The Sacklers had given away hundreds of millions of dollars, and for decades the Sackler name had been associated in the public mind with philanthropy.

But Patrick Radden Keefe reveals the other side of the Sackler name in Empire of Pain, where he exposes (in meticulous and gripping detail) how the Sacklers were responsible for developing OxyContin, the painkiller that is described as the ‘taproot’ of the opioid epidemic.

There are so many elements to this story that are in equal parts shocking and not at all surprising. People navigating their way out of trouble with money is nothing new. Big pharmas getting away with stuff that is ethically questionable is nothing new. However, the length of time that it took for people to join the dots on the social destruction that the use of OxyContin initiated was remarkable.

To break it down –

Prior to the introduction of OxyContin, America did not have an opioid crisis. After the introduction of OxyContin, it did.

People who had been prescribed OxyContin, and then could no longer get it, moved to street drugs such as heroin or fentanyl (chemically, these drugs are closely aligned, and all are highly addictive). The issue lay in the initial prescription. OxyContin was prescribed to all sorts of people for all sorts of reasons. It was marketed aggressively to doctors, using techniques that were groundbreaking.

The drug became one of the biggest blockbusters in pharmaceutical history, generating some $35 billion in revenue.

Keefe’s narrative style is precisely what I want in my nonfiction, and in Empire of Pain, what stands out is the development of rich ‘characters’. Keefe creates a detailed and insightful account of each of the Sacklers, beginning with father Isaac, whose ‘motto’ guided the growth of his children’s pharmaceutical business –

…if you lose a fortune, you can always earn another… But if you lose your good name, you can never get it back.

Which makes this bit kind of tricky (because it suggests that the Sacklers knew that what they were peddling was very, very damaging) –

Whereas the Sacklers tended to insist, through elaborate ‘naming rights’ contracts, that any gallery or research center that received their generosity must prominently feature the family name, the family business was not named after the Sacklers.  In fact, you could scour the Purdue Pharma’s website and find no mention of the Sacklers whatsoever.

Empire of Pain is packed with astounding detail, particularly around patent law and the marketing of the drug. Arthur was the first to use terms such ‘broad spectrum’ in medical literature, provided sample packs of OxyContin to get people started until they could fill their prescription, and gave away branded stethoscopes to medical students (get them while they’re young…).

It becomes clear that Purdue Pharma was ‘lucky’ to stumble across the formula for OxyContin, and once they did, they put all their eggs in that basket (they did not develop or manufacture anything else of significance).

…in the pharmaceutical art…you have to make your money in the interval between marketing and obsolescence.

And the Sacklers mined that interval in a way not seen before.

There’s a subplot – Arthur Sackler’s art collection and extraordinarily generous donations.

Arthur was insistent that he was not merely some plutocrat collecting baubles: he was creating a durable public good.

The Sackler name appeared in museums, in universities, and for scholarships and prizes. Arthur ‘…desired posterity, but not publicity’. But their name was not linked to their product (There’s Isaac’s family motto coming to force). They maintained until the end, that OxyContin was a ‘very good medicine’ and that it was ‘very effective and safe’, and displayed a dogged determination to ignore the link between the drug that they had created and how it was being used. It made any ‘genuine moral epiphany’ an impossibility. The empire crumbled. The devastation caused by opioids remains.

4/5 Gripping (all 535 pages of it).