Empire of Pain: The Secret History of the Sackler Dynasty

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe
Published by Doubleday
Publication date: April 13, 2021
Genres: Book Clubs, Non-fiction, History

Bookshop, Amazon

I often talk about fiction that evokes strong emotion, but I’m not as likely to find it in nonfiction. Until now. Patrick Keefe’s Empire of Pain has left me angrier than I’ve been in a long time. The book’s subtitle should clarify things: The Secret History of the Sackler Family Dynasty. If you’ve never read Dopesick or any news on the opioid crisis in America the name Sackler might not ring a bell. They are the family that created and profited from Oxycontin, the FDA approved narcotic that is widely perceived to be at the root of the current epidemic. Keefe traces the family from their arrival in America to their present-day legal battles in a book that is more compelling than most novels.

Notoriously private, the Sacklers preferred to be known for their philanthropy, as evidenced by their name on institutions around the globe: the Sackler wing at the Met in NYC, the Sackler wing of Oriental Arts at the Louvre, the Tufts’ Sackler School of Graduate Biomedical Sciences, to name a few. Prior to the turn of the 21^st century very little was known about them at all. Empire of Pain puts an end to all that as Keefe places the previously private lives of the three brothers, Arthur, Raymond, and Mortimer, doctors all, and their descendants under a magnifying glass.

By the time World War II ended Arthur, Raymond, and Mortimer used their medical degrees to start their own research facility studying the chemical workings of the brain. At the same time Arthur began working in medical advertising—a fledgling field at the time due to the fact ads were found in professional journals only and the idea of promoting a drug didn’t even exist. Arthur changed all that by helping companies like Pfizer, a chemical company moving into pharmaceuticals, promote their new drugs. In 7 years they increased their sales force from 8 to 2,000. His flair and drive made Valium one of the first million-dollar drugs.

With their increasing wealth the brothers bought small pharma companies to pursue research and manufacturing of drugs. One of these was Purdue Frederick, which became Purdue Pharma. The company sold over-the-counter remedies like Betadine and Senokot, but the Sacklers wanted something bigger. It was the 1970s and in England Mortimer managed a family-owned company trying to find ways to make morphine safer. Pain relief for terminal cancer patients was a growing problem, but while morphine was the drug of choice concerns over safety and addiction meant it was prescribed sparingly. This company developed a coating that became what we call extended-release or time-release and began selling MS Contin—morphine in a pill that released into the body slowly and steadily, providing greater relief. This was the magic pill of the Sacklers’ dreams.

Keefe handles the details, ALL the details, of both the Sacklers personal and professional lives so skillfully Empire of Pain reads easily. At the same time, it is replete with facts and figures, the result of years of research, interviews. There is no relying on anecdotal or secondhand accounts for the truth—it’s there in emails, corporate filings, government documents, legal documents, and transcripts. All of which fly in the face of the Sacklers continuing to claim that OxyContin is not the problem, it’s the people who abuse it and get addicted.

“Addicts want to be addicted. They get themselves addicted over and over again.”

– Richard Sackler

This is the same kind of logic the NRA and gun lobbyists use: Guns don’t kill people, people kill people.

There is so much to unpack in the plethora of  Sackler lies, but a few things are easily understood even to someone with no medical degree:

 

1. Purdue never ran any studies on Oxy addiction or dependence.
2. They incentivized their sales force to sell ever greater amounts and larger doses of Oxy, using data to narrow in on hot spots in low income, white, high heavy-labor areas of the country like Maine, Ohio, West Virginia, and western Pennsylvania.
3. Purdue Pharma president, Richard Sackler, testified in 2001 that he had no knowledge of the drug being abused until 2000, despite corporate emails dating back to 1997 describing abuse issues.
4. In OxyContin’s clinical trials it was clear that the drug did not provide 12 hours of pain relief as prescribed. Withdrawal began in as little as 8 hours necessitating the need for a third daily pill.
5. The Sackler influence on politicians was such that from 1994 to 2015, the quota of oxycodone that the DEA allowed to be legally manufactured was raised 36 times.

Every page of Empire of Pain unveils another instance of incalculable avarice and disdain for human life (Purdue had a 2011 goal to get FDA approval of Oxy for children) that continues to this day. In 2018 when faced with lawsuits from virtually every state in America it declared bankruptcy to avoid paying out settlements. The Sackler influence ensured a judge favorable to uncoupling the liabilities of Oxy from the corporate proceedings. The family agreed to a slap on the wrist settlement from the DOJ in 2020 that was so slight, they are still ranked in the top 20 wealthiest families in America (Forbes).

Sadly, this is not a story with a happy ending. Even with tighter controls on OxyContin the epidemic has moved on to other drugs like heroin and fentanyl. A tipping point has been crossed and one smug, arrogant family continues to deny any responsibility and live off the blood money of hundreds of thousands of dead Americans. Empire of Pain is not a happy book. There is no justice, so why bother reading something that’s going to make your head explode? Because the only thing left is the shame of the truth. This is exceptional reading on the power of money and how its pursuit can corrupt not just people, but governments. A brutal education, but one I highly recommend.

 

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