A dynastic dive into opioids

Book review of Empire of Pain: The Secret History of the Sackler Dynasty

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 moral opprobrium and expensive accountability. 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,” Mr Keefe writes. “After the introduction of OxyContin, it did.”

In Empire of Pain, Mr Keefe, a staff writer for The New Yorker, traces the fortunes of the family dynasty at the centre 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.

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 favourable to his advertising clients. Arthur’s imprint on the paper was everywhere, Mr Keefe writes, but initially “his name could not be found anywhere on the masthead.”

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 tranquilisers 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 tranquilisers were about to expire, Roche 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,” Mr Keefe writes, but Arthur would spend the rest of his life trying to downplay the connection.

Mr 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.

Empire of Pain: The Secret History of the Sackler Dynasty

Author: Patrick Radden Keefe

Publisher: Doubleday

Price: $32.50; Pages: 535

It was Raymond’s son Richard who would push Purdue into the field of pain management. Mr 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 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. They also continued to obscure their family name behind the banner of Purdue Pharma. After pleading guilty to a misdemeanour 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 R&D, 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,” Mr Keefe writes. 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.

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. Mr 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 Mr Krishnamoorthi was having none of it: “I would submit, sir, that you and your family are addicted to money.”

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