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Empire of Pain review: the Sacklers, opioids and the sickening of America | Books


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By 2016, opioids had torn a piece out of Appalachia and the rust belt. The deep drop in life expectancy among white Americans without four-year degrees would no longer be ignored. OxyContin, Purdue Pharma’s highly addictive painkiller, helped elect Donald Trump.

In Empire of Pain, Patrick Radden Keefe methodically and meticulously chronicles this tale of woe and crisis, indifference and corruption. His Secret History of the Sackler Dynasty lays bare the price exacted by the family’s drive for wealth and social mountaineering.

The Sackler name came to dot the Metropolitan Museum of Art, the Smithsonian, Tate Modern and the Louvre. They rose – others paid dearly.

Keefe is a veteran writer at the New Yorker. His 2019 bestseller, Say Nothing, chillingly examined the convergence of youth, zealotry and destruction in Northern Ireland. He even solved the mystery behind a disappearance.

Like Say Nothing, Empire of Pain is drenched in misery, this time the byproduct of OxyContin, the go-to drug for Purdue. Since 1999, opioid-related deaths have risen more than fivefold. By the numbers, opioids have killed more than 450,000 in the US in two decades.

Keefe’s book builds upon The Family that Built an Empire of Pain, a 2017 long read. Empire of Pain is filled with firsthand interviews and takeaways from confidential and original documents. It is a chilling and mesmerizing read, “substantially built on the family’s own words”. Which is what makes it so damning.

The Sacklers did not cooperate. Indeed, they sought to derail publication. Keefe raises the possibility he was placed under surveillance, an attempt to intimidate him and his family. Nonetheless, the Sacklers’ indifference and smugness rise off the pages like steam from a sewer.

In one 1996 email, Richard Sackler, Purdue’s chairman and president, demands the company become as feared as a “tiger with claws, teeth and balls”. Asked repeatedly at deposition years later if Purdue played any role in the opioid crisis, he steadfastly answers: “I don’t believe so.”

A cousin, Kathe Sackler, actually boasts that OxyContin was a “very good medicine” and a “safe medicine”. She also claims credit for coming up with the “idea”. But she doesn’t end there.

Confronted with the question, “Do you recognize that hundreds of thousands of Americans have become addicted to OxyContin?”, she can only muster: “I don’t know the answer to that.”

The drumbeat surrounding the monster birthed by Purdue is as old as the century itself. Barry Meier, then of the New York Times, published Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic, in 2003.

Yet faced with pushback from Purdue and the Sacklers, the powers that be swept the crisis under the rug. Even the Times came down with a case a temporary case of cold feet.

In 2007, under George W Bush, the US justice department only delivered a relative slap on the wrist. The Sacklers, major Republican donors, had unleashed a full-scale counter-attack starring Rudy Giuliani, Mary Jo White, formerly in charge of the southern district of New York and the Securities and Exchange Commission, and a bevy of high-priced legal talent.

Strings were seemingly pulled, career prosecutors’ findings and recommendations discounted and binned. Purdue agreed to pay $600m to resolve a felony charge of misleading and defrauding physicians and consumers. Three executives entered guilty pleas and agreed to $34.5m in penalties. None of the individuals criminally charged were Sacklers.

In the words of a former DoJ lawyer, this was “a political outcome that Purdue bought”. The company named its in-house law library after one of the designated-offenders and paid millions in post-employment compensation: a reward for taking a bullet for the team.

Paul McNulty, then deputy attorney general, helped handcuff justice. John Brownlee, the federal prosecutor for the western district of Virginia, clashed with McNulty over the disposition of the case. Word spread that Brownlee’s job tenure was shaky. He resigned in April 2008. For the record, James Comey, McNulty’s predecessor as deputy AG, resisted Purdue’s entreaties.

Among hundreds of interviews, Keefe spoke to Brownlee and Rick Mountcastle, the line prosecutor and career lawyer who handled the case. Still at DoJ, Mountcastle raises the possibility Purdue had an inside man at the Food and Drug Administration who enabled OxyContin in exchange for the prospect of future employment.

Kathe Sackler is sworn in before the House oversight committee, in December last year.
Kathe Sackler is sworn in before the House oversight committee, in December last year. Photograph: Reuters

Based on a 1995 email, Mountcastle began to suspect that Curtis Wright, then an FDA examiner, had turned a blind eye to the dangers posed by OxyContin. Purdue would later tap Wright to be an executive director. In 2003, Wright testified that he still believed addiction to OxyContin was “rare”.

“I think there was a secret deal cut,” Mountcastle tells Keefe. “I can never prove it, so that’s just my personal opinion. But if you look at the whole circumstances, nothing else explains it.”

Regardless, the FDA helped pave the way for an opioid epidemic. Dr David Kessler, FDA commissioner when OxyContin received the agency’s approval, acknowledged “certainly one of the worst medical mistakes”.

Donald Trump spoke of the toll of the opioid crisis but in 2020, as election day loomed, his Department of Justice announced a “global resolution” of the government’s investigation into Purdue and the Sacklers. By then, the company was in bankruptcy and the target of a barrage of civil lawsuits.

The Sacklers agreed to pay a $225m civil penalty, little more than the 2% they had taken from Purdue. But no one would be prosecuted. Asked why the government had not brought criminal charges against the Sacklers, Jeffrey Rosen, Bill Barr’s deputy attorney general, declined to say.

The government, Keefe writes, was “so deferential toward the Sacklers that nobody even bothered to question them”.

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