Empire of Pain Summary

How did one of America's wealthiest families build a fortune worth billions while leaving a trail of devastation in their wake?

1. A Foundation of Ambition

The Sackler family's journey begins with Isaac Sackler and his three ambitious sons, Arthur, Mortimer, and Raymond. Despite starting with modest means, their father instilled in them a belief that reputation is the most valuable asset. Isaac’s passing words—emphasizing the importance of a "good name"—became ironic as the brothers later tarnished their reputation while amassing their fortune.

Arthur, the eldest, was the driving force. From a young age, he diversified his income through side hustles, often involving his brothers in his ventures. His industrious nature continued into adulthood as he juggled careers in medicine and advertising. By blending these fields, he pioneered a new form of pharmaceutical marketing that targeted physicians directly.

One of Arthur's greatest accomplishments was his role in promoting Valium as a treatment for a range of conditions. His aggressive advertising methods made him immensely wealthy and set the stage for the Sacklers’ future pharmaceutical endeavors.

Examples

• Arthur's work for his high school paper included an impressive knack for ad sales.
• His advertising firm revolutionized Valium's marketing, making it the most prescribed drug in America.
• He even bought Purdue Frederick to support Mortimer and Raymond’s careers, solidifying the family’s presence in pharmaceuticals.

2. The Evolution of Purdue Frederick

Purdue Frederick was an unremarkable pharmaceutical company when the Sacklers acquired it in 1952. Its primary products—an ear wax remover and a laxative—were functional but uninspiring. However, with the brothers’ efforts, the company evolved into a cornerstone of the Sackler dynasty.

The younger brothers, Mortimer and Raymond, managed the company's operations while Arthur concentrated on advertising and other ventures. Over time, they expanded Purdue’s reach, exploring international markets and developing new products. Their acquisition of a British firm’s time-release morphine pill transformed their perspective on pain management.

This time-release morphine pill became MS Contin, which initially targeted cancer patients. It allowed for more convenient at-home pain management, a groundbreaking advancement at the time. This success inspired their later development of OxyContin.

Examples

• Purdue Frederick generated wealth from even its modest initial offerings.
• Mortimer’s European business trips enabled the acquisition of innovative pharmaceutical technologies.
• MS Contin was marketed as a revolutionary option for cancer pain relief.

3. The Sackler Name and Philanthropy

The Sacklers strategically built their public image through philanthropy. They donated enormous sums to prestigious institutions such as Harvard, Oxford, and the Guggenheim, earning recognition and gratitude for their generosity. By associating their name with art and education, they wove themselves into the fabric of elite society.

Yet, the Sacklers were cautious about attaching their name to business ventures. They preferred to maintain low profiles in relation to their companies. Their secrecy may have served to obscure questionable marketing practices and shield themselves from scrutiny.

While the family name adorned museum wings and libraries, criticism of their products began to surface. The family’s detachment from their own companies only deepened the mystery, especially as legal battles began.

Examples

• The Sackler Wing at the Met is an architectural symbol of their philanthropy.
• Institutions like the Tate Modern and the Louvre prominently displayed their name.
• Despite such generosity, their businesses operated under a veil of secrecy.

4. OxyContin’s Development and Strategy

In 1996, Purdue Pharma, under the next generation of Sacklers, released OxyContin. A potent opioid, OxyContin used the time-release technology first seen in MS Contin. However, unlike MS Contin, Purdue aimed to expand OxyContin’s use well beyond terminal illnesses.

To market OxyContin, the Sacklers had to counter reluctance among doctors to prescribe opioids. Purdue’s multimillion-dollar marketing campaign aggressively portrayed OxyContin as safe for a variety of pain conditions despite known risks of addiction. The company claimed its time-release coating minimized abuse potential, though this was never adequately researched.

Within years, sales of OxyContin soared. The Sacklers made billions, but the consequences of their product were already emerging in communities across the United States.

Examples

• FDA’s Curtis Wright approved OxyContin after a close relationship with Purdue executives.
• Purdue launched “educational” campaigns to normalize opioid prescriptions.
• In just four years, OxyContin’s sales passed $1 billion, enriching the Sacklers.

5. Marketing at Any Cost

Purdue’s aggressive sales tactics were unparalleled. Their sales reps targeted physicians, emphasizing unresearched claims like a supposed one percent addiction rate. This statistic, based on a dubious letter to a journal editor, was repeated until it gained the appearance of truth.

Purdue also funded advocacy groups to push for broader pain treatment guidelines. These groups, which appeared independent, actually lobbied for big pharma’s interests. By minimizing addiction concerns, Purdue changed the public perception of opioids from dangerous substances to miracle drugs for pain relief.

This systematic deception fueled soaring profits—for both the company and the Sackler family—while laying the groundwork for a national crisis.

Examples

• Sales reps encouraged doctors to prescribe OxyContin as a treatment to “start and stay” with.
• The FDA label’s wording gave a false sense of security about the drug’s addiction risks.
• Purdue funded the Pain Care Forum to lobby for opioid-friendly medical policies.

6. Ignoring the Warning Signs

Evidence of OxyContin abuse flooded Purdue’s offices as early as 1997. Reports showed patients crushing pills to bypass the time-release coating for stronger effects. However, Purdue dismissed these warning signs and instead promoted higher dosages under the guise of “pseudo-addiction.”

The company spun patient withdrawal symptoms as untreated pain, recommending escalating prescriptions. This denial allowed the opioid crisis to take root, ruining countless lives while billions flowed into the Sackler accounts.

Despite lawsuits that Purdue faced over these issues, the Sacklers insisted the blame lay solely on drug abusers, shielding themselves from accountability.

Examples

• Purdue’s legal secretary compiled early evidence of OxyContin abuse from online forums.
• Physicians reported signs of withdrawal and addiction, but Purdue called it "pseudo-addiction."
• Purdue encouraged higher dosages, compounding the problem.

7. Scandals and Settlements

Legal action against Purdue Pharma intensified as the opioid epidemic spiraled out of control. In 2007, the company pleaded guilty to misleading the public about OxyContin’s risks. The fine, though large, barely made a dent in the Sacklers’ fortunes. Key evidence from the case was sealed, protecting the family further.

The Sacklers ensured they remained insulated through strategic financial maneuvers. Billions were gradually moved into family trusts and offshore tax havens. These schemes preserved their wealth even as Purdue Pharma’s market value plummeted.

In 2019, facing pressure, Purdue filed for bankruptcy in a deal absolving the Sacklers of further liability. It ensured the family kept their wealth while the company endured blame.

Examples

• Purdue paid a $600 million fine but avoided public trials.
• The Sacklers withdrew billions from Purdue before its bankruptcy.
• States’ attempts to sue the family stalled, as much of their money was hidden.

8. Public Backlash Grows

The Sackler name became synonymous with the opioid epidemic as activists and artists called for accountability. Protests erupted at museums worldwide, demanding the removal of the Sackler name from public spaces.

Photographer Nan Goldin led high-profile demonstrations, highlighting the family’s role in fueling addiction. Many institutions, once proud of Sackler donations, chose to dissociate from the family.

This cultural reckoning permanently marred the Sackler reputation, erasing any goodwill from decades of philanthropy.

Examples

• Nan Goldin protested at the Guggenheim Museum, throwing attention on Sackler donations.
• Museums like the Louvre quietly removed the family name from exhibits.
• Public outrage intensified as opioid-related deaths surged.

9. A Legacy of Wealth and Disgrace

Despite losing Purdue Pharma, the Sacklers retained their wealth, leveraging legal strategies to avoid criminal charges. However, they could not escape societal condemnation. Their vast fortune now serves as a reminder of how profit-driven corporate actions can cause irreparable harm.

The family’s story embodies the dark side of the pharmaceutical industry, where ethical boundaries are often overshadowed by financial goals.

Attempts to hold the Sacklers accountable continue, but their billions remain largely out of reach.

Examples

• Purdue turned into a public trust, but the Sacklers’ billions remain intact.
• The 2021 settlement did not require the Sacklers to admit wrongdoing.
• Generations of Sacklers still benefit from the fortune amassed by Purdue Pharma.

Takeaways

1. Scrutinize marketing claims for health products; understand how information can be misleading.
2. Support accountability in industries where harm results from negligence or profit motives.
3. Advocate for transparency and ethics in business practices to prevent future public harm.