In June 2013, Tufts President Anthony Monaco traveled to Purdue Pharma’s headquarters in Stamford, Connecticut to personally give Raymond Sackler an honorary degree. In 1980, Dr. Sackler and his brothers Arthur and Mortimer donated the funds to establish the Sackler School of Graduate Biomedical Sciences, which is located on the Tufts Health Sciences campus in Boston’s Chinatown. The honorary degree Sackler received, Doctor of Humane Letters, is said to symbolize the university’s great respect for the recipient. Patrick Collins, Executive Director of Public Relations at Tufts, says Sackler was given the honorary degree “in recognition of his philanthropic vision and lifelong dedication to supporting interdisciplinary science.” This event was made more significant as Monaco made the trek to Purdue Pharma rather than awarding him the degree at the commencement ceremony in Medford. Purdue Pharma L.P. is a privately held pharmaceutical company that Raymond, along with his two brothers Arthur and Mortimer, created in 1991 after buying the company in 1951. In 1996, it became the site of the development of the prescription painkiller OxyContin. At the ceremony, Monaco praised Sackler’s “entrepreneurial spirit,” claiming that “it would be impossible to calculate how many lives [he has] saved.”

What can be calculated, however, are the lives devastatingly impacted by the opioid epidemic, which the Sacklers exploited for profit through Purdue Pharma’s marketing of the prescription painkiller OxyContin. According to the CDC, from 2000 to 2016, more than 600,000 people have died from drug overdoses, with majority of those deaths involving an opioid. On average, 115 Americans die every day from opioid overdoses, and prescription opioids play a big role in the epidemic. According to the National Institute of Drug Abuse, 21 to 29 percent of patients that are prescribed opioids for chronic pain misuse them. The opioid epidemic has become deadlier in recent years, with EMS opioid overdose calls in Massachusetts at 20,978 in 2016, up from 8,389 in 2013. In fact, opioid-related deaths in Massachusetts are more than four times higher in 2015 than in 2000, according to an August 2017 assessment by Massachusetts Department of Public Health. The report explicitly states that the opioid epidemic has had a “rapid and insidious geographic spread throughout the Commonwealth,” and that “almost every community is affected.” The epidemic disproportionally affects those of low income, as people on Medicaid are more likely to be prescribed opioids and less likely to have “evidence-based addiction treatment.” The CDC finds that people with low income or on Medicaid are high risk for prescription opioid overdose, reporting in 2011 that the rate of overdose deaths due to prescription opioids was highest in states with higher poverty levels. Before we can praise Raymond Sackler’s “entrepreneurial spirit,” we first must look at what human expense these profits came from.

The Sackler family is a major benefactor to Tufts through donations from individuals and the Sackler Family Foundation. The Sackler School of Graduate Biomedical Sciences is the most visible monument to this relationship. Mayer and the Trustees’ vision was made possible by the gifts of Dr. Arthur M. Sackler, Dr. Mortimer D. Sackler, and Dr. Raymond R. Sackler, and the school was given their name in 1983. The school was founded on July 1st, 1980 by the Board of Trustees and then-President of Tufts University Jean Mayer, upon the belief that an interdisciplinary and collaborative program is necessary for advancing health. Collins describes the naming process as “reviewed by the Board of Trustees and often are governed by a legal agreement negotiated between the donor and the university specifying the conditions of the gift.” He also points out that gifts from the Sacklers were received by Tufts “more than a decade before OxyContin was introduced to the marketplace.”

OxyContin is the most widely prescribed formulation of the semi-synthetic opioid Oxycodone, which is intended for use by patients with severe and chronic pain. Armed with tried-and-true marketing strategies and a new formula, Purdue was poised to generate tons of revenue from OxyContin. One of their boldest claims in 1996 was that one dose provided 12 hours of pain relief, which was twice as long as generic medications available at the time. They also recommended that patients take two doses a day to ensure full relief, and insisted that OxyContin was safer than rival painkillers. These exaggerated claims would come to be characteristic of Purdue Pharma’s aggressive marketing tactics, which persisted even in the face of complaints from doctors and patients that the drug was wearing off sooner than promised. A 2016 Los Angeles Times investigation into confidential Purdue documents and records spanning three decades found that Purdue executives ignored the fact of variability in OxyContin’s effects and instead sought to protect the financial gains that OxyContin offered the company. Meanwhile, throughout the late 1990s and early 2000s, the role of OxyContin in fostering a cycle of addiction was slowly becoming clear.

Ian Wong, Director of Health Promotion and Prevention at Tufts, works closely with Tufts students on issues of substance use and addiction and knows intimately the effects that the epidemic has had on Tufts students and their families. In 2002, he was part of then-Governor Mitt Romney’s Opioid Prevention Task Force within the Massachusetts Department of Public Health. There, he studied the epidemic’s effects on 50 Massachusetts cities and towns in order to improve prevention services. He emphasizes that the cycle of opioid addiction might start with taking doses for pain, but soon the impulse is not to get high, but to feel normal: “The withdrawals are really tough. You get caught in this cycle.” In the event that patients are cut off from a supply of prescription painkillers such as OxyContin, heroin and other “street” opioids such as fentanyl are the only other option. As much as prescription monitoring programs aim to prevent opioid use, and in some cases refer people to treatment programs, rates of addiction and overdose are rising.

Purdue’s marketing campaign for OxyContin is now widely characterized as aggressive and immoral. A 2007 lawsuit found Purdue executives guilty of “misbranding” the drug. Three individual executives—a top lawyer, former medical director, and the Purdue president at the time—were implicated and ordered to pay $600 million, comprised of both fines to federal and state agencies and settlements to patients and other private plaintiffs. Purdue Pharma issued a statement acknowledging that “some employees made…certain statements about OxyContin to some health care professionals that were inconsistent with the F.D.A.-approved prescribing information for OxyContin and the express warnings it contained about risks associated with the medicine.” So who was in charge in 2001, approving these inconsistent statements about OxyContin at the expense of patient health? None other than Dr. Richard Sackler, the son of Raymond Sackler. He served as the president of Purdue Pharma from 1991 to 2003, and afterwards served on its board of advisors.

In October of last year, Esquire published an investigative longread titled “The Secretive Family Making Billions from the Opioid Crisis.” It characterizes the Sackler as “private” and unwilling to attach their family name to their successful pharmaceutical company. “To the extent that the Sacklers have cultivated a reputation, it’s for being earnest healers, judicious stewards of scientific progress, and connoisseurs of old and beautiful things,” Christopher Glazer writes. The Sacklers’ name and reputation has been successfully divorced from Purdue and OxyContin, and instead attached to all kinds of philanthropic ventures. Later the same month, The New Yorker released their own exposé (“The Family That Built An Empire of Pain”) and the Sacklers were under fire again—this time, within the context of what the current presidential administration has deemed a “public health emergency.” The main actors in this decades-long drama are Raymond, Mortimer, and Arthur Sackler. It wasn’t until 1991, four years after Arthur’s death, that Raymond and Mortimer turned Purdue’s efforts entirely to pain management. OxyContin was launched in 1996, and has since generated about $35 billion for Purdue and the Sackler family.

So the Sackler family is rich. By some accounts, they are a dynasty worth $14 billion. This is the sole reason why individual members of the family have been able to brand themselves as philanthropists above all else. While sitting on Purdue’s board, they are patrons of the arts, sciences, and medicine. Their name is emblazoned on art museums around the world—among them the Metropolitan Museum of Art’s Sackler Wing and the Smithsonian Museum’s Sackler Gallery. The Yale School of Medicine has recognized Richard Sackler—son of Raymond and former Purdue executive—as “a steadfast friend” of Yale, where he and his parents have funded professorships, endowments, and an institute. Raymond and Beverly Sackler have funded institutes bearing their name at Cornell and Columbia. And of course, there are the Sackler Schools of Graduate Biomedical Sciences at New York University and Tufts University.

There are now 13 biomedical graduate programs at the Sackler School ranging from biology to pharmacology and drug development. The Elizabeth Byrnes Lab at the Sackler School has its primary focus in the study of opioids and its biological effects. The purpose behind the lab’s research mentions that one cause of the opioid epidemic is “the increased use and misuse of powerful prescription painkillers, such as OxyContin®…While the risk of overdose death and addiction-related disease are of primary concern, the long-term impact of increased opioid exposure across such a broad population remains unknown.” Within these statements made by the Elizabeth Byrnes lab, it is clear that representatives of the Sackler School’s research recognize the role of OxyContin in the opioid epidemic, implicating Purdue Pharma and therefore the actions of members of the Sackler family. Therein lies the irony: the potentially life-saving research done on the opioid crisis is conducted in labs funded by money from a company that has exploited people’s lives for profit. The Tufts Daily published an editorial in October that details this very dilemma, calling upon the Sackler School to change their name and revoke Raymond Sackler’s honorary degree, and at the very least to acknowledge the Sacklers’ role in the opioid crisis.

We are not the only community who is looking for justice and accountability, all the while wondering what that accountability might look like in a crisis as widespread as this. As far back as 2002, Ian Wong remembers the Department of Public Health “butting heads” with Purdue Pharma when they asked Purdue for money to fund prevention efforts, and were turned away. “It’s like the tobacco industry, and the things they knew behind the scenes about their product,” he says. In 2016, when a Kentucky judge ruled that Purdue’s internal documents, including the testimony of Richard Sackler, be made public, Kentucky House Speaker Greg Stumbo hoped for “vindication,” for a day when “Purdue Pharma would have to sit facing a jury.” Meanwhile, other groups have turned to raising awareness and pressure through direct action. In March, photographer Nan Goldin led a group called Prescription Addiction Intervention Now (P.A.I.N.) in a die-in at the Sackler Wing of the Metropolitan Museum of Art. They brandished a “SHAME ON SACKLER” banner as Goldin read, “In the name of the dead. Sackler family. Purdue Pharma. Hear our demands. Use your profits. Save our lives.” P.A.I.N. calls for cultural institutions to reject Sackler money. Public attitudes about the family are rapidly changing. Their legacy, which is tied up in the reputations of institutions that have uplifted their names, hangs in the balance.

When navigating Purdue Pharma’s website, one is immediately confronted by a pop-up that implores visitors to read an “open letter” about “illicit opioid abuse.” In it, they announce that they are “taking action” on opioids, which includes manufacturing pills so that they are harder to crush and supporting prescription monitoring programs. Earlier this year, Purdue Pharma officially ended any promotion of OxyContin to physicians. This is small comfort when the marketing succeeded in the first place, and when there are now generic versions of the drug available. In addition, they have begun to sponsor prevention programs all over the country. Promotional materials now feature the language, “This is our fight, too.” Meanwhile, “their fight” comes at a convenient time, with multiple lawsuits pending and public opinion turning against them. It also doesn’t include a commitment to limit the sales of their moneymaking drug OxyContin.

The Sackler family’s gift to Tufts was received in 1980, before Purdue Pharma as we know it developed and marketed OxyContin to disastrous effects. These days, Tufts’ Sackler School fosters scientific research and innovations that aim to “discover new knowledge to understand how diseases arise and can be overcome.” But what does it mean for these discoveries to bear a name directly implicated in one of the most urgent health crises of our time? Do the scientific and health innovations of the Sackler School outweigh the harm Purdue Pharma has done? There is no simple answer. But it is clear that Tufts University and other institutions that have benefited from Purdue Pharma’s money have not done enough to address and question the origins of this money. The Tufts administration’s official position remains the same, with Collins stating, “There are no plans to change the school’s name.” Tufts continues to praise Raymond Sackler’s philanthropy.  “His legacy in this regard remains unchanged,” Collins says. This is patently false. Raymond Sackler’s legacy is changing, and it cannot be separated from Purdue Pharma’s legacy. State governments, public health entities, and the communities affected by the opioid epidemic are making sure of it.

What will be the legacy of the Sackler School, and of Tufts, if they continue to uplift this name? What if “overcoming disease” is not just about laboratory science, but also about reckoning with the ways in which power and money are embedded in our institutions of higher learning?