Introduction
In "Empire of Pain," Patrick Radden Keefe tells the gripping story of the Sackler family, their rise to immense wealth and power, and their eventual fall from grace. This book uncovers the dark secrets behind one of America's richest families and their role in the devastating opioid crisis that has claimed hundreds of thousands of lives.
The story begins with Isaac Sackler, a Jewish immigrant who arrived in America with little more than his good name. On his deathbed, he told his three sons – Arthur, Mortimer, and Raymond – that while he couldn't leave them much money, he was proud to pass on his good name. Little did he know that his sons would go on to build a vast fortune, becoming one of the wealthiest families in America, only to eventually lose that very thing their father held most dear: their reputation.
The Rise of the Sackler Empire
Arthur Sackler: The Visionary Hustler
Arthur Sackler, the eldest of the three brothers, was a born hustler. Even as a high school student, he showed a knack for business, selling ads for the school paper on commission. His entrepreneurial spirit was so strong that he had to delegate some of his side gigs to his younger brothers, Mortimer and Raymond.
Despite graduating during the Great Depression, Arthur's hard work and business acumen allowed him to buy his parents a grocery store in Brooklyn. He then pursued a medical degree at NYU, juggling a full course load with numerous jobs and extracurricular activities.
After medical school, Arthur's ambition led him to work at a state psychiatric hospital during the day while spending evenings and weekends at a medical advertising agency called William Douglas McAdams. His talent for advertising quickly propelled him up the ranks, and within two years, he became the agency's president. Eventually, he bought the firm outright.
Arthur's approach to pharmaceutical advertising was revolutionary. As a doctor himself, he knew how to appeal directly to physicians. He placed ads in medical journals and sent literature to doctors' offices. He even enlisted prominent doctors – and sometimes fake ones – to endorse products. His colleagues would later claim that he had essentially invented the wheel of pharmaceutical advertising.
One of Arthur's most successful campaigns was for Valium, a minor tranquilizer produced by Roche. His strategy focused on convincing physicians to prescribe Valium for almost any ailment, major or minor. This approach was so effective that Valium became the most prescribed drug in America for years, making Arthur incredibly wealthy in the process.
Mortimer and Raymond: The Kid Brothers
While Arthur was building his advertising empire, his younger brothers, Mortimer and Raymond, also became doctors. Arthur, ever the big brother, got them jobs at the same psychiatric hospital where he worked. The three brothers eventually started a research center at the hospital, exploring drug treatment options that could replace the harsh practices of shock therapy and lobotomies, which were standard at the time.
In 1952, Arthur made a decision that would shape the family's future: he purchased a small pharmaceutical company called Purdue Frederick for his younger brothers to manage. This seemingly insignificant acquisition would later become the foundation of the Sackler family's vast wealth and notoriety.
Building the Sackler Dynasty
Purdue Frederick's initial products were far from glamorous – a laxative and an ear wax remover. However, by the mid-1960s, the company was making the Sackler brothers very wealthy. While the three brothers owned equal shares, Arthur was busy running his advertising agency, leaving Mortimer and Raymond in charge of day-to-day operations.
Mortimer and Raymond had very different personalities and approaches to business. Mortimer was a jet-setter who enjoyed spending time in Europe, looking for opportunities to expand the business. He was known for his hot temper, competitive nature, and love of luxury. He owned homes in the French Riviera, Paris, and London, and was a frequent patron of the opera. Like his older brother Arthur, Mortimer would marry three times and have eight children across those marriages.
Raymond, on the other hand, was quieter and more of a peacemaker. He chose to live closer to the family business, buying an estate in Connecticut. Unlike his brothers, Raymond only married once, to a woman named Beverly, with whom he had two sons, Richard and Jonathan.
While Mortimer and Raymond were building Purdue Frederick, Arthur continued to expand his influence in the pharmaceutical world. He owned shares in a rival advertising agency, started a medical newspaper that featured ads from his own agency, and even created a company that collected sales data from pharmacies, allowing the Sacklers to track physicians' prescribing habits.
A significant breakthrough came when the brothers acquired a British company that had developed a time-release morphine pill. This innovation allowed cancer patients to manage their pain at home rather than having to visit the hospital regularly for treatment. The Sacklers called this new product MS Contin, and it would become a game-changer in pain management.
The Sackler Name: A Symbol of Prestige
As the Sackler brothers amassed their fortune, they began to use their wealth to build a reputation as philanthropists. Their name soon adorned some of the world's most prestigious institutions, from Harvard and Oxford Universities to the Guggenheim and the Louvre.
One of the most notable examples of their philanthropy was the Sackler Wing at the Metropolitan Museum of Art in New York City. Opened in 1978, it was an impressive space featuring a tower of glass and a large reflecting pool surrounding the relocated ruins of an ancient Egyptian temple. This grand gesture elevated the Sackler name to new heights in New York high society.
The brothers' philanthropic efforts were extensive and far-reaching. Some of the institutions bearing the Sackler name included:
- The University of Oxford's Sackler Library
- The Tate Modern's Sackler Escalator
- The Guggenheim Museum's Sackler Center for Arts Education
Despite their generosity in philanthropy, the Sacklers were notoriously private when it came to their business dealings. They rarely gave interviews and seemed to go out of their way to create distance between themselves and their companies. This desire for privacy may have been motivated by Arthur's need to obscure the integrated nature of his many ventures, particularly given the questionable marketing techniques used to promote drugs like Valium.
As Purdue Frederick continued to grow, it faced some regulatory challenges. The company received a warning from the Food and Drug Administration for selling MS Contin without proper approval. However, the company's lawyer, Howard Udell, argued that FDA approval was unnecessary since the active ingredient, morphine, wasn't new.
The Sacklers' secretive approach to business would take on new significance in the years to come, particularly with the introduction of their next product: a potent painkiller called OxyContin.
The Next Generation and the Birth of OxyContin
Arthur Sackler's death in 1987 marked a turning point for the family. The process of settling his estate was long and contentious, given his many heirs and the complex, intertwined nature of the brothers' business affairs. Eventually, Arthur's heirs sold their third of Purdue Frederick, but the event created a significant rift between the three families.
Within Purdue, Mortimer's side of the family represented the A shares, while Raymond's side held the B shares. Board meetings often devolved into shouting matches and even physical altercations, with the two families sitting at opposite ends of the table.
In 1990, the second generation of Sacklers joined the board, creating a new company called Purdue Pharma. Mortimer's daughters from his first marriage, Ilene and Kathe, represented the A side, while Raymond's sons, Richard and Jonathan, represented the B side.
Purdue Pharma's fortunes had skyrocketed with the success of MS Contin, but the company faced a looming challenge. Once the patent on MS Contin expired, generic drug companies would be able to produce cheaper versions, threatening Purdue's monopoly.
The idea for OxyContin emerged during this time, though its exact origins are disputed. Kathe Sackler claims she suggested applying the time-release coating of MS Contin to a different opioid, oxycodone, during a dinner with her cousin Richard. Richard, however, disputes this account. Regardless of who came up with the idea, Richard took charge of its development, pushing the research team to work tirelessly on the new drug.
Richard Sackler embodied many traits of his uncle Arthur: he was deeply private, devoted to his work, and pursued his goals with narrow obsession. Known as a taskmaster and micromanager, Richard lacked people skills but was determined to see OxyContin succeed.
In 1994, a highly confidential memo was sent to the Sacklers outlining a secret plan to market OxyContin for use beyond cancer pain. This was a bold move, as physicians still had strong reservations about prescribing opioids, and oxycodone is roughly twice as strong as morphine. To tap into the broader and more lucrative general pain market, Purdue would need to change the paradigm of pain management.
The Launch and Marketing of OxyContin
The first major hurdle Purdue had to overcome in bringing OxyContin to market was gaining FDA approval. The company had previously skirted around regulators with the release of MS Contin, and they employed similar tactics this time. They focused their efforts on Curtis Wright, who oversaw pain medication approvals at the FDA.
Purdue developed a close relationship with Wright during the approval process, which lasted several months as they negotiated the details of the drug's label. The coziness of this relationship became apparent when, shortly after OxyContin was approved in record time, Wright left the FDA to work for Purdue Pharma with an annual salary of $400,000.
Once OxyContin received FDA approval, Purdue Pharma launched an aggressive marketing campaign. The company's strategy relied heavily on its large sales force, who were trained to allay physicians' concerns about prescribing opioids. The sales representatives used several key talking points:
Time-release coating: They claimed that because the active ingredient was released over 12 hours, it didn't produce the rapid high and craving associated with addiction.
Low addiction rate: Sales reps were instructed to repeat the statistic that less than one percent of opioid patients became addicted. However, this figure was based on a single, non-peer-reviewed letter to the editor in a medical journal, not on comprehensive studies.
Versatility: OxyContin was marketed as the painkiller to "start with and stay with," suitable for both short-term and long-term pain, whether severe or moderate.
FDA endorsement: If doctors remained skeptical, sales reps would point to the FDA-approved label, which stated, "Delayed absorption is believed to reduce the abuse liability of the drug."
In addition to these direct marketing strategies, Purdue funded organizations like the American Pain Foundation and the Pain Care Forum. While these groups appeared to be grassroots organizations advocating for reforms in pain management, they were actually "astroturf" organizations lobbying on behalf of big pharma.
The marketing efforts paid off handsomely. Just four years after its release in 1996, OxyContin's annual sales topped $1 billion. Over time, the Sackler family would make a staggering $35 billion from their blockbuster drug.
The Opioid Crisis Unfolds
As OxyContin's sales soared, reports of widespread abuse and addiction began to surface. In 2000, Jay McCloskey, the federal prosecutor for Maine, sent out thousands of letters to physicians across the state warning them about the dangers of OxyContin. By this point, Maine was in the grip of a full-blown opioid crisis, and it wasn't the only state affected.
When confronted with these issues, Purdue's lawyer, Howard Udell, would later claim in court that McCloskey's letter was the first time they had heard about widespread abuse of the drug. This, however, was a lie.
Evidence shows that Purdue was aware of the potential for abuse much earlier:
In 1999, Udell had asked his legal secretary, Martha West, to research the abuse of OxyContin. She found online chat rooms filled with people describing how to remove the time-release coating so the pill could be crushed and snorted. West sent her report to senior management and several Sacklers.
As early as 1997, sales representatives were including reports of abuse in their field notes.
Patients had been complaining to doctors that the drug wore off before the promised 12 hours, leading to withdrawal symptoms.
In response to these issues, Purdue introduced the concept of "pseudo-addiction." They told doctors that patients experiencing withdrawal symptoms were actually suffering from the return of pain, not addiction, and that the solution was to increase the dosage.
As criticism mounted, Purdue attempted to shift blame, arguing that the problem was with abusers, not the drug itself. They suggested that anyone addicted to OxyContin likely had a history of drug abuse or addiction. The company maintained that they didn't want the voices of people who genuinely needed pain relief to be lost in the controversy.
Legal Troubles and Public Scrutiny
The first major criminal investigation into Purdue was led by John Brownlee, a U.S. Attorney in Virginia, a region heavily impacted by the opioid crisis. Over several years, his team built a case by sifting through millions of internal documents.
In 2007, to avoid a public trial, Purdue agreed to a guilty plea bargain. The company paid a $600 million fine and requested that the judge seal all the evidence from the case. Thanks to political connections, no member of the Sackler family was charged. Instead, three executives, including Howard Udell, took the fall but avoided felony charges.
Given that Purdue was making billions each year from OxyContin sales, this outcome amounted to little more than a slap on the wrist. The company continued to profit from OxyContin while the opioid crisis deepened across the country.
As public awareness of the opioid epidemic grew, so did scrutiny of the Sackler family and their role in it. In 2018, a protest at the Guggenheim Museum, organized by photographer Nan Goldin, marked the beginning of a public pressure campaign on institutions to remove the Sackler name from their walls.
By 2019, almost every U.S. state was suing Purdue Pharma for its role in the opioid crisis, with fourteen states naming the Sacklers personally. Thousands of additional cases were brought by counties, cities, and hospitals. Purdue Pharma found itself buried in litigation.
The Fall of an Empire
As legal pressure mounted, Purdue Pharma attempted to address some of the criticisms by developing a new, tamper-resistant formulation of OxyContin. However, this new version was only released after the original patent had expired, leading many to view it as a cynical attempt to extend the company's monopoly rather than a genuine effort to address the drug's dangers.
In a surprising move, Purdue announced it would no longer produce the old version of OxyContin due to safety concerns and asked the FDA to ban generic versions as well. The FDA complied with this request. However, studies later found that the new formula had little effect on the opioid crisis, as many people were already addicted and turned to other drugs like heroin or fentanyl instead.
Facing mounting legal challenges and public pressure, Purdue Pharma eventually reached a settlement deal with the states. The company declared bankruptcy and agreed to be restructured as a public trust. The Sackler family agreed to contribute $3 billion from the sale of Mundipharma, their international firm, plus a conditional $1.5 billion if it sold for a high enough price.
Crucially, the settlement allowed the Sacklers to admit no wrongdoing, and no individual family members would be charged. While many states were reluctant to accept these terms, it was likely the best outcome they could achieve. Since the 2007 investigation, the family had been withdrawing billions from the company and hiding it in tax havens, leaving Purdue Pharma nearly worthless.
The Tarnished Legacy
The fall of the Sackler empire represents a stark contrast to the family's humble beginnings. From their roots in Brooklyn, Arthur, Mortimer, and Raymond Sackler built a pharmaceutical giant through innovative marketing and the production of powerful prescription drugs. Their children continued this legacy, developing OxyContin, a drug that would generate billions in profits but also catalyze a devastating opioid epidemic.
The Sackler name, once synonymous with philanthropy and adorning some of the world's most prestigious institutions, is now forever tarnished. Museums, universities, and other organizations have begun removing the Sackler name from their buildings and programs, distancing themselves from the family's controversial legacy.
Despite the public disgrace and the loss of Purdue Pharma, the Sackler family managed to retain much of their wealth. They remain one of the richest families in America, though their reputation has been irreparably damaged. The story of the Sacklers serves as a cautionary tale about the dangers of unchecked corporate greed and the devastating consequences it can have on society.
Final Thoughts
"Empire of Pain" offers a compelling and deeply troubling account of how one family's pursuit of wealth and power contributed to one of the most severe public health crises in American history. The Sacklers' story raises important questions about corporate responsibility, the ethics of pharmaceutical marketing, and the role of money in shaping public policy and healthcare practices.
The opioid crisis continues to affect communities across the United States, with hundreds of thousands of lives lost and many more forever changed. While the Sacklers have faced public scrutiny and legal consequences, many argue that the punishments they've received are insufficient given the scale of the damage caused by OxyContin.
As society grapples with the ongoing effects of the opioid epidemic, the story of the Sackler family serves as a stark reminder of the need for greater oversight in the pharmaceutical industry and the importance of holding corporations and their leaders accountable for their actions. It also highlights the complex relationship between philanthropy and reputation, showing how even the most generous donations can't erase the consequences of unethical business practices.
Ultimately, "Empire of Pain" is not just the story of one family's rise and fall, but a reflection on American society itself – its values, its vulnerabilities, and the often blurry line between innovation and exploitation. As we move forward, the lessons learned from the Sackler saga must inform our approach to healthcare, corporate regulation, and the pursuit of justice for those harmed by corporate malfeasance.