Empire of Pain. By Patrick Radden Keefe. Doubleday; 560 pages; $32.50. Picador; £20
AT 50,000 OVERDOSE deaths a year and rising, America’s opioid crisis has never been worse. What began in the late 1990s as an epidemic of prescription pain-pill abuse morphed into a worse one of illicit heroin and, later, fentanyl. Prosecutors and the public have zeroed in on Purdue Pharma, which introduced the blockbuster drug OxyContin in 1996. Of the colossal revenues it generated, some $13bn was paid to the company’s previously low-profile owners, members of the Sackler family, who have recently sunk from honoured arts patrons to society pariahs.
Patrick Radden Keefe’s excellent new book tells the story of this now-infamous clan. He traces the empire of the title to Brooklyn in 1920, and a trio of brothers born to Jewish immigrants: Arthur (the eldest and, in Mr Keefe’s telling, the “patriarch”), Raymond and Mortimer. Arthur Sackler’s business acumen and questionable ethical judgment proved lucrative. He in effect invented the field of medical advertising, creating the first family fortune after aggressively marketing the sedatives Librium and Valium to doctors, without a serious study of the addiction risks. A fascination with Chinese artefacts led him to bequeath huge sums to prestigious museums. For decades the Sackler name would primarily be associated with that largesse.
Arthur died in 1987, almost a decade before Purdue, which the brothers had acquired in 1952, began selling OxyContin. By the time that happened, his branch of the family no longer held a stake—facts that its members hope will exonerate them from the taint of the “OxySacklers”. But after a gripping if lengthy account of the patriarch’s career in the first third of his book, Mr Keefe’s view is less forgiving. “So many of the antecedents of the saga of OxyContin could be found in the life of Arthur Sackler,” he concludes.
For the other two brothers and their descendants, Purdue yielded money beyond even Arthur’s imaginings. “The prescription blizzard will be so deep, dense and white,” Richard Sackler, son of Raymond, promised at the launch party for OxyContin. His words proved all too prophetic. The plan for mass-market opioids was abetted by misleading advertising, which claimed that less than 1% of patients would become addicted, and a vast salesforce incentivised by lucrative commissions.
The company peddled theories of “pseudo-addiction” (for which the cure was said to be more opioids) and of “opiophobia” among sceptical doctors. The guardrails against harm buckled in the face of Purdue’s wealth and the lawyers and lobbyists it could buy. Regulators endorsed ludicrous claims about the drug’s safety. A serious case brought by federal prosecutors in Virginia in the early 2000s was watered down by the Department of Justice. Thousands of doctors were given all-expenses-paid trips. Altogether, OxyContin took in $35bn in sales.
The results were brutal. Other drug manufacturers soon followed Purdue’s lead. When OxyContin was reformulated in 2010 to make it more difficult to abuse, many Americans who were already addicted switched to heroin and, eventually, fentanyl. In 2019 a team of economists rigorously evaluating OxyContin’s impact concluded that its introduction and marketing “explain a substantial share of overdose deaths” over 20 years.
Purdue is now the subject of many lawsuits brought by state and city governments. Sifting through the reams of evidence unearthed by court proceedings, Mr Keefe shows how callous some of the remaining Sacklers have been over the destruction wrought around them—blaming the problem on immoral addicts rather than the drug, and regarding themselves as victims of a media witch-hunt. Shiftless third-generation types are rendered with evident loathing, skilfully skewered by their own words in court or by Mr Keefe’s (anonymous) sources. One aspiring fashionista wishes an obstreperous journalist would focus less on her last name and more on the hoodies she designs.
The company pleaded guilty to assorted federal charges over its handling of OxyContin in November 2020. No Sacklers, and no executives, were obliged to acknowledge guilt personally, however, “as if the corporation had acted autonomously, like a driverless car”, Mr Keefe observes. Still, the Sackler name is mud. Museums and universities refuse their money. The Sackler wing of the Metropolitan Museum of Art, which houses an ancient Egyptian temple, was targeted by protesters chanting “Temple of greed! Temple of Oxy!” Purdue is bankrupt (and may not pay the retirement benefits of its salespeople).
Yet ongoing legal efforts to claw back the fortunes extracted by the owners appear unlikely to succeed. The implosion of the empire of pain, it seems, comes with a golden parachute. ■
This article appeared in the Books & arts section of the print edition under the headline "Patrick Radden Keefe traces the roots of America’s opioid epidemic"