Book Review: ‘Empire of Pain,’ by Patrick Radden Keefe

Keefe nimbly guides us through the thicket of family intrigues and betrayals — how Arthur purchased the patent medicine company Purdue Frederick for his brothers, Mortimer and Raymond, in 1952, before he grew apart from them; and how Arthur’s heirs sold their shares to the surviving brothers after he died in 1987. Arthur’s descendants have tried to distance themselves from their cousins, protesting that they weren’t involved in the creation of OxyContin, but Keefe suggests they can’t get away from Purdue’s origin story. Arthur had created a fortune and a template.

It was Raymond’s son Richard who would push Purdue into the field of pain management. Keefe portrays Richard as ambitious, arrogant and almost comically impatient. One of Purdue’s reliable if unglamorous best sellers was a laxative; a restless Richard leaned on his staff to “get it to work more quickly.”

But OxyContin was different. Its innovation resided in its time-release coating, intended to slow down delivery of its chief ingredient, oxycodone — an opioid twice as potent as morphine, even if physicians back then were mostly unfamiliar with the name and assumed it was weaker. Purdue decided it wouldn’t correct this misapprehension; instead, the company instructed its salespeople to target family physicians, whom the company called “opioid naïve.”

The Sacklers themselves were shrewd — insisting all along that they had no idea that an alarming number of Americans were getting addicted to their product, even if their own sales data reflected what was happening. They also continued to obscure their family name behind the banner of Purdue Pharma. After pleading guilty to a misdemeanor charge for misleading regulators in 2007, the company perversely doubled down on opioids by developing a painkiller patch. But the Sacklers otherwise slashed spending on research and development, choosing instead to start siphoning off more and more money for themselves.

This strategy came in handy in 2019, when Massachusetts became the first state to sue Sackler family members by name, and their response was to declare Purdue Pharma bankrupt, which allowed them to obtain an injunction on any lawsuits; by then “the family had looted its own company,” Keefe writes, and “Purdue Pharma’s coffers were nearly empty.” Last month, the Sacklers offered to pay $4.275 billion from their personal fortune in an attempt to end thousands of lawsuits that have been filed against the company. Whether their bid is accepted remains to be seen.

Needless to say, Keefe, who wrote about the Sacklers for The New Yorker in 2017, didn’t get the family to cooperate with this book, but in a note he recalls receiving a thumb drive that was mailed to him anonymously and included thousands of pages of documents. He sifted through 40 boxes of files from congressional investigations into the pharmaceuticals industry in the late ’50s and early ’60s. He interviewed dozens of former Purdue employees. He got in touch with Richard’s college roommate, who remembered Richard’s determination to spend a summer “solving the scientific riddle of the orgasm.” Even when detailing the most sordid episodes, Keefe’s narrative voice is calm and admirably restrained, allowing his prodigious reporting to speak for itself. His portrait of the family is all the more damning for its stark lucidity.

Amid all the venality and hypocrisy, one of the terrible ironies that emerges from “Empire of Pain” is how the Sacklers would privately rage about the poor impulse control of “abusers” while remaining blind to their own. Keefe describes a moment during congressional hearings last year, when Representative Raja Krishnamoorthi questioned Richard’s son, David, who tried to distance himself from a $22 million mansion his family had acquired by saying it was merely an “investment property” — as if that was exculpatory. But Krishnamoorthi was having none of it: “I would submit, sir, that you and your family are addicted to money.”