• Data centers as target: Environmental nonprofits now oppose data center development using tactics similar to past campaigns against oil, gas, nuclear, and chemical industries.
• Call for realism: America needs bipartisan energy and electricity policies that prioritize abundance, cost, and reliability amid accelerating AI demand.
• Climate movement critique: After Paris Accords, net-zero rhetoric led to trillions spent on green schemes without practical returns.
• Energy infrastructure losses: Zero-emission nuclear sites closed prematurely while coal reduction outpaced replacement, with blocked gas pipelines despite fracking benefits.
• CEO failures noted: Many CEOs failed to oppose unworkable energy policies, allowing climate activists to dominate decisions.
• Data centers equated to essential industry: Described as factories of the digital economy whose restriction raises compute costs and offshores technology.
• National competitiveness stake: AI, cloud computing, finance, healthcare, manufacturing, and defense all hinge on abundant domestic compute capacity.
• Leadership demand: Executives should publicly oppose data center moratoriums and educate on true energy requirements.

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Data center moratoriums are the new fracking bans. Environmental nonprofits are deploying the same playbook against data centers that they have used against oil, gas, nuclear and chemical companies over the past decade, and many business leaders are again tempted to stay silent.

But America is at a crucial moment that demands bipartisan realism on energy and electricity, the lifeblood of economic prosperity and global power. As artificial intelligence accelerates, abundance, cost and reliability must take precedence. Anything less will weaken national security, stifle growth and fuel inflation.

After the 2015 Paris Accords, the environmental movement initiated its attack on the carbon molecules underpinning electricity, fuel and pharmaceuticals. “Net zero,” “decarbonization” and “energy transition” became organizing principles for governments, profit centers for consultants, and buzzwords for corporate pledges rooted in financial engineering over reality. Trillions in taxpayer dollars have since been squandered on “Green New Deal” schemes in the U.S. and Europe.

We were told that eliminating carbon emissions was a moral necessity to deter an “existential” threat to humanity. Yet zero-emission nuclear plants were shut down before replacements were ready. Coal generation was dismantled faster than it could be replaced with reliable alternatives. Gas pipelines were blocked even as hydraulic fracturing unleashed energy abundance and affordability and strengthened America’s global position. In the past decade, the U.S. has removed more than 100 gigawatts of reliable coal and nuclear generation. Europe deindustrialized with even greater zeal, producing higher costs, poorer citizens and populist backlash.

Looking back, too many CEOs failed to challenge energy policies they knew were unworkable. Some supported them outright, either because they misunderstood physics or because political pressure made dissent risky. Climate activists were handed the reins as targets replaced trade-offs and aspirations replaced economic sense.

The arsonists are donning the firefighter helmets again. Trying to stop data center construction while expecting continued economic growth is no different from trying to stop oil, gas and nuclear production while expecting reliable, affordable electricity.

Data centers aren’t a luxury. They are the factories of the 21st-century economy, converting energy into processing capacity the way refineries convert oil into gasoline and chemical plants convert minerals into batteries. Treating them as something society can simply “pause” doesn’t reduce demand for digital services; it constrains the supply of compute, raising costs and outsourcing technological progress elsewhere.

The U.S. can’t afford to repeat its energy mistakes. Artificial intelligence, cloud computing, finance, healthcare, manufacturing and defense all require abundant, affordable compute power built at home. CEOs need not speculate about whether data center moratoriums will hurt their businesses—they already know the answer.

Leadership now means speaking up, telling the truth about what energy and electricity actually require and saying no to data center moratoriums.

Mr. Huntsman is chairman and CEO of Huntsman Corp., a petrochemical manufacturer.

Journal Editorial Report: The week's best and worst from Kim Strassel, Allysia Finley and Dan Henninger. Photo: Alex Wong/Getty Images/Isabel Infantes/Reuters/Michael Brochstein/Zuma Press

Dark Woke won’t be vanquished. In the wake of Renee Good’s death in Minneapolis, the movement is reasserting itself from the Midwest to the Pacific coast, pushing Democrats to embrace combative cultural stances — and white, Millennial women are its shock troops.

The New York Times defined “Dark Woke” last year as “an attempt to step outside the bounds of the political correctness that Republicans have accused Democrats of establishing.” In the Gray Lady’s telling, it “requires being crass but discerning, rude but only to a point.” Examples range from Gavin Newsom’s meme warfare to Jasmine Crockett’s alliterative insults (“Will a vindictive, vile villain violate voters’ vision?”). GQ, meanwhile, observed that the objective is to “subvert the qualities that people think made wokeness cringe — the virtue policing, the polite ‘when they go low, we go high’ posturing — and go Joker mode to make Democrats cool again.” 

These aren’t mutually exclusive definitions. Dark Woke is a meme with amorphous contours. Sometimes, it’s merely rhetorical; other times, it offers serious strategies to challenge MAGA with a dose of its own post-liberal medicine. Either way, it’s rooted in the same demand posed by grassroots Democrats to the party establishment: throw some punches, or we’ll primary you into oblivion.

Since Good’s demise on the icy streets of Minnesota, videos of enraged anti-ICE protesters are proliferating on social media. In one clip posted by the Fox News reporter Matt Finn, an ICE agent goes up to two shiny SUVs blocking traffic, warning the women in them not to “make a bad decision.” The women, both of whom appear to be Millennials, aren’t intimidated. “I think I’m making exactly the right decision,” one says. When the officer signs off with, “Thank you, have a good day,” she replies with a grin: “I hope you have a terrible day.” In another viral clip, a gaggle of whistling women surround a reporter; one gleefully taunts him as another screams, “Nazi!” 

Or there’s the TikTok video circulating on X, in which a blue-eyed, salt-and-pepper-haired woman who describes herself as a 42-year-old single mother and “relationship anarchist” slips sexily into her Carhartt overalls while spelling out a “dating-profile request” for a man whom she can “call, right now, and say, ‘Hey, get in the passenger seat and let’s go fuck some shit up.’” 

These street soldiers aren’t the antifa types torching cars or the rioters looting stores. They are, like Good, Millennial moms in the Midwest. They’re people from normal quarters of American life who are spending time during the workday putting their bodies and vehicles on the line to protect illegal migrants, some with serious criminal records, from deportation. And they see ICE as a neo-Gestapo that calls for more than rhetorical condemnation.

The Washington Post this week wrote about the growing activist coalition: “As the Trump administration deploys thousands of federal immigration officers and agents around the nation, a loose-knit but increasingly organized network of activists is tracking their whereabouts and documenting arrests.” With whistles and messaging apps, these ICE “watchers” or “verifiers” are often trained by nonprofit groups, according to the Post article, which adds that they are “dispatched to spot arrests, record interactions, and, where possible, get contact information for family members of those arrested.”

This partly explains why Dark Woke is growing amid President Trump’s immigration crackdown. Tracking ICE supplies a sense of agency and community at a time when people feel powerless and atomized. It is also a clue as to why there are so many upscale white women in the ranks of the Dark Woke army. 

Last fall, the GOP pollster Alex Tarascio “asked likely voters if they agreed that it’s acceptable to go beyond peaceful protest in response to ICE enforcement, even if it breaks the law,” as he put it in an X post. “Overall, just 24% of Americans agreed. But among white women, 18 to 44, who identify as liberal? The number shoots up to 61%.” Half that number, only 30%, disagreed. Among all liberals, the number was nearly 20 points lower, at 42%. And among all likely voters, the number dropped to less than a quarter of the population.  

Why are white liberal women especially eager for battle? People like Good are motivated by a sincere commitment to social justice, to be sure. Good was so moved by the prospect of ICE deportations in Minneapolis that she joined a midday protest after dropping off her 6-year-old at school.

However, there is also no shortage of research in recent years showing that young women on the Left struggle more with mental health than do other cohorts. In 2024, Times columnist Thomas Edsall dug into studies on the “happiness gap,” noting “one of the findings emerging from this research is that the decline in happiness and in a sense of agency is concentrated among those on the Left who stress matters of identity, social justice and the oppression of marginalized groups.”

In 2025, a study published by Zach Goldberg at the Right-of-center Manhattan Institute found that “females and liberals tend to rank higher than their male and conservative counterparts in certain personality traits that are associated with greater susceptibility to internalizing symptoms. These symptoms are characterized by inwardly directed emotional distress, including feelings of sadness, worry, and fear, which can manifest as conditions like depression and anxiety.” 

Research from the Institute for Family Studies has likewise found that “when we control for education, race, age, and income, …  liberal women ages 18 to 40 are over three times as likely to report frequent feelings of loneliness compared to their conservative peers.”  

Renee Good, of course, was married and — at least in the tragic record of her final minutes — cheerful in demeanor. Unhappiness and lapsed agency may or may not explain her personal decision. However, it’s fair to speculate that rational disapproval of Trump is not the only explanation for why more and more young progressive women are training as “ICE watchers” and joining physical protests. Tellingly, the Institute for Family Studies found that “a large part of [the] loneliness gap comes from different rates of marriage and church attendance. … Adding controls for marriage and church attendance, ideology becomes less important, with marriage being the strongest predictor of feeling less lonely.”

Feelings of misery and powerlessness, especially acute on the young female Left, will ensure Dark Woke lingers, and reemerges as opportunities for catharsis present themselves. These opportunities will be especially compelling when they offer a perceived sense of community, or of self-sacrifice for the common good. 

Satisfaction, though, will prove illusory, because the source of the young women’s pain is not really injustice, except in the sense that a grave injustice has been committed against happiness in the destruction of our communities, social bonds, and overall humanity.

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• Synagogue Fire: Arsonist targeted Congregation Beth Israel in Jackson, setting fire around 3 a.m. that damaged the library, administration offices, and Torah scrolls.
• Suspect Details: Stephen Spencer Pittman, 19, faces federal charges for maliciously damaging a building by fire or explosive; GPS and texts linked him to crime.
• Motivation: Pittman allegedly cited the synagogue’s “Jewish ties,” used the phrase “Synagogue of Satan,” and confessed to his father before arrest.
• Community Response: Jackson’s faith organizations offered worship spaces, and state leaders pledged support and cooperation with investigations.
• State Action: Gov. Tate Reeves directed the Department of Public Safety to assist federal partners, while Commissioner Sean Lindell vowed state and federal charges.
• Historical Context: Attack follows spike in antisemitic incidents, referencing prior violent attacks like the Tree of Life massacre and other recent assaults.
• Suspect Profile: Pittman, from Madison, excelled in baseball at St. Joseph and Coahoma Community College and posted about faith before radicalization.
• Potential Influences: Social media revealed antisemitic imagery and rhetoric, prompting questions about factors driving his shift from everyday interests to arson.

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Hate found its way to Mississippi’s largest Jewish house of worship, Congregation Beth Israel, when an arsonist intentionally set fire to the synagogue at about 3 a.m. Saturday, damaging the only synagogue in Jackson.

The alleged suspect’s name, Stephen Spencer Pittman, was released late Monday. According to the FBI, he faces charges of maliciously damaging or destroying a building by fire or an explosive.

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Russ Latino, a native Mississippian and founder of the Jackson-based Magnolia Tribune Institute, said an affidavit filed in U.S. District Court for the Southern District of Mississippi alleges Pittman admitted to law enforcement that he set the fire at Beth Israel because of its “Jewish ties.” Latino added that Pittman referred to the synagogue as the “Synagogue of Satan” and detailed the steps he took leading up to the arson.

Latino noted that “Synagogue of Satan” is an antisemitic phrase that both Nick Fuentes and Candace Owens have used in recent years. “Nothing in his personal profile points out anything political. There is no Trump or Biden or Harris. There are just a lot of bible verses,” he said, adding, “But ‘Synagogue of Satan’ well, that is a pretty specific alliteration and the same phraseology used by Fuentes and Owens,” he said.

His social media presence on X shows a young man posting about his Christian faith and baseball, where he was a standout player in both high school and college.

Latino said the entire Jackson community has rallied around the Beth Israel congregants. “Many different faith organizations had reached out and offered their houses of worship for the Beth Israel members so they can practice their faith,” he said.

Mississippi Gov. Tate Reeves echoed that community sentiment, saying the state of Mississippi stands with the members of the congregation. “This heinous act will never be tolerated, and the perpetrator should face the full and solemn weight of their actions. I have directed the Mississippi Department of Public Safety to support our federal law enforcement partners in any manner necessary as they investigate this horrible situation and pursue state charges,” he said.

Public Safety Commissioner Sean Lindell said the department was fully engaged and working closely with its federal and local partners to hold those responsible accountable. “We will pursue charges at both the state and federal levels to see that justice is served,” Lindell said.

The arson follows years of violent attacks against the nation’s Jewish community, dating back to October 2018, when Robert Bowers murdered 11 worshipers at the Tree of Life synagogue in Pittsburgh’s Squirrel Hill neighborhood, the worst massacre of Jews in American history.

Julie Parish, who lives in Squirrel Hill and is the Mid-Atlantic regional director of StandWithUS, said she is horrified by the deliberate arson at Beth Israel Congregation. “To target Mississippi’s largest and oldest house of worship, desecrating sacred Torah scrolls and destroying a library and administration offices is an act of unmitigated evil,” Parish said.

Parish, who has documented scores of graffiti attacks in Pittsburgh’s largest Jewish neighborhood, said while this fire was an attempt to intimidate and harm, “It will not succeed.”

Violence targeting Jews and Jewish institutions surged after the Oct. 7, 2023, attack on Israel by Hamas-led terrorists. Since then, a Jordanian national broke into a solar power generation facility in Wedgefield, Florida, because he believed the company supported Israel, causing nearly $500,000 in damage.

Last May, two Israeli Embassy staffers were killed by a lone gunman in Washington, D.C. A month later in Boulder, Colorado, Mohamed Sabry Soliman allegedly threw Molotov cocktails at a march supporting Israeli hostages. Prosecutors say Soliman attacked the group with incendiary devices, injuring at least seven people and killing one.

The Anti-Defamation League reported 8,873 antisemitic incidents in the United States in 2023, a 140% increase from 2022. In 2024, the total climbed again, reaching 9,354 incidents of antisemitic harassment, vandalism, and assault nationwide.

Last April, on the first night of Passover, Cody Balmer scaled an iron security fence at the governor’s mansion in Harrisburg, Pennsylvania, in the middle of the night. Carrying used beer bottles filled with gasoline, Balmer allegedly evaded police and security as he attempted to carry out a terrorism plot to kill Gov. Josh Shapiro.

Footage shows Balmer made it as far as the doors near where Shapiro and his family, including his wife and children, were sleeping, but he was unable to get inside. He then set a second fire and fled, never once encountering state police.

Balmer told police he intended to beat Shapiro with a small sledgehammer if he encountered him. He also said Shapiro needed to know that Balmer “will not take part in his plans for what he wants to do with the Palestinian people.”

Balmer was sentenced to 25 to 50 years in prison in October.

Beth Israel’s library and surrounding rooms suffered severe damage, with smoke spreading throughout the building. The two Torahs kept in the library were destroyed.

Latino said the sanctuary was also damaged, along with five Torahs housed there. However, an eighth Torah, rescued during the Holocaust and displayed in a glass case, survived.

Pittman, 19, who goes by his middle name, lives in Madison just outside Jackson. According to an affidavit filed in the U.S. District Court for the Southern District of Mississippi, he faces federal charges for using fire to maliciously damage or destroy a building involved in interstate commerce.

When he appeared in court, the judge asked him if he understood his rights to an attorney, and Pittman responded, “Yes, sir, Jesus Christ is Lord.”

Federal investigators were able to identify him pretty quickly because of text messages he allegedly sent to his father in the course of setting the fire on Saturday. “That was in the affidavit. His father was pleading with him to come home but he replied ‘I did my research,’” Latino said.

Pittman is alleged to have confessed to his father, who then contacted the FBI.

GPS data indicated that Pittman was at the synagogue.

Local news reports show Pittman was an honor student and an outstanding baseball athlete who graduated from St. Joseph in 2024. Since then, he has been an outfielder at Coahoma Community College.

JOSH SHAPIRO ADMITS VIOLENCE ALMOST DROVE HIM FROM RACE

Three days ago, around the time of the attack, a post on what investigators believe is Pittman’s Instagram account suggested his interests extended beyond baseball. The account featured an image of Princess Clara, an animated character from Drawn Together known for religious fanaticism and bigotry, pushing Mumble O’Algo, a secondary character depicted wearing a Star of David and carrying bags of money, into a pool while shouting, “A Jew in my back yard! I can’t believe my Jew crown didn’t work. You are getting baptized right now!”

The question is who radicalized this young man, with seemingly no ideological bent, from posts about baseball and faith to attempting to burn down a house of worship and using phraseology like “Synagogue of Satan.”

• Bankruptcy settlement: Purdue Pharma and Sacklers' $7B deal pays $3,500–$16,000 to harmed individuals who filed paperwork and waive future suits, with payouts starting March and company rebranded as Knoa Pharma now focused on addiction treatment.
• Physician regret: ER doctor-author notes addiction often began with prescriptions and lamented medical community being misled by claims that modern opioids were non-addictive, despite extensive litigation and deaths.
• Targeted marketing: Purdue tailored opioid campaigns to insured groups like elderly and veterans, even using staged patient profiles and feminist empowerment themes to encourage prescribers to initiate and maintain opioid therapy.
• Fraudulent asset transfers: After 2007 plea, Sacklers increased revenue withdrawals to 70%, described by courts as a “milking program,” with Justice Department calling transfers fraudulent; Supreme Court rejected a full lawsuit release for future claims.
• Naming-rights ban: Revised deal bars Sacklers from requesting naming rights for donations, while upcoming release of 43M industry documents aims to document corporate wrongdoing already evidenced in archives.
• Promotion tactics: Savings cards boosted OxyContin uptake; internal slides showed one million dollars in savings cards returned $4.28M, encouraging long-term high-dose use despite overdose risks.
• Dose escalation: Purdue pushed titration to higher doses for profit, linking length of treatment to dose and celebrating high-dose increases while publicly framing “Individualize the Dose” as marketing to boost product movement.
• Empowerment messaging: American Pain Foundation, funded by Purdue, promoted women advocating for pain rights via social gatherings, while media coverage (e.g., Jane Brody) criticized cautious doctors, reinforcing demand for more opioids.

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Editor’s note:

Dr. Matt Bivens — a reporter turned emergency medicine physician — has been chronicling the opioid catastrophe for his Substack, The 100 Days. Yesterday, he wrote about the end of the Purdue Pharma bankruptcy case, explaining how aggressively and cynically Purdue hooked patients.

You probably know the broad story already. After all, (good) books have chronicled the awfulness of Purdue and the Sackler family, which owned it.

Nonetheless, I asked Dr. Bivens if I could rerun his excellent piece. As I said to him:

I don't think we can explain what happened with opioids, pharma, Purdue, and "the fifth vital sign" [the effort to encourage and even force physicians to aggressively treat pain as if it was as important as breathing] enough times.

We may have learned a little about opioids, but it has done nothing to change our broader crisis around benzos, ketamine, and stimulants - all these drugs that (at best) blur the line between medical and recreational use, that turn doctors (willingly or not) into drug dealers and patients (willingly or not) into addicts. And the fact the ADHD drugs continue to be given out like candy for kids year after year is a national disgrace.

He was gracious enough to agree.

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(Finding the best Unreported Truths - even when they aren’t mine.)

—

One final note: I cut one section (detailing the pricing of various doses of Oxycontin) for length. Otherwise it is exactly as Matt wrote it.

Without further ado:

One of America’s most infamous corporate characters just made its final curtain call. The $7 billion bankruptcy deal approved over the holidays for Purdue Pharma and its billionaire owners, the Sackler family, includes compensation for individuals harmed by OxyContin® or other prescribed opioids: from $3,500 to $16,000 (before legal fees), available to anyone who filled out the right paperwork a long time ago and who promises not to sue. The payments might begin as soon as this March.

Purdue, with a new name (Knoa Pharma) and under new management, gets to re-dedicate itself now to treating opioid addiction. As an ER doctor also board-certified in addiction medicine, I’ve spent years reviving (or failing to revive) people who’ve overdosed on fentanyl or heroin or oxycodone, and who, more often then not, first got hooked on opioids via a prescription from a doctor.

I’ve also spent years commiserating with other doctors about how, back in the day, we were set up to fail our patients, thanks to a confused mishmash of nonsense about how no one gets addicted to modern opioid therapy anymore.

Yet even today — after all of the multi-billion-dollar settlements and lawsuits, after hundreds of thousands of overdose deaths, after hearings and speeches in Congress — few people seem to really understand how coldly and methodically Purdue (and other opioid manufacturers, but especially Sackler-led Purdue) worked at getting people addicted. They focused in marketing and sales trainings on the need not just to convince doctors to start patients on opioids — but to keep them on opioids, and at the highest achievable doses.

As laid out in particularly withering detail in the Massachusetts and New York state lawsuits, Purdue had an opioid sales strategy for every American identity group with good insurance. They targeted the elderly, showing doctors “profiles of fake elderly patients, complete with staged photographs” to help the doctor get comfortable hooking up grandma. They targeted veterans — who, in my state of Massachusetts, are three times more likely to die of a drug overdose than non-veterans, but until that sad day also do have great insurance!

Purdue, both directly and through front organizations like the American Pain Foundation, even came up with the idea that getting addicted to OxyContin® could be a form of feminist self-actualization. Under the heading “Empowerment — women,” notes from a marketing strategy session elaborate approvingly that the “empowerment angle can be used with any program.”

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First, a note about the just-approved Purdue bankruptcy deal, which may surpass even the case of Lehman Brothers as America’s all-time example of “fraudulent conveyance,” the practice of moving money out of the reach of creditors. At least in terms of shamelessness, Purdue has no peer.

Purdue has been targeted by federal authorities on multiple occasions, and 2007 was the year of a watershed plea deal. It’s no doubt clarifying to have the Justice Department force you to publicly confess and hand over hundreds of millions of dollars, and the Sackler family were suitably alarmed.

Before 2007, as owners of Purdue, they had been taking out a tidy 15% of annual revenues for themselves. But after 2007 — even as they massively escalated their deceptive sales and marketing, and even as opioid-associated lawsuits against the company started piling up — the Sacklers read the writing on the wall. They started taking home 70 percent (!) of revenues.

“[T]he Sacklers initiated a ‘milking program,’ withdrawing from Purdue approximately $11 billion — roughly 75% of the firm’s total assets — over the next decade,” was how the clearly disgusted judges of the U.S. Supreme Court described this. The U.S. Justice Department referred to these withdrawals as “fraudulent transfers.”

The current Supreme Court is a generally pro-business, corporate-friendly collection of men and women in matching silly robes, but even they have standards. When the Sacklers offered to return $4.3 billion to Purdue’s bankruptcy estate (in occasional installments, over many years), in exchange for a judicial order that they could never be sued for any past or future opioid-related claim by anyone — that was too much even for this Supreme Court, which said “no,” returning the case to bankruptcy court.

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The just-completed revised deal stipulates that the Sacklers — who’ve had medical schools and a wing at The Met named in their honor — can no longer request naming rights in return for charitable donations. That’s a relief, as I fervently hope to die without ever seeing the solemn announcement of someone at Knoa Pharma proudly accepting the First Annual Richard Sackler Award for Public Service, or some other such atrocity.

No, I’ve suffered enough mental trauma just browsing for countless days through the indispensable digital archive of more than 6 million opioid industry-related documents maintained jointly by University of California, San Francisco, and Johns Hopkins University. As an aside, the bankruptcy deal — which calls itself “The Plan” — promises to deliver up 43 million more documents to the public soon:

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While more data is always welcome, the documents we have now already definitively document the banality of this evil.

Moving product by weight

One of Purdue’s best investments was the introductory savings card for OxyContin®, a discount coupon that sales staff hand-delivered to doctors’ offices or mass e-mailed.

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“Save up to $70 with the OxyContin® Savings Card.” As cited in the New York attorney general’s lawsuit against Purdue.

Purdue’s internal analysis showed these had a phenomenal return on investment: Every $1 million spent on OxyContin® savings cards translated into $4.28 million in revenue. The savings cards “helped” patients afford to try opioid therapy — with the result that many would end up trapped on opioids long term.

Consider some PowerPoint slides:

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From a 2011 internal marketing presentation at Purdue, as cited by the Massachusetts attorney general’s lawsuit against the company.

That slide celebrated how a savings card up-front made it far more likely the patient would be stuck on OxyContin® three months later. That may be bad for the patient, but it’s good for Purdue.

Never mind that the Massachusetts Department of Public Health found that patients still on prescription opioids after 90 days were four times more likely to die of an opioid overdose in the next year, and 30 times more likely to die of an overdose in the next five years. From Purdue’s point of view, if the patient’s on OxyContin® after 90 days, that’s some fine work.

And it’s even better work if the doses have been rising steadily.

OxyContin® tablets, usually taken twice daily, start at 10 mg and rise up to 80 mg. (There was even briefly a 160 mg tablet, for about nine months, back in 2000-2001. Purdue “voluntarily” stopped marketing it. It’s incredible to think of such dosing — the equivalent of taking an entire bottle of 64 standard Percocet® pills every day.)

Purdue would charge more for higher doses…

“Titration” — the medical term for adjusting a dose until a desired effect is achieved — was thus a sales obsession. Sales staff had to “practice verbalizing the titration message” at workshops, where they’d be told not just the stats on how many new prescriptions the sales force had brought in — but specifically how many high-dose up-titrations. (For completeness, the trainings also talked about titrating back down in a stepwise fashion, to prevent opioid withdrawal symptoms — but these were sales team trainings, not medical trainings, and titrating sales down was never the emphasis.)

Meanwhile, ads in journals would help doctors see how to climb the titration ladder:

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A 2008 Purdue promotional message for medical providers. Follow the arrow and just keep moving on up!

What’s more, Purdue’s business teams crunched the numbers and found that higher doses encouraged longer treatment courses — so if you can get the patient titrated up to 60 mg or 80 mg, chances are you’d see not just one week’s worth of profits, but profits for months or years.

A patient kept on the highest dose of OxyContin® for a year, per the Massachusetts attorney general, brought in $10,959.25.

Which sounds like better business: earning a one-time $38 from a patient with back pain, or $10,959 every year from that same patient’s back pain?

Exactly.

So, the business goal was clear: Push doctors (and other prescribers) to titrate toward higher OxyContin® doses, supposedly in search of that sweet spot for symptom control, but actually because daily, high-dose opioid exposure turns people into opioid addicts loyal customers.

“There is a direct relationship between OxyContin LoT [Length of Treatment] and dose,” observed a Purdue internal marketing presentation in 2012.

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Purdue internal marketing presentation, 2012, as cited by the Massachusetts attorney general’s lawsuit against the company.

Eventually, Purdue launched an OxyContin® campaign around the slogan “Individualize the Dose.” But this had little to do with finding the appropriate medical treatment for a given individual. Why, if that had been the idea, many would probably still be taking Tylenol® or ibuprofen. No, this was discussed in Purdue documents, and presented at board meetings, as a marketing initiative. It was about moving product. “Individualize the Dose” came up in the same context as celebrations when high-dose OxyContin® was on the rise, and handwringing when prescribers started getting shy.

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More Purdue messaging for doctors.

‘Let women addict educate women in their natural settings’

It’s worth remembering that none of this was happening in a vacuum.

Makers of opioids everywhere, undaunted by Purdue’s 2007 guilty plea and fine, were not just telling doctors that “modern opioids were safe”; they were also telling patients that they had a God-given right to be pain-free, and to demand that their doctors see them, hear them and treat them.

Everyone from the Joint Commission to the American Medical Association to the American Pain Foundation was singing some variation of that song.

In that regard, a “brainstorming session” in 2007 at the American Pain Foundation — a front organization entirely funded by Purdue and other opioid manufacturers — continued a long-running riff on how the pain of women was not taken seriously by doctors. It was time, according to the notes of the session, to talk about Empowerment - Women:

“Empowerment angle can be used with any program,” the pain foundation team noted approvingly. It added, “encourage patients to advocate for their rights … Consider viral tactics/word of mouth education – let women educate women in their natural settings (e.g., Tupperware parties, garden groups, e-cards).”

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Internal notes from the Pain Foundation’s meeting. Included, for example, in the Oklahoma lawsuit against Purdue.

Jane Brody, the New York Times health reporter, showed up to the metaphorical Tupperware party around then with an account of weeks of severe pains after she took the unusual step of having both knees replaced at one go.

“Most doctors are clueless or unnecessarily cautious about treating pain,” she wrote in her widely-read health column in 2005. “They are especially ill-informed about opioids.”

I wouldn’t mind seeing an indignant New York Times berate me and my fellow doctors by asking how we’d ever allowed this opioid crisis catastrophe. But no. Brody was complaining that we hadn’t been slinging enough dope! We needed to hand it out even more liberally! It reminds me of the famous Christopher Hitchens statement, “I became a journalist because I did not want to rely on newspapers for information.”

Over at Purdue, Brody’s complaints — her loud advocacy for everyone’s right to be pain-free after surgery — must have been a marketing Godsend:

“I did not know that the dose of the sustained-release opioid OxyContin (oxycodone) that I was taking — 20 milligrams twice a day — was a ‘low’ dose until seven weeks after surgery. [Note: 40 mg a day is not “a low dose”. It’s equal to taking eight oxycodone / Percocet® tablets a day!]

“I also did not know that the other pain drug I was prescribed for breakthrough pain, Percocet, was really short-acting oxycodone plus acetaminophen. Because my pain was frequently intolerable despite the two doses of OxyContin, I was taking as many as 10 Percocets a day. [Note: So, she was taking the equivalent of 18 Percocet a day?] … Yet, when I complained about the severity of my pain, which had me crying for several hours a day, the surgeon added an anti-inflammatory drug and told me to take half the OxyContin and Percocet.

In other words, the surgeon dealing with this querulous and powerful woman took on a thankless task, and got himself savaged in the pages of The New York Times, because he advocated for her long-term health over her short-term comfort.

He told her for her own good to woman-up, scale back on the massive opioid doses, and maybe be a bit more philosophical about the pain inherent in opting for simultaneous knee replacements. As a physician I can tell you: It’d have been much quicker and easier to titrate up her OxyContin® dose.

Brody has written followup columns in years since about the joys of bilateral knee replacements. She’s described dancing, and touring Vietnam by bicycle. She retired in 2022 but is still going strong at 84, doing podcasts and judging contests. (She did not respond to a query.)

One wonders what would have happened to her if her surgeons, instead of trying to wean her off of opioids in those few crucial weeks, had bowed to “Empowerment - Women,” and set out to “Individualize Jane Brody’s Dose”. If she’d been rapidly titrated up to OxyContin® 80 mg twice daily — the equivalent of 32 standard Percocet® pills every day — would she have continued to be a functioning New York Times reporter?

Would she even be alive today?

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Thanks again to Dr. Bivens for this piece. If you want to read more from him, find his Substack, “The 100 Days,” here.