizations and citizen advocacy groups in order to impact regulation and acceptance of your products inform the committee? What is your understanding about direct to consumer advertising’s impact on patient and physician behavior, and how will you suggest we address it legislatively?
5. Having been the subject of multiple investigations, legal proceedings, interaction with the federal and state government agencies and lobbyists, what would be your recommendation for this committee to provide oversight and reform the government’s role in the substance use disorder and overdoses?
6. In 2002 you claimed that social conditions were responsible for the increase in opioid addiction and offered to provide scholarships to young people in vulnerable communities, given that drug overdoses including opioids continue to be a national crisis, what would you recommend to address the social determinants that are known to predispose to substance use, addition and overdose.
7. You developed the IMS system to track medications. What would you recommend to the DEA to track opioids and other controlled substances from manufacturing to patient use. How would you prevent diversion.
The House Committee on Oversight and Reform can rise to meet the challenging time in our American experiment. It is in a position to shed a light and more importantly help set a course to address the devastation of the drug crisis and more general Death of Despair”. The committee can start by building a process that invites stakeholders to answer questions at the core of the drug crisis. The committees focus on the Sacklers and maintaining the narrative that they are evil will not change the reality experienced by many Americans and contributes to substance use and death of despair. To have an impact on preventing the further escalation of the drug abuse crisis a different narrative and approach to the problem of is necessary. A narrative that recognizes the various stakeholders that actively and passively played and continue to play a part in this public health crisis. The committee and all of us need to recognize the powerful socio-economic forces shaping our communities in the post COVID 19 era. This in addition to examining the impact in the past 30 years of increasing globalization and financialization on communities around the nation. As leaders of the committee, congressperson Maloney and Romer, can transcend the toxic partisanship that has defined congress and contribute reestablishing congress’ role as the representative of the people.
In preparation for the hearing, Chairwoman Maloney issued a memo describing documents obtained by the Committee showing how members of the Sackler family used the OxyContin business to “stretch” Purdue’s financial targets and increase earnings. The documents also reveal how Sackler family members pressured Purdue executives to grow market share for OxyContin and other opioids, including by targeting high-volume prescribers and pushing higher strength doses.