What did they know, and when
did they know it? That is, when did the Sackler family know that OxyContin, the
drug responsible for their vast fortune, was also partly responsible for the
opioid crisis? Such questions are no abstraction to the family of billionaires
currently fending off some 3,000 lawsuits filed by nearly every state, as well
as many cities, counties, and tribal governments, in America. The lawsuits
allege, among other crimes, that the privately owned Sackler family business,
Purdue Pharma, downplayed the risks of its blockbuster drug while illegally
boosting its sales, and that this scheme to profit led to
Discovering anything about the Sackler family, let alone the innermost workings of its privately owned companies, is not easy. The earliest investigations into OxyContin and the emerging overdose crisis did not mention the Sackler family by name at all. Even a front-page story in The New York Times, “Cancer Painkillers Pose New Abuse Threat,” did not use the Sackler family name. This gets to a paradox at the heart of their story. The Sacklers donated lavishly to art museums and galleries, insisting in return that the family name be plastered prominently on the walls of institutions like the Guggenheim and New York’s Metropolitan Museum of Art. But their name appeared nowhere near any of their pharmaceutical businesses.
In his new book, Empire of Pain: The Secret History of the Sackler Dynasty, New Yorker writer and investigative journalist Patrick Radden Keefe has provided the fullest picture of Sackler family dynamics so far, including what the family knew about OxyContin’s dark side and when. The book unfolds in three parts, with the first focusing on Sackler brothers Arthur, Raymond, and Mortimer, all doctors who grew up in Brooklyn in the early twentieth century. It was Arthur Sackler who mastered both medicine and marketing. Arthur was the brains behind the advertising campaign for Valium, which was the top-selling drug in the United States from 1968 until 1982, solidifying Arthur and the Sackler family as major players in the pharmaceutical business. But it was under a new generation of Sacklers—led by Richard Sackler (Raymond’s son) and Kathe Sackler (Mortimer’s daughter)—that the family’s fortune grew significantly more, thanks to OxyContin, which since 1996 has netted about $35 billion in sales for their company Purdue Pharma.
There have been numerous lawsuits and investigations into Purdue and OxyContin over the years, including a $600 million fine for false marketing in 2007, but none presented such rich insight into the family that’s been quietly reaping profits this whole time. A huge trove of court filings in 2019 laid the groundwork for Keefe’s exposé; he later also received a mysterious thumb drive by mail. Empire of Pain is ultimately a multigenerational tale of an American dynasty and its rocky tumble from the peaks of high society to the status of social pariah. Moving alongside the history of how the Sacklers accumulated their wealth is Keefe’s lucid, unrelenting portrayal of how the Sacklers, especially Richard, were fully aware of alarming reports of overdose deaths related to their product but continued to press and press for more sales. It’s also the story of how America’s government and regulatory agencies gladly furthered the Sackler family’s corporate interests.
If Arthur Sackler flew close to the sun selling Valium, it was Richard Sackler’s campaign to sell as much OxyContin as humanly possible, and then some, that set the whole family, and possibly a chunk of their vast fortune, ablaze.
Whatever your feelings on the excesses of American wealth in today’s gilded age, the Sackler clan featured in Empire of Pain come across as a petty, cold, and perpetually aggrieved bunch, despite their enormous wealth. Keefe’s reporting on the Sacklers, a mammoth undertaking that draws on discovery documents, internal company memos, and emails displaying Succession-level bickering among Sackler family members, is a window into their bunker mentality, reinforced by impenetrable walls of denial.
The book’s prologue sees Kathe Sackler casually answering questions during a deposition for a massive lawsuit against her and her family in 2019. “Some measure of defensiveness was to be expected from a corporate official being deposed in a multibillion-dollar lawsuit,” Keefe writes. “But this was something else. This was pride. The truth is, she said, that she, Kathe, deserved credit for coming up with ‘the idea’ for OxyContin.” (In fact, oxycodone, the sole ingredient in OxyContin, was invented in 1916 by a group of German scientists; the Sacklers simply added a delayed-release mechanism to it that was supposed to make each dose last 12 hours but didn’t.) While being deposed, Kathe is asked a simple yes or no question: “Do you recognize that hundreds of thousands of Americans have become addicted to OxyContin?” Her lawyers blurt out “Objection!” and all Kathe can say is, “I don’t know the answer to that.”
America’s poor system of public health surveillance, as demonstrated by the Covid-19 pandemic, makes it hard to figure out exactly how many people in this country are addicted to opioids, and which opioids they’re addicted to. But as a company, Purdue knew early on that OxyContin was a hit, especially in illegal markets. Two senior Purdue executives testified to Congress that it was not until the year 2000 that the company first learned of OxyContin’s popularity among recreational drug users. Yet Keefe’s reporting shows that Purdue and the Sacklers knew about the drug’s rampant “misuse” before then. In 1999, under the sardonic pseudonym “Ann Hedonia” (a play on the condition anhedonia, the inability to feel pleasure), one of Purdue’s legal secretaries, whose identity remains anonymous in the book, logged onto online forums and message boards devoted to recreational drug use. The purpose of her online mission was to prepare a memo cataloging the ways in which people were using OxyContin and becoming addicted to it.
Ann Hedonia found that people
were easily bypassing the drug’s supposed time-release coating and either snorting or injecting the pure
oxycodone underneath. By this time, OxyContin sales were generating $20 million
per week, which somehow for Purdue’s then-president, Richard Sackler, wasn’t
enough. According to emails obtained by Keefe, Richard Sackler’s response to
news of the sales was, “not so
great.… Blah, humbug. Yawn.”
According to a 2004 deposition, Ann Hedonia circulated her findings in a memo to “all the Sacklers” involved in running the company, a memo that Keefe reports later went missing from Purdue’s files. OxyContin was approved by the Food and Drug Administration in 1996, and Keefe documents that as early as 1997, reports of OxyContin’s misuse around the country flooded into Purdue from its sprawling sales force. With so much OxyContin flowing through the medical system, significant amounts of the drug spilled over onto the street. At one point, OxyContin was selling for $1 per milligram (an 80 milligram pill could sell for $80 or more). While plenty of patients found pain relief with OxyContin, many others found the drug numbed the pain of trauma, economic precarity, and isolation.
How did Richard Sackler respond to news of growing addiction to OxyContin? He doubled down, and cranked up the sales.
By far the most enraging detail, for me, in Empire of Pain is how Richard Sackler decided to handle the risks of the drug. In emails that were either leaked to Keefe or appeared in court filings, Richard Sackler shows outright contempt for people who struggle with substance use disorders. He and Purdue capitalized on the long-standing stigma toward people who use drugs that is central to American drug policy, and made it a go-to feature of their overall defense strategy, as Keefe explains:
What Purdue should do, [Richard] decreed, was “hammer on the abusers in every way possible.” They are “the culprits,” he declared. “They are reckless criminals.”
Keefe writes that this became the company line “promoted to the outside world, and also to its own workforce.” In an email dated February 1, 2001, Richard Sackler says, “Abusers aren’t victims. They are the victimizers.” Purdue’s defense has consistently been that the company simply manufactured and sold a legal drug approved by the FDA, and that if anyone is a criminal, it is those who became addicted and “abused” their drug.
The story of Ann Hedonia, the legal secretary at Purdue who researched the memo about recreational OxyContin use, is a study in how the company demeans and discredits those with substance use disorders. In the book, Keefe gives Ann Hedonia the pseudonym Martha West. One day at Purdue’s headquarters in Connecticut, a top lawyer, Howard Udell, noticed West walking around the office with a limp. She told Udell that she suffered from back pain stemming from a car accident. “We got to get you on OxyContin,” Udell told her. Through a referral from Purdue’s medical department, West was connected to a local pain specialist in Connecticut. Eventually, she became addicted to OxyContin, and just as she’d read in the online drug forums, she crushed and snorted her medication for a concentrated dose of oxycodone.
After 21 years at the company, West was fired for “poor work performance,” and she was escorted out of the building by Security. West tried to sue Purdue, but Purdue fought back, dirty. Purdue lawyers got hold of her medical records and exploited what they viewed as her main weakness: a substance use disorder diagnosis. Purdue lawyers asked, “Was OxyContin not just the latest entry in a litany of substances she had abused?” She was characterized as an unhinged “drug abuser” with no moral or legal ground to stand on.
In press for Empire of Pain, Keefe told The New York Times that he did not set out to write an “opioid crisis book, per se.” After all, the Sacklers are just one family, and a type of family that American capitalism seems routinely to cook up these days. The opioid crisis is a story about the Sacklers, but it is also much bigger than them. It’s not only a story about people overdosing, dying, or becoming addicted to drugs. It’s also a story of how pain is treated in America, and how the American way of government caters to rich corporations while screwing over individuals.
Up until the 1990s, opioids were rarely prescribed long-term for chronic “non-malignant pain.” That is, pain that isn’t caused by cancer. There are a few reasons for this—one is that doctors were correctly being taught that opioids cause physiological dependency in their patients. Another is that the federal government once operated under a spirit of robust regulatory enforcement that did not let pharmaceutical companies release new opioids on the market very easily. Enter the so-called Reagan Revolution, and the fervor for small government that transformed the country. Both parties proceeded to cut budgets and hollow out regulatory agencies across critical sectors, especially pharma and health care. Now free enterprise could flourish, and the rising tide would lift all boats, etc. At the same time, there really was a problem with the undertreatment of pain in this country, though the Sacklers and their drug were maybe the worst solution to it.
At first, Purdue’s team of scientists and lawyers were aware that the FDA would probably restrict OxyContin solely to the cancer pain market. But Keefe dug up an internal company memo that shows a hidden plan “to expand the use of OxyContin beyond Cancer patients to chronic non-malignant pain.” After its courtship of a former FDA official named Dr. Curtis Wright, Purdue got what it wanted from the federal government: approval of its drug for “moderate to severe pain,” which dramatically expanded the market and reach of OxyContin.
“This didn’t just ‘happen.’ It was a deftly coordinated, planned event,” Keefe reports Richard Sackler telling his staff after the drug flew through the FDA’s approval process. Whereas other filings can linger for years at the FDA, “this product was approved in eleven months, fourteen days.” Shortly after the approval of OxyContin, Curtis Wright left the FDA and went to work for Purdue Pharma with a first-year compensation package of $400,000.
This story is much bigger than the Sacklers indeed. Without government regulators all too willing to cave to corporate interests, or an industry norm of putting profits ahead of patient health and safety, the Sacklers never would have gotten this far.
Finally, there’s the tragic story of pain patients. While the volume of opioid prescriptions has dropped by 60 percent from their peak in 2011, the number of overdose deaths continues to soar, and not from OxyContin but from much more potent, illicitly manufactured opioids like fentanyl. Just as the Sacklers scapegoated people who suffered addiction, the screws have been tightening on patients suffering from intractable pain. Efforts to dial back opioid prescribing have put pain patients who actually need relief in the crossfire. Things are so bad that academics are now studying a rash of patient suicides related to rapid, often mandatory, opioid tapers. After a Veterans Affairs doctor abruptly cut off a military veteran from opioids he was using to manage chronic pain, the vet shot himself in the VA parking lot. As in many projects about the opioid crisis, stories of pain patients tend to be an afterthought. Empire of Pain focuses much more on Sackler family dirt and addiction than the plight of pain patients today who, as Brian Goldstone reported in Harper’s, view themselves as “refugees” of the opioid crisis.
Keefe’s book is ultimately an important record of private greed facilitated by a corrupted government. The book’s conclusion is somewhat open-ended. The Sacklers have proposed to settle all pending litigation against them by coughing up some $4 billion. It remains unclear if that deal will be the end of their story. But one thing that’s certain after reading Keefe’s book is that between an ever-growing death toll from overdose deaths and a generation of pain patients left to fend for themselves, much more than lawsuits and money is needed to get America out of this painful nightmare.