Book of the week: Empire of Pain

Patrick Radden Keefe examines the dynasty behind the opioid crisis

(Image credit: Darren McCollester/Getty Images)

“Some books make you so angry you want to chuck rocks at the bad guys they expose,” said John Arlidge in The Sunday Times. “This book is one of those.” It tells the story of the Sackler family, whose firm, Purdue Pharma, created the painkiller OxyContin, which “fuelled America’s opioid crisis”.

Although this isn’t the first book about the crisis, it goes further than any other: Patrick Radden Keefe, a writer for The New Yorker, draws on newly released court documents and more than 200 interviews to show how the Sacklers derived a multibillion-dollar fortune from a pill they “knew was highly addictive”.

The epidemic it spawned has destroyed communities, and killed half a million people – “more than died in all the wars the country has fought since 1945”. And yet for decades, the Sacklers “got away with it” – even becoming celebrated philanthropists, thanks to their lavish donations to museums and galleries.

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The three Sackler brothers, Arthur, Mortimer and Raymond, were born to Jewish immigrants in Brooklyn, became doctors and bought Purdue in 1952, said Joanna Walters in Literary Review. Arthur became a “leading light in the nascent medical advertising industry” – a “toxic marriage of pills and ad men” – and deployed “all kinds of slippery tactics” to make Valium the most widely abused prescription drug of its day.

Where he led, his descendants followed, said Samanth Subramanian in The Guardian. When OxyContin was launched in 1996, the Sacklers relied on studies they themselves had funded to bolster the claim that it was less addictive than other opioids. The drug was approved by the Food and Drug Administration (FDA) – by an official who a year later was “working at Purdue, earning $400,000 a year”.

Equally amoral was Purdue’s marketing of OxyContin, said Melanie Reid in The Times. Sales reps “fanned out across the US”, targeting doctors in regions where many people lived with chronic pain. Patients were offered free 30-day taster courses, and doctors were incentivised to “titrate up” – gradually increase the dose. When it became clear that thousands were becoming addicted, Purdue shifted the blame to the drug users – as Arthur Sackler had done with Valium.

“It is a measure of great and fearless investigative writing that it achieves retribution where the law could not.” To this day, no Sackler has ever faced criminal prosecution – and the family has retained most of its billions in personal wealth. “But Radden Keefe has, word by forensic word, dismantled what mattered most to them: their reputation.”

Pan Macmillan 560pp £20; The Week Bookshop £15.99

Empire of Pain

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