While antibiotic resistance was a popular story in the media in 2015, it paled in comparison to interest in the opioid epidemic. The federal government released yet another study. The news was grim. Opioid prescription rates were triple the number dispensed in 1999.1 Enough Oxy had been prescribed that year to medicate every American for nearly a month.2 It had killed more people than had fatal car crashes and guns combined (52,000). The lethal overdoses from Purdue’s blockbuster surpassed the peak year of HIV/AIDS deaths (1995). Statisticians blamed OxyContin for the first decline in more than twenty years in the life expectancy of Americans.3 A report from the CDC confirmed what some doctors had suspected: prescription opioid users were forty times more likely to become heroin addicts, making meds like Oxy the most effective gateway drugs into heroin. The Veterans Administration released a report that highlighted the danger of higher dosing. It sampled five years of chronic pain patients on OxyContin and found that those who died of an opioid overdose took on average 60 mg daily. There were few deaths for patients on 30 mg a day.4
The escalating epidemic prompted the CDC to urge doctors either to “carefully justify” or “avoid” prescribing more than 60 mg daily. Still, the guidelines were voluntary. Only seven states had passed legislation to limit the duration and number of prescriptions.5 That was the same year the author learned that a party took place at Purdue’s Stamford headquarters to celebrate a national survey released by Johns Hopkins. It revealed the extent to which Purdue’s different messages had caused confusion among primary care physicians, the country’s top prescribers of opioids. Nearly half erroneously believed that Purdue’s tamper-resistant pill was less likely to cause addiction than standard formulations from its rivals.6
In 2016, OxyContin and the opioid epidemic had become a topic on the presidential campaign. More than 200,000 Americans had died of opioid overdoses since the government began collecting statistics in 1999.7 Purdue felt pressured again. Although OxyContin sales had fallen 40 percent since their 2012 peak, it was the brand name the public associated with the crisis. The Joint Commission, responsible for accrediting hospitals and clinics, reversed its 2001 position and declared that it “does not endorse pain as a vital sign.”8 Purdue thought it was only a matter of time before its painkiller came under stricter FDA regulation. As a result, it executed a contingency plan to expand aggressively overseas. The Sacklers used their Mundipharma network. Arthur, Mortimer, and Raymond had established a single Mundipharma Limited in London in August 1955. By 2016, through licensing agreements, distribution deals, and family ownership stakes sometimes hidden in offshore tax havens, Mundipharma consisted of ninety-seven companies operating in more than one hundred countries. Richard Sackler admitted in a 2015 deposition that the Sackler family owned Mundipharma.
The OxyContin expansion strategy concentrated on countries where opioids were underused. China, Brazil, and India were at the top of Purdue’s list. The plan was to launch a slightly modified version of the same aggressive campaign as the company had in the 1990s in the U.S. The core message again was that the “silent epidemic of pain” was undertreated. As Purdue had done in the U.S., Mundipharma hired leading industry lobbyists in each country. It proved “very good at co-opting regulators,” said Stanford’s Keith Humphreys, who is familiar with Mundipharma’s growth.9 There is evidence of its success. In the past three years, OxyContin sales are higher by up to 700 percent in half a dozen European and South Asian countries. Mundipharma was ranked as one of the fastest-growing pharmaceutical firms in Brazil’s pain market.10
When the Los Angeles Times brought the Mundipharma expansion to the attention of former FDA commissioner David Kessler, he immediately recognized Purdue’s strategy. “It’s right out of the Big Tobacco playbook. As the United States takes steps to limit sales here, the company goes abroad.”11
In 2017, top public health experts at ten universities gave forecasts about opioid deaths in the coming decade. The grim consensus was “it will get worse before it gets better.”12 The most dire scenario was that as many as an additional 650,000 Americans will die by 2027, more than the entire population of Boston and almost as many Americans as would die from prostate and breast cancer over the same time.13
The Sackler-family directors had launched a belated effort to burnish their reputation and that of Purdue. December 2017 marked the start of the company’s national ad campaign in which it endorsed the CDC guidelines for safe opioid prescribing. In January, it announced an initiative to put pill disposal boxes in pharmacies and health clinics, began a radio campaign to warn of the dangers of abusing opioid painkillers, rolled out a training program to provide EMS workers with supplies of an overdose antidote (naloxone), and introduced a new medication to combat the common opioid side effect of constipation.14 In February, not long after forty-one state attorneys general had subpoenaed more internal Purdue marketing and promotion documents, the company announced its intent to slash its sales force by half. And it would no longer directly market Oxy to individual physicians, instead concentrating on hospitals and clinics. Industry analysts noted that Purdue had softened its long-standing message that “we’re not the drivers of the problem, the addicts are the drivers of the problem.”15
The financial press reported Purdue was also attempting to wean itself from its addiction to OxyContin revenues and profits. At its peak in 2012, the drug accounted for 94 percent of the company’s sales. As of 2018, it was still 84 percent. The Sacklers were looking for alliances with drug firms specializing in oncology and sleep meds.16
In March 2018, the national focus returned to the lethal fallout from Purdue’s star drug. President Trump announced the outlines of a new push to resolve the opioid crisis as “a public health emergency.” There were 115 overdose deaths daily.17 Congress had by then passed more than sixty short-term fixes during the past decade. Although throwing more money at the problem has never worked, it evidently allowed politicians to demonstrate that if they were not ending the crisis, they were at least studying and talking about it a lot.
At the same time that American politicians were wondering what to do about its “public health emergency,” British politicians were embarrassed by revelations that the Sacklers had not only run their foreign OxyContin operations from the U.K., but had taken advantage of a loophole to avoid paying $1.4 billion in taxes over twenty-five years (it stopped in 2016 after the law changed). Napp Pharmaceuticals, founded by Arthur, Mortimer, and Raymond in 1966, was the manufacturer for the OxyContin shipped to most countries other than the United States. Together with Mundipharma, Sackler-manufactured OxyContin accounts for 70 percent of the drug used in Britain. Under the scheme, Napp produced the OxyContin and then “sold” it at cost to Mundipharma in Bermuda. Bermuda Mundi then “sold” it for distribution to other Mundipharma companies worldwide. On paper, all the profit was earned in Bermuda and that is where it stayed. Bermuda-based companies do not pay taxes on income from sales.
But Napp never shipped the OxyContin to Bermuda. All the transfers and sales were phantom ones that existed only on paper.18
Adding to the outrage in the U.K., by crafting the elaborate arrangement, Mortimer avoided paying millions in personal income, capital gains, and inheritance taxes on his international holdings. He contended he was not “domiciled in the UK,” despite having been a resident there for thirty-six years before his 2010 death. His British third wife and the couple’s three British-born children were raised in the U.K. (the tax domicile rules were changed as a result of the outrage over how Mortimer had worked the system).I19
A month after those disclosures in Britain, seven members of the Sackler family resigned as Napp Pharmaceuticals directors. None made any public comment. Napp issued a statement that said: “As part of ongoing and regular operational reviews, changes have been made to Napp’s board of directors.”
In 2019, the momentum picked up against the Sacklers in the U.S. Purdue was in the crosshairs of angry patients, dozens of the country’s best class action attorneys, almost all state attorneys general, and Justice Department prosecutors.20 More than two thousand civil lawsuits filed by cities and counties had been consolidated under the jurisdiction of a federal district judge in Ohio.21
In March, the Massachusetts attorney general filed an amended complaint different from all others.22 It was the first to rely on Purdue’s own records to charge that the Sackler-family directors had personally “created the epidemic and profited from it through a web of illegal deceit.”23 The complaint named eight Sacklers who had served on Purdue’s board as defendants. They were the widows of Raymond and Mortimer, along with five of their children and one grandchild.24
“Eight people in a single family made the choices that caused much of the opioid epidemic. The Sackler family owns Purdue, and they always held a majority of the seats on its Board. Because they controlled their own privately held drug company, the Sacklers had the power to decide how addictive narcotics were sold. They hired hundreds of workers to carry out their wishes, and they fired those who didn’t sell enough drugs. They got more patients on opioids, at higher doses, for longer, than ever before. They paid themselves billions of dollars. They are responsible for addiction, overdose, and death that damaged millions of lives. They should be held accountable now.”
A few weeks after the Massachusetts complaint, the New York attorney general not only named the Sackler-family directors as defendants, but she was the first to contend they had transferred hundreds of millions in assets to offshore tax havens (a billion dollars through Swiss bank accounts). New York, according to the complaint, “wants to claw back some of the profits earned by the family over the decades.”25
Through their lawyers, the Sacklers named as defendants vehemently denied the charges and vowed an aggressive defense. They were no longer only battling lawsuits seeking tens of billions in damages. The Sacklers were now trying to salvage the family’s public reputation. Although they had been well known inside the pharmaceutical industry and the worlds of art and philanthropy, it was mostly in the wake of the 2019 lawsuits naming them individually that they became familiar to millions of Americans who had never taken an OxyContin pill and never heard of Purdue. The opening night when New York’s A-list paid tribute to the Sacklers at the Metropolitan Museum’s Temple of Dendur seemed a long-forgotten memory as the family’s role in the opioid epidemic attracted episodes on 60 Minutes and PBS’s Frontline and investigations by The New York Times, Boston Globe, and Los Angeles Times.
Gossip columnists reported that New York society shunned the Sacklers. Purdue’s banker, JPMorgan Chase, declined to do business with the company and some of the family. Hildene Capital Management cut ties with them.
It had seemed hyperbole when an unnamed plaintiff’s lawyer told Britain’s Guardian in December 2018 that the Sacklers were “essentially a crime family… drug dealers in nice suits and dresses.”26 In 2019, however, such a statement was longer mere litigation posturing. John Coffee, Columbia University Law School’s director of its Center on Corporate Governance, had been retained by Utah’s Division of Consumer Protection. It wanted his opinion as to whether Richard Sackler, and his cousin Kathe, could be held civilly or criminally responsible for how they ran Purdue. Coffee’s sixty-one-page report, submitted in July and initially sealed by the court, concluded that “the Sackler-family dominated club… is dysfunctional corporate governance, and there is little to distinguish the control the Sacklers exercised over Purdue from the control that the Godfather held over his Mafia family.”27
Not even the family’s legendary art philanthropy was safe. Some of Arthur’s family tried protecting his legacy from the backlash over OxyContin, a drug that went on sale nine years after his death.“The opioid epidemic is a national crisis and Purdue Pharma’s role in it is morally abhorrent to me,” Elizabeth, his second daughter, said in a statement sent to an art magazine. Herself a noted art and culture philanthropist, she drew distance from her cousins who had served as Purdue directors. “None of his [Arthur’s] descendants have ever owned a share of Purdue stock nor benefitted in any way from it or the sale of OxyContin.”28 Jillian, Arthur’s third wife, wrote an op-ed in the Washington Post, in which she said Arthur had “been found guilty by association—along with the rest of what is referred to by the blanket designation ‘the Sackler family’—because of some family members’ association with Purdue Pharma, the maker of OxyContin.”29 II 30 But the tsunami of anger over the contrast between the accumulating body count and the billions in profits reaped by the Sacklers spared no one.31 Some institutions that had received millions in Sackler bequests distanced themselves from the family. Public petitions with tens of thousands of signatures submitted to Harvard and Tufts asked the schools to remove the Sackler name, which Tufts announced it would do. Oregon’s Senator Jeff Merkley requested their name be eliminated from the Smithsonian, where Arthur’s art collection is on permanent display.
Photographer Nan Goldin, herself in recovery from an OxyContin addiction, organized widely publicized demonstrations to force Sackler-funded institutions to stop accepting any more of their money. Elizabeth Sackler supported her.32 It has worked in some instances. London’s Tate and New York’s Guggenheim announced they would no longer accept Sackler bequests. Britain’s National Portrait Gallery canceled a planned $1.3 million gift from the Sackler Trust. A small museum in South London returned a donation. The biggest blow was when the Metropolitan Museum joined the “no more Sackler money” contingent, although the Met, for the time being, says it has no plans for renaming the Sackler Wing that houses the Temple of Dendur.
In an effort to reverse the bad press, in March 2019, a couple of days after the New York attorney general had filed the complaint seeking to claw back the family’s early profits, Purdue announced it had reached a settlement with the Oklahoma attorney general in a case that had been scheduled to be the first to trial by early summer. Purdue agreed to pay $270 million. Although no Sacklers were named in that case, the family announced it made a $75 million “goodwill” contribution to Oklahoma State University’s Center for Wellness and Recovery.33 III 34
It was a gesture that for most Americans, especially the relatives of those who died from OxyContin, seemed calculated and far too little too late. The Sacklers had bought their way out of the 2007 federal prosecution. The Oklahoma settlement spurred speculation that the family had developed another escape strategy. Some legal experts thought Purdue was preparing to settle a few major lawsuits before declaring bankruptcy. Others said that given the legal hurdles involved in suing corporate directors, the family might be able to protect a significant part of its personal fortune. The idea that the Sacklers were trying to shield their OxyContin wealth got momentum with news that some family members had sold their New York homes for large estates in Florida, a state where homesteading laws protect all residences from creditors.35
Richard Sackler’s son, David, was the president of an LLC that bought a West Palm Beach office building for $6.8 million and was about to spend $7.4 million on a Boca Raton mansion.36 Those Florida purchases were not known when David tried to soften the family’s image in a summer Vanity Fair interview.37 He said his four-year-old had returned from nursery school one day and asked, “Why are my friends telling me that our family’s work is killing people?” According to Sackler, he and his relatives were tired of “vitriolic hyperbole” and “endless castigation.”38 Instead of putting a human face on the Sacklers the interview added to the growing anger against them. The Daily Mail headline was typical: “Heir to $13B OxyContin Fortune Says Son, 4, Asked if Family Kills People, Rejects Blame for Opioid Crisis and Plays Victim in Interview.”39
One of the themes David Sackler pressed was Purdue’s long-standing claim that OxyContin had such a small share of all prescription opioids that it was impossible for it to have been primarily responsible for the opioid crisis. Oxy is, Sackler said, a “tiny, niche little product with tiny market share.” On Purdue’s website, a page titled “Common Myths About OxyContin” listed its “small percentage of the total opioid market.” A DEA report unsealed during the summer seemed to bolster the assertion; Purdue had only 3.3 percent of the prescription opioid market from 2006 to 2012. Those measurements include, however, instant release opioid painkillers, most of which are available as inexpensive generics. The instant release opioids account for 90 percent of all sales. The remaining 10 percent for extended release opiates accounts for 60 percent of all revenues ($25.4 billion in 2018). Oxycodone dominates that segment. Moreover, the studies on market share do not consider potency. A September 2019 ProPublica analysis revealed that based on the amount of oxycodone sold, Purdue had 16 percent of the market, the third-largest opioid seller in the U.S.40
If the Sacklers believed a single interview might help stem the tide of public anger, they misjudged the power of the case presented by dozens of state attorneys general. Those complaints rely on Purdue’s files to persuasively argue that its wrongdoing was not a few isolated instances that could be ascribed to the unauthorized behavior of some errant executives. The 51 million pages of documents Purdue has produced in response to subpoenas detail a course of conduct likely to result in civil racketeering and fraud charges against former executives and possibly even some Sackler-family directors.41
In September 2019, an insider to the negotiations between Purdue and a couple of dozen lead plaintiffs leaked the outline of an offer the Sacklers had made and that they valued between $10 billion and $12 billion.42 In exchange for ending all pending lawsuits, the Sacklers would pay $3 billion in cash and put Purdue into a structured bankruptcy.43 Court-appointed trustees would select a board of directors to run a for-profit Purdue as a public-benefit corporation.44 Overdose and addiction mitigation drugs in Purdue’s pipeline would be distributed free of charge to communities affected by the opioid epidemic.45
The lead plaintiffs were divided. The Massachusetts and New York attorneys general insisted the family pay more cash up front, about $4.5 billion. The Sacklers could manage that if they agreed to immediately sell their interests in Mundipharma.46 But the family resisted, claiming that if buyers knew Mundipharma had to be sold at a fire sale price, it would fetch less than half what it was worth a couple of years earlier.47
Not only did the Sacklers refuse to personally offer more than $3 billion cash, they insisted they pay it over seven years of installments. The largest contributions, more than half, would come in years five through seven.48 They wanted the same seven years to unload their Mundipharma stake.49
One thing evident despite all the argument over how much cash the family should pay was that the Sacklers would be left with upward of $4 billion of their OxyContin profits. That estimate of how much wealth the Sacklers would retain seemed low when, a few weeks later, court documents revealed that Purdue had paid the Sackler-family directors $12 to $13 billion in profits.50 “This apparent settlement is a slap in the face to everyone who has buried a loved one due to this family’s destruction and greed,” said Josh Shapiro, Pennsylvania’s attorney general. “It allows the Sackler family to walk away billionaires and admit no wrongdoing.”51
There was also considerable skepticism about the financial numbers and projections the Sacklers provided. Although the family had shown what auditors said were complete finances, veteran attorneys and investigators have had trouble getting an accurate accounting of the extent of Sackler ownership in Imbrium and Adlon Therapeutics, two limited partnerships launched by Purdue in early 2019. Both share the company’s Connecticut headquarters and are run by former Purdue executives. Adlon recently got FDA approval for an ADHD medication and Imbrium has signed a joint marketing deal with a Japanese drug company for an insomnia pill in the FDA approval pipeline.52 Besides U.S. holdings that are opaque to investigators, there are offshore trusts, holding companies, and limited partnerships in international tax havens. Many of the foreign OxyContin distributorships are wrapped in a series of contracts between shell companies based in Cypress, Bermuda, Switzerland, Singapore, and the Channel Islands. Whatever ownership stake the Sacklers might have is nearly impossible to determine given the corporate secrecy laws of those tax haven jurisdictions. Even the family’s nonpharmaceutical holdings are difficult to assess. Their stake in Cap 1 LLC, a closely held company that owns and manages ski resorts, is estimated to be worth close to $2 billion. Its balance sheets are not public, however.53
When Purdue’s Sackler-family directors had voted themselves four billion dollars in company profits from 2008 to 2016, the money was distributed to a dozen entities and trusts they controlled and then in many cases transferred to Swiss financial institutions.54 One frequently used company, Rosebay Medical, is listed in twenty countries, from Australia to Germany, as owning some Sackler medical firms.55 No one paid much attention to Rosebay’s U.S. address. It is run from an office in Oklahoma City, the same one that Arthur, Mortimer, and Raymond had used decades earlier as a mailing address for some of their drug companies (and the same address listed for David Sackler in 2018 when he spent $22 million to buy a Bel Air mansion).56 IV 57
The complex corporate chess game in which Arthur Sackler excelled has for decades become how the Sacklers arrange their finances. That byzantine structure is the reason for such great distrust among plaintiffs’ attorneys and victims’ relatives. Given how the Sacklers and Purdue lied over the marketing of OxyContin, few believe the figures the family’s lawyers and accountants rely on to account for $4 billion to $5 billion of purported value in the settlement.58 Two overdose and addiction mitigation drugs in Purdue’s pipeline, for instance, are estimated to be worth at least $4.4 billion over a decade.59 Nalmefene is an older drug that Purdue is modifying to a new version that counteracts opioid overdoses. The second drug is an over-the-counter naloxone nasal spray.60 The problem is that the FDA has not approved either. Although they are on a fast track, when they reach the market they will enter a competitive field dominated by Narcan and Teva’s recently approved generic nasal spray.61 The robust sales figures projected by the Purdue attorneys are anything but certain.
Maryland’s attorney general, Brian Frosh, dismisses the billions promised in the sales of drugs not even on the market as “vaporous. I have not seen a deal that would yield anywhere close to those types of returns.”62 Others are irritated that Purdue has crafted a way to use drugs that would mitigate the deadly effects of OxyContin as a way to finance a settlement. “This family started a national fire,” said New York attorney general Letitia James. “An arsonist should never be able to give advice on fire prevention.”63
There was another feature of the proposed settlement that caused significant consternation. Purdue would continue selling OxyContin. Although it would be a fraction of its former sales, and without the promotion that had made it America’s most abused drug, it is a sticking point. Since it is Purdue’s only commercially successful drug, its sales are needed to keep the public trust version of the company afloat until the two treatment drugs get FDA approval.64
The settlement offer from the Sacklers was high-stakes poker. The family’s attorneys had indicated they were likely to file a “free-fall” bankruptcy if the offer was not accepted. Without any agreement about the details of a reorganization, there would be far more extensive litigation as the plaintiffs battled over Purdue’s remnants. Some state attorneys general feared a free-fall filing might ultimately provide $1.2 billion for the states and cities, a tenth of the Sackler offer.65 The clock against which the parties negotiated was an October 21 trial date in an Ohio court for the so-called multidistrict litigation. It had been brought by cities and counties, hospitals, even Indian tribes, against Purdue and other manufacturers, as well as drug distributors and pharmacy chains.
On September 12, 2019, the executive committee representing the two thousand plaintiffs recommended accepting the Sackler offer. In addition to the $3 billion in cash, the Sacklers had agreed to put toward the settlement any amount over $3 billion when they eventually sold Mundipharma.66 Twenty-three states, four U.S. territories, and most of the cities and counties agreed. But the sharp divisions that had split the plaintiffs during the negotiation now came to a public head. California, New York, Pennsylvania, and twenty-four other states opposed the deal.
Purdue filed for bankruptcy protection on Sunday, September 15. It put all litigation against the company on hold. It made it unlikely that Purdue, with a rapidly shrinking balance sheet, will itself ever be on trial. The dissenting state’s attorneys instead will focus on pursuing Sackler-family directors. While the Sacklers had been willing to contribute financially to an overall settlement, they made it clear they would not admit any personal liability. Moreover, they would spend whatever is necessary of their considerable fortune to keep intact their perfect record of never having a civil judgment against any family member who served as a Purdue director. That standoff means those state investigations and resulting private civil lawsuits could take years.67
There is a widespread and understandable sentiment among the victims’ families that the company and the Sacklers must be punished. Purdue and OxyContin have deservedly become the public face for the near–quarter million victims. Still, no matter how severely they are ultimately held to account, few believe it will result in full justice in the opioid crisis. It will not answer questions about all those responsible for the deadly epidemic nor will it hold many of them liable. By putting the responsibility for the crisis so squarely on Purdue and the Sacklers, there is a risk others who played material roles in creating and feeding the epidemic may not pay a price. That is the hope among thousands of others, sales representatives and executives of rival pharma companies with their own opioid products, overprescribing doctors, FDA bureaucrats who did not want to restrict OxyContin, pharmacists who diverted prescriptions to the black market, and pain management experts who preached that opioids were not addictive when prescribed for pain.
A real solution will take much more than money and free treatment drug giveaways. Besides the human toll, cities and states have spent more than a trillion dollars since 2000, everything from the additional cost of health care to criminal justice, social services, and drug treatment, as well as lost productivity and earnings from those who died.68 Litigation alone cannot fix the problem. A multidisciplinary solution that focuses on education for patients and doctors, pain medicine alternatives, and addiction treatment can work but will require patience and commitment from policymakers.
Hopefully, the energy the government and the public have focused on Purdue and the Sacklers will not fade once they are held accountable. The cost has been too high for anyone to walk away unpunished from the trail of destruction left by prescription opioids.
I. In the 1980s, Mortimer had purchased the five-thousand-acre Rooksnest Estate outside London. It is where Theresa, his wife, lives today. The couple also had a grand flat in London. When British tax authorities tried proving that Rooksnest Estate was Mortimer’s main home, there was no evidence that he or any other Sackler owned it. The owners were instead five companies, three based in Bermuda. Some of the estate farming contracts are with a company in the Channel Islands (Beacon Co.). Earls Court Farm Limited, another Bermuda company, managed the property. The author found that a previous director on that board was Christopher Mitchell Benbow, the solicitor who was a director of Napp Pharmaceuticals and represented the Sacklers on most of the U.K. business ventures.
II. Since Arthur’s 1987 death, Jillian Sackler has become a Dame of the British Empire and was awarded the National Academy of Sciences’ “Einstein” Award in 2005. She carried on his philanthropy as the president of the Dame Jillian and Dr. Arthur M. Sackler Foundation for the Arts, Sciences and Humanities. In a February 2018 statement, she said, “Passing judgment on Arthur’s life’s work through the lens of the opioid crisis some 30 years after his death is a gross injustice.”
III. Teva Pharmaceuticals had also settled the Oklahoma suit before the trial. Johnson & Johnson, through its subsidiary Janssen, was the only company to go to trial. On August 26, 2019, when a judge ruled against J&J and ordered it to pay $572 million to the state, he relied on Oklahoma’s century-old public nuisance law. “The harm it [the opioid crisis] has wrought, and the threat it continues to pose to the health, safety and welfare of the State, make it the worst nuisance Oklahoma has ever known.” That law traditionally covered instances in which there was interference with the use of public property. Applying it to commercial activity was a first. Judges in Connecticut and North Dakota had earlier rejected public nuisance claims against opioid manufacturers.
IV. In Purdue’s 2007 $635 million guilty plea and settlement with the federal government, the Consent Agreement required the company to list all companies in which it had any ownership interests. It listed 215 entities. Only later did prosecutors realize that the Sacklers had omitted nearly two dozen firms that oversaw investments and property management for the family. Four months after the plea agreement, Rhodes Pharmaceuticals opened in Coventry, Rhode Island, and began producing painkillers based on oxycodone, morphine, and hydrocodone. It has become one of the largest manufacturers of off-patent, generic opioid painkillers. The Sacklers concealed their ownership stake of Rhodes. It came to light in 2015 when the FDA followed a patent assignment to Rhodes back to Purdue.