Empire of Pain: The Secret History of the Sackler Dynasty

“Empire of Pain: The Secret History of the Sackler Dynasty”

by Patrick Radden Keefe

Doubleday, 535 pp. $32.50

The opioid epidemic has killed nearly half a million Americans over the past two decades. Many of their loved ones, along with public health advocates and experts, believe that one very rich, very famous family has never fully faced the consequences for its role in those deaths. “Empire of Pain,” the explosive new book by journalist Patrick Radden Keefe, is an attempt to change that — to hold the family accountable in a way that nobody has quite done before, by telling its story as the saga of a dynasty driven by arrogance, avarice and indifference to mass suffering.

The family is the Sacklers, who until a few years ago most people knew only as the benefactors of universities and museums, including a Smithsonian gallery named for Arthur M. Sackler. But the clan, which made its fortune in the pharmaceutical business, was also the money and power behind Purdue Pharma, the maker of OxyContin, a potentially addictive pain medication that has played a key role in the opioid crisis. The Sacklers and their legal representatives have long challenged reports suggesting that they deliberately downplayed Oxycontin’s dangers or otherwise bear some responsibility for the epidemic. Among those reports was a 2017 article by Keefe in the New Yorker, where he is a staff writer. The magazine stood by the article following an internal review.

The Sacklers did not cooperate with Keefe in the writing of his book. As he explains, in his final attempt to get answers from the Sacklers, he sent a lengthy memo of queries, by request, to a family lawyer. A brief, one-and-a-half-page response claimed that Keefe’s questions were “replete with erroneous assertions built on false premises” — and declined to answer them specifically.

In “Empire of Pain,” Keefe marshals a large pile of evidence and deploys it with prosecutorial precision. Some of the material comes from other journalists, among them Barry Meier, author of the acclaimed 2003 book “Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death,” who is also a key character in Keefe’s story. The rest comes from Keefe’s own reporting, which included interviews with more than 200 people, access to internal company documents, and a review of tens of thousands of pages of court documents that public and private lawyers collected in the course of their investigations and lawsuits.

Purdue introduced OxyContin in the late 1990s, at a moment when the medical profession was seeking better ways to alleviate pain, which it had been neglecting. A central problem for generations was that the most effective drugs were prone to cause addiction. Enter OxyContin, a hard-shelled pill that released its powerful medication slowly and steadily, thus avoiding the peaks and troughs of pain relief that can foster addiction.

Or at least that was the sales pitch. In reality, people figured out pretty quickly how to extract the opioid substance, usually by crushing the pill’s shell. Then they would ingest it, frequently by snorting, and get a quick high. From there, people would sometimes move on to illicit drugs like heroin and, in too many cases, fatal overdoses.

One of the book’s most revealing episodes is from 1999, as the first stories of OxyContin addiction were spreading, when a Purdue corporate officer asked his legal assistant to enter online chat rooms under a pseudonym and learn how people might be abusing the drug. She discovered the stories of crushing and snorting, Keefe writes, and put it all in a memo that Purdue later denied having but whose existence a Justice Department investigation subsequently confirmed.

The twist in the story is that the legal assistant ended up taking OxyContin for back pain, at her boss’s suggestion, and got addicted by using some of the same methods she’d investigated. Her work performance suffered, and Purdue fired her after 21 years with the company. She later sued, but the legal action went nowhere, Keefe reports, because the company subpoenaed her old medical records to show that she had struggled with addiction before.

It was a few years after her memo circulated, in 2007, that federal prosecutors first went after Purdue, winning what seemed at the time to be a significant victory. One of the company divisions pleaded guilty to “misbranding” OxyContin, while three top executives pleaded guilty to individual misdemeanor versions of the same crime. Purdue also agreed not to contest an official fact-finding document detailing the company’s marketing methods, which management designed specifically to overcome physician fears about addiction.

But neither the fine nor the pleas did much to change company behavior, according to Keefe.

As for the Sacklers themselves, they were not among the executives who faced charges. And as the body count grew, family members insisted that the problem was the people getting addicted, not the drug or Purdue’s marketing of it.