Book Review: Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe

The story told in Empire of Pain is not just about the opioid painkiller OxyContin and its devastating effects on millions of pain sufferers. That story has been told several times by very competent writers. Instead, Patrick Radden Keefe traces the lives of the Emperors of Pain—the Sackler family—from their beginnings in America right up to the point that their pharmaceutical empire crumbles around them.

At first, you might wonder why Keefe spends so many pages tracing the early history of the family, reaching all the way back to 1913. He starts his story with a focus on the patriarch of the Sackler family, Isaac Sackler, father of Arthur, Mortimer and Raymond Sackler. He doesn’t even turn his attention toward OxyContin, the blockbuster drug marketed by Purdue Pharma, until after page 200.

His broad focus will make more sense when you finish this book. He is painting a complete picture of how and why this family could operate with such arrogance, greed and disregard for human life. These characteristics were the reason the members of this family could create ruthlessly aggressive marketing campaigns for multiple drugs that turned out to be addictive or bank massive profits from these actions and shut their eyes to the wreckage caused.

It is incomprehensible to the decent, caring people I know that anyone could act with such reckless abandon. And rake in billions of dollars while doing so. Perhaps it requires this meticulous history to be able to grasp the magnitude of this family’s pitiless greed.

Meticulous Reporting

The word I see most often used to describe Keefe’s writing is “meticulous.” It is accurate. He has compiled a staggeringly comprehensive history of all the major players in this family.

The family’s Machiavellian actions are viewed against a similarly detailed backdrop of Congressional hearings, federal investigations and court cases. I could have, in fact, have lived with a little less detail about Arthur Sackler’s art collections and a litany of all the marriages and residences.

The sections of the book that were the most fruitful for me, considering that I have been documenting the opioid epidemic for 15 years, were the thorough backstories about investigations and legal actions. It was in these sections that there was the greatest sense that justice might be done for all the lives lost as a result of the unrestrained and fraudulent marketing of OxyContin.

Many of the questions I had as I watched overdose deaths climb through the roof were finally answered, along with answers to questions I didn’t even know I should ask.

For example:

• Why didn’t anyone go to jail when federal attorneys charged Purdue Pharma executives with crimes in 2007? 
• Why didn’t their admission of guilt make any difference in the years that followed? 
• Why did the FDA fail to take any action to rein in this catastrophe that continues to this day? 
• How have the Sacklers and their key staff managed to escape consequences, year after year?

Just Deserts

By the time you close this book, you will know without a doubt that the Sacklers have inherited, if not the poverty they deserve, the complete annihilation of their once-sterling reputations as business magnates and social darlings. (If you make an internet search of the term “Sacklers social pariahs,” you’ll get 153,000 search results.) This is a weighty book and a lot to digest. Even so, it would be rewarding reading for any person that has lost a member of their family or dear friend to opioids.