Empire of Pain, the American Dynasty Behind OxyContin

This article is about “Empire In Pain,” a new book on the Sackler family and their OxyContin driven, opioid crisis. It provides a look into how far back the treachery of the family goes, clearly the most villainous force in American medical history. How can it be that one family in broad daylight, could be responsible for the deaths of more than 450,000 Americans, with not one of them spending a day behind bars? Empire of Pain, the American Dynasty Behind OxyContin

Criminal genius and the resources to even enlist McKinsey, the top consulting firm in the world to assist in their scheming is the answer. But the worm is now turning. Thousands of cases are filed and Patrick Radden Keefe’s revealing new book will help it along.


In ‘Empire of Pain,’ the American Dynasty Behind OxyContin

What’s in a name? Apparently plenty for the members of the Sackler family, who plastered their surname on prestigious galleries and institutions while taking care to keep the source of their riches under wraps.

For years, their company Purdue Pharma had been in the news for creating OxyContin — the powerful painkiller whose introduction in 1996 ushered in a new era of both pain management and opioid addiction — while the Sackler name remained better known for philanthropy than for pharmaceuticals. “I don’t believe Purdue has a legal responsibility,” one family member insisted in a deposition two years ago, when asked about the company’s role in the opioid crisis. “I mean, it’s very, very, very complex.”

Taking cover under complexity has been a common strategy for tobacco companies and big oil — entities that have profited from disaster while seeking ways to avoid any moral opprobrium and expensive accountability. But even the most elaborately complex phenomena can still have relatively simple beginnings, a kernel that requires only the ingenuity and ruthlessness of people who are ready to exploit it.

Since 1996, 450,000 Americans have died from opioid overdoses, making them the leading cause of accidental death in the country. In “Empire of Pain,” Patrick Radden Keefe tells the story of how the Sackler family became a decisive force in a national tragedy. “Prior to the introduction of OxyContin, America did not have an opioid crisis,” Keefe writes. “After the introduction of OxyContin, it did.”

Many books about the opioid crisis have been published in recent years, including Beth Macy’s “Dopesick” and Sam Quinones’s “Dreamland.” Back in 2003, the New York Times reporter Barry Meier released “Pain Killer,” a meticulous indictment of Purdue Pharma that compared the narcotic power of OxyContin to a “nuclear weapon.” In “Empire of Pain,” Keefe sets out to do something different, tracing the fortunes of the family dynasty at the center of it all. What starts out as a humble origin story in 1913 — the year of Arthur Sackler’s birth in Brooklyn, to immigrants from Central Europe — becomes an engrossing (and frequently enraging) tale of striving, secrecy and self-delusion.

Keefe is a staff writer for The New Yorker whose previous book, “Say Nothing,” depicted the code of silence that clung to the Troubles in Northern Ireland. “Empire of Pain” recounts how another code of silence did its work, obscuring complicity and deflecting guilt.


Patrick Radden Keefe, whose new book is “Empire of Pain: The Secret History of the Sackler Dynasty.”
Credit…Caroline Tompkins for The New York Times

The first third of the book revolves around Arthur, who fulfilled his immigrant parents’ dreams by becoming a doctor. But as someone who had juggled multiple jobs in high school, Arthur was never content to practice medicine and simply leave it at that. He tried his hand at pharmaceutical advertising — and turned out to be extremely good at it. One of his inspired creations was a weekly paper for doctors called The Medical Tribune, which featured articles that were favorable to his advertising clients. He liked to stay behind the scenes and “do things the way I want to do them.” Arthur’s imprint on the paper was everywhere, Keefe writes, but initially “his name could not be found anywhere on the masthead.”

Throughout his career, Arthur maintained that he wasn’t trying to influence physicians, just to “educate” them. Among his biggest triumphs as an adman was the marketing of the tranquilizers Librium and Valium, beginning in the 1960s. The drugs’ manufacturer, Roche, insisted they weren’t addictive — even though the company had evidence showing they were. Once the patents on the tranquilizers were about to expire, Roche finally relented to government controls. By then, 20 million Americans were taking Valium, and Arthur was rich. “The original House of Sackler was built on Valium,” Keefe writes, but Arthur would spend the rest of his life trying to downplay the connection.

Keefe nimbly guides us through the thicket of family intrigues and betrayals — how Arthur purchased the patent medicine company Purdue Frederick for his brothers, Mortimer and Raymond, in 1952, before he grew apart from them; and how Arthur’s heirs sold their shares to the surviving brothers after he died in 1987. Arthur’s descendants have tried to distance themselves from their cousins, protesting that they weren’t involved in the creation of OxyContin, but Keefe suggests they can’t get away from Purdue’s origin story. Arthur had created a fortune and a template.

It was Raymond’s son Richard who would push Purdue into the field of pain management. Keefe portrays Richard as ambitious, arrogant and almost comically impatient. One of Purdue’s reliable if unglamorous best sellers was a laxative; a restless Richard leaned on his staff to “get it to work more quickly.”

But OxyContin was different. Its innovation resided in its time-release coating, intended to slow down delivery of its chief ingredient, oxycodone — an opioid twice as potent as morphine, even if physicians back then were mostly unfamiliar with the name and assumed it was weaker. Purdue decided it wouldn’t correct this misapprehension; instead, the company instructed its salespeople to target family physicians, whom the company called “opioid naïve.”

The Sacklers themselves were shrewd — insisting all along that they had no idea that an alarming number of Americans were getting addicted to their product, even if their own sales data reflected what was happening. They also continued to obscure their family name behind the banner of Purdue Pharma. After pleading guilty to a misdemeanor charge for misleading regulators in 2007, the company perversely doubled down on opioids by developing a painkiller patch. But the Sacklers otherwise slashed spending on research and development, choosing instead to start siphoning off more and more money for themselves.

This strategy came in handy in 2019, when Massachusetts became the first state to sue Sackler family members by name, and their response was to declare Purdue Pharma bankrupt, which allowed them to obtain an injunction on any lawsuits; by then “the family had looted its own company,” Keefe writes, and “Purdue Pharma’s coffers were nearly empty.” Last month, the Sacklers offered to pay $4.275 billion from their personal fortune in an attempt to end thousands of lawsuits that have been filed against the company. Whether their bid is accepted remains to be seen.

Needless to say, Keefe, who wrote about the Sacklers for The New Yorker in 2017, didn’t get the family to cooperate with this book, but in a note he recalls receiving a thumb drive that was mailed to him anonymously and included thousands of pages of documents. He sifted through 40 boxes of files from congressional investigations into the pharmaceuticals industry in the late ’50s and early ’60s. He interviewed dozens of former Purdue employees. He got in touch with Richard’s college roommate, who remembered Richard’s determination to spend a summer “solving the scientific riddle of the orgasm.” Even when detailing the most sordid episodes, Keefe’s narrative voice is calm and admirably restrained, allowing his prodigious reporting to speak for itself. His portrait of the family is all the more damning for its stark lucidity.

Amid all the venality and hypocrisy, one of the terrible ironies that emerges from “Empire of Pain” is how the Sacklers would privately rage about the poor impulse control of “abusers” while remaining blind to their own. Keefe describes a moment during congressional hearings last year, when Representative Raja Krishnamoorthi questioned Richard’s son, David, who tried to distance himself from a $22 million mansion his family had acquired by saying it was merely an “investment property” — as if that was exculpatory. But Krishnamoorthi was having none of it: “I would submit, sir, that you and your family are addicted to money.”


Empire of Pain, the American Dynasty Behind OxyContin

Empire of Pain, the American Dynasty Behind OxyContin

Kirkus Reviews, the gold-standard for independent & accurate reviews, has this to say about

What Goes Around Comes Around:

A stable, positive, non preachy, objective voice makes the book stand apart from others in the genre. A successful guide that uses anecdotes to reveal powerful truths about life.

~ Kirkus Reviews

“The author gives readers not just points or principles to ponder, but real human experiences that demonstrate them!
Kirkus Reviews
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“I’ve read a number of books that focus on sharing a similar message, including “The Secret” by Rhonda Byrne, “The Answer” by John Assaraf & Murray Smith, “The Celestine Prophecy” by James Redfield, “Think and Grow Rich,” by Napoleon Hill, and I must say that I find Rob’s to be my favorite. – Sheryl Woodhouse, founder of Livelihood Matters LLC