According to the Centers for Disease Control and Prevention, in the quarter century following the introduction of OxyContin, some 450,000 Americans had died of opioid-related overdoses. Such overdoses were now the leading cause of accidental death in America, accounting for more deaths than car accidents — more deaths, even, than that most quintessentially American of metrics, gunshot wounds. In fact, more Americans had lost their lives from opioid overdoses than had died in all of the wars the country had fought since WWII.
There is a Chinese proverb that says, “Wealth does not pass three generations”, and in a way, Empire of Pain: The Secret History of the Sackler Family explores this adage. Journalist Patrick Radden Keefe takes a deep dive into explaining how three Depression-era brothers created an empire from nothing; how their children rapaciously turned a multi-million dollar conglomerate into a multi-billion dollar one; and how the third, current, generation is so entitled and out of touch that they insist on enjoying their family’s vast fortune while disavowing any connection to its accumulation. The book ends with the bankruptcy of Purdue Pharma — the exclusive manufacturer of OxyContin, wholly owned by the Sackler family — and universities, galleries, and museums around the world removing the Sackler name from their buildings. The Sackler family may have funnelled much of their wealth into offshore accounts in anticipation of their current legal imbroglios, but their name will be forever linked with the devastating opioid crisis that they knowingly unleashed on the world and it remains to be seen whether the current generation will have the knowhow to generate more wealth, or simply blow through what they have.
I most enjoyed the early parts of Empire of Pain: the story of two Eastern European Jewish immigrants who travelled to Brooklyn in pursuit of the American Dream and the work ethic that they instilled in their three sons; each of whom became a medical doctor, entrepreneur, and philanthropist. The eldest, Arthur, was a polymath, aesthete, and the most striving of the brothers (he would pay for his own and his brothers’ educations with his side hustles while in med school himself) and it was Arthur who would come up with the idea of owning each arm of the octopus that is drugs manufacturing and marketing. As Radden Keefe writes, “They could develop a drug, have it clinically tested, secure favorable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.” And while this first generation of brothers wasn’t entirely likeable or honorable, they did seem to work quite hard and commit themselves to philanthropic acts (even if, as Arthur’s lawyer once explained, Philanthropy wasn’t charity. It was a business. It was all about the tax write offs, the purchase of prestige, and the Sackler name above the door.) When the narrative gets to the second generation — those who developed OxyContin and unleashed a massive salesforce to push it on initially reluctant prescribers — the Sacklers appear to have entirely lost their humanity in the pursuit of colossal wealth.
In the 1940s, Arthur Sackler had watched the introduction of Thorazine. It was a “major” tranquilizer that worked wonders on patients who were psychotic. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. The beauty of the minor tranquilizers was that they were for everyone. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. Now Arthur’s brothers and his nephew Richard would make the same pivot with a pain-killer: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. And cancer was a limited market. If you could figure out a way to market OxyContin not just for cancer but for any sort of pain, the profits would be astronomical.
The details of this story are maddening — the pill mills, the corruption at the FDA, backroom deals at the Justice Department — and if I had a complaint it would be that there are simply too many details. Radden Keefe quotes everyone from doormen to other journos and countless unnamed insiders; there is an entire chapter (in an already long book) about Richard Sackler’s college roommate (who would find the man who eventually became the main driver behind OxyContin’s marketing push to be unempathetic and out of touch). And if I had another complaint: The main defense that the Sacklers seem to offer is that they were small players in the opioid market (they claim a 4% market share; Radden Keefe says that calculated in a different way, they were closer to 30%), yet the thrust of this book is that this one family and their small pharmaceutical company are entirely responsible for the opioid crisis (including the ensuing rise in heroin and fentanyl abuse in America), and I don’t know if the author proved that to me. (The Sacklers’ other defense is that they can’t be responsible for how addictive types might abuse their otherwise valuable medication and that leads to the interesting question of whether opioid manufacturers should be treated like Big Tobacco [who knowingly marketed a lethal product and ended up paying the price] or like the Gun Lobby [who get away with insisting that responsibility for the use of guns is entirely in the hands of the user.] I honestly don’t know the answer, but it’s an interesting question.) As an investigative journalist, Radden Keefe has found a great hook with the Sackler family — the humble beginnings, the genius and quest for respectability of the founders, the greed of the next generation that led to the accumulation of billions and the disgrace of the family name — but I wish he added more perspective on how they fit into the bigger picture of a genuine health and social crisis. This is an exhaustive story of a family, but it didn’t feel like the whole story.
As they sought to hide from a historic crisis of their own creation, the Sacklers could sometimes seem like Pandora, gazing, slack-jawed, at the momentous downstream consequences of their own decisions. They told the world, and themselves, that the jar was full of blessings, that it was a gift from the gods. They opened it, and they were wrong.
I might come across as nitpicking but this is still a 4+ star read; Radden Keefe tells a fascinating story about an urgent topic, and while it might be a bit long, I was never bored. One thing for certain: Were the Sackler wealth not to pass the third generation, there would be few tears outside the family.
