In Empire of Pain, Patrick Radden Keefe compellingly narrates the story of the Sacklers and their connection to the opioid epidemic through OxyContin, the drug that the Sacklers’ pharmaceutical business devised, created, and marketed.
Keefe’s epic has it all: money, power, sex, public and private corruption, deceit, legal proceedings and investigations, disease, death, and tragedy. And perhaps best of all, it leaves readers with two unstated yet fascinating questions.
Keefe starts with the life of Arthur Sackler, the man who made the Sacklers’ first fortune. In high school during the Great Depression, Sackler used a combination of great entrepreneurial skill and hard work to help support his parents and two younger brothers. Then he put himself and his two brothers through college and medical school.
Sackler practiced psychiatry, owned and operated advertising agencies that specialized in marketing pharmaceuticals, and published a medical newsletter. He masterminded the wildly successful and in retrospect unscrupulous marketing of Librium and Valium, brought his brothers into his business ventures, and made them all very rich.
At the same time, Sackler lived a very complex personal life and devoted considerable time and money to the arts and philanthropy. He and his family donated lavishly to museums and universities. In exchange, they insisted on prominent placement of the Sackler name on buildings and exhibits.
After Arthur’s death, his brothers Mortimer and Raymond and their families made far bigger fortunes from their pharmaceutical company, Purdue Pharma, which marketed OxyContin.
Through dubious methods, Keefe explains, they secured Food and Drug Administration approval to market OxyContin (1) as appropriate for all patients with pain rather than merely for cancer patients, (2) for lifetime use rather than short-term use, and most importantly (3) with claims that their drug created less risk of addiction despite being more powerful than other opioid medications.
This marketing campaign was wildly financially successful but eventually got the Sacklers and Purdue into trouble, Keefe shows, as they pursued it with increasing aggressiveness. In 2007, a Purdue affiliate pleaded guilty to federal criminal charges. In 2020, Purdue Pharma pleaded guilty to more federal criminal charges. The Sacklers’ lawyers, however, managed to convince the Department of Justice in both 2007 and 2020 not to indict the Sacklers.
Meanwhile, state attorneys general began asserting a myriad of civil claims against Purdue and the Sacklers for massive sums. Keefe describes how these claims led Purdue to file for bankruptcy and to use that proceeding to stay the claims against both the company and the Sacklers to gain leverage in their highly complex negotiations with the state attorneys general to turn Purdue into a charitable trust that would, along with the Sacklers, fund massive payments to the states through the continued sale of opioids.
Along with this litigation, the intense controversy associated with the Sacklers’ responsibility for the opioid epidemic has led to public shaming of the Sacklers. Museums and universities have refused further gifts from the family, have removed the Sackler name from buildings and exhibits, and have ended relationships with the family.
As key developments in this saga continue to unfold, Keefe’s narrative implicitly raises two intriguing questions. He notes that the Department of Justice decisions in 2007 and 2020 not to pursue criminal charges against the Sacklers remain unsolved mysteries. He does not, however, explore why the state attorneys general, who have been vociferous in their condemnations of the Sacklers and so aggressive in pursuing civil claims to recover vast sums from them, have not pursued their own criminal charges (which generally are not stayed by bankruptcy proceedings) against the Sacklers.
Keefe also does not offer any thoughts about whether the consequences of legal OxyContin distribution through physicians and pharmacies enhance or detract from arguments for legalization of heroin and other currently illegal drugs.
Legal distribution of OxyContin by prescription after consultation with physicians has caused great harm to some patients to whom it has been prescribed. Legal distribution, however, avoids contaminated drugs of dangerously varying potencies. Legal distribution, moreover, generally has not resulted in the extensive collateral harm caused by the illegal drug trade: massive funding of drug cartels and gangs; violence by the cartels and gangs that continues to kill vast numbers of innocent third parties not involved in the drug trade; and widespread corruption of law enforcement and the judiciary in Mexico and other foreign countries.
Would we — especially those of us who don’t use illegal drugs — at least be safer if those who wish to use heroin, for example, could instead legally obtain uncontaminated heroin with consistent potency by prescription, after consultation with physicians, rather than through dangerous black markets?
David M. Simon is a lawyer in Chicago. For more, please see www.dmswritings.com.