The Weekly Reflektion 36/2026

Watching for signals and acting on what they are telling us has been a theme in many of our Reflections. There are many reasons for ignoring signals and failing to act. The greatest of these is when the signals tell you something that you don’t want to know and in particular if this something is likely to affect financial performance and the bottom line.

What do you do when you hear something you don’t really want to know about?

In our Reflektion in week 35/2026 we used the story of the fire at Napp Technologies and a quote from Raymond Sackler to emphasize the importance of personal responsibility. This week we will turn to the painkiller OxyContin and this time it is the son, Richard Sackler, that plays a key role.

OxyContin was introduced by Purdue Pharma in 1996. It contained oxycodone, a powerful opioid painkiller, in a controlled-release tablet designed to provide pain relief for approximately 12 hours. For many patients suffering severe or chronic pain, OxyContinprovided substantial and sometimes life-changing relief. Many people working for Purdue could therefore reasonably believe that they were helping patients and improving lives.

There was, however, a serious danger. Oxycodone is addictive, and the controlled-release mechanism could be defeated by crushing the tablet. The drug could then be swallowed, snorted or injected, allowing a large dose to be absorbed rapidly. U.S. Food and Drug Administration (FDA), the federal agency responsible for regulating the safety and effectiveness of medicines, initially believed that the slow-release formulation would reduce its abuse potential.

Purdue aggressively promoted OxyContin and communicated the message that addiction among properly treated patients was uncommon. Promotional material even claimed that opioid addiction occurred in less than one percent of patients, a claim the FDA later said had not been substantiated.

By 1999–2000, treatment centers, emergency departments, communities and law-enforcement agencies were reporting OxyContin addiction, and deaths. Some geographical areas showed extraordinary growth in prescriptions. Increasing sales could be interpreted as evidence of a demand for pain treatment that had previously not been met. But they could also indicate something much more worrying, abuse and. The FDA later ordered Purdue to display stronger warnings on the drug packaging as evidence of addiction, misuse and abuse accumulated.

Purdue possessed detailed prescribing information that it routinely used for marketing. Information that indicated addiction trends were increasing was deliberately suppressed, and company representatives were told not to write and distribute any negative reports. Richard Sackler, who became Purdue’s president in 1999, was an important figure in the company’s promotion and commercial development of OxyContin and he refused to accept the evidence of the addiction trends. The enormous financial success of the drug created an obvious potential conflict. Information questioning its safety also threatened the company’s most important product. By 2001 OxyContin generated more than $1 billion annually and accounted for around 90% of Purdue’s prescription sales.

Organisations normally have good people who believe in what they are doing. Operations may have functioned successfully for years. Production may be increasing and financial performance may be excellent. Yet amongst that apparent success there may be signals that things are not as they should be. We must actively search for information that challenges what we already believe. When signals contradict our preferred explanation, we should investigate them rather than explain them away. 

In his book, ‘Empire of Pain’, Patrick Radden Keefe tells the story of OxyContin. He quotes letters to Purdue Pharma from people that thanked them for the life changing benefits of OxyContin for chronic pain. Then he quotes the letters from distraught parents that tell of the death of their children from OxyContin abuse. Two powerful signals, however both need to be addressed, not just the one that suits.