Review: Patrick Radden Keefe puts the Sackler dynasty under the microscope

A cold eye on hallowed profession
  • Empire of Pain: The Secret History of the Sackler Dynasty, by Patrick Radden Keefe. Picador, $34.99.

Patrick Radden Keefe's last book was a detailed investigation of the IRA and their long campaign in Ulster. In this book, he examines the opioid crisis in the United States in the years on either side of the new century. He is focused in particular on OxyContin and its aggressive marketing by Purdue Pharma, a private company completely owned by the Sackler family.

The book is divided in three parts. The first deals with Arthur, Mortimer and Raymond Sackler, three young men who qualified as medical doctors and used their knowledge of how the medical industry works in the USA to make a huge amount of money. This section deals in particular with the oldest member, Arthur, who became involved in the marketing side, setting up a number of companies and buying older ones.

In 1952, he bought a small pharmaceutical company called Purdue Frederick, and gave it to his two younger brothers Mortimer and Raymond. His name and their names would never appear, then or later, on any publicity concerning the company. By this time, he developed an interest in Chinese artifacts and he was beginning his long career in philanthropy, supporting rooms or whole buildings in universities and museums, insisting that the Sackler name should appear in some form in the title of the edifice in question.

The second section of the book deals with the story of OxyContin, a pain relief medication in tablet form. Developed at Purdue, it was supposed to release the oxycodone part over a 12-hour period. However, users quickly discovered that they could lick off the covering of the tablet or simply break it open to reveal pure oxycodone which could be sniffed or heated with water for injecting. In either case, it was soon the drug of choice for many street addicts as well as for patients who became addicted to it after having it prescribed by their GP.

By the time in 1996 that OxyContin was being released, the older Sacklers had been replaced by the next generation. In the case of Purdue, that was Richard, son of Raymond. As an undergraduate, he had devoted one summer holiday to the study of orgasms, before eventually buckling down and earning the right to take the Hippocratic oath. His strength was micromanagement of the company, and in particular of the work of the sales reps who were criss-crossing the country, flogging their product to doctors and encouraging them to move their patients from the 10mg version to the 20 or 40 or 80 mg form, and for a while to the 160 mg hit. They were particularly successful in country areas - for some time, OxyContin was known as "hillbilly heroin".

The last section of the book looks at the attempts by different state and federal bodies to rein in the epidemic of drug abuse led by OxyContin. It would be nice to say that they were successful, but by this stage, the Sacklers were so wealthy and so powerful, that most attempts were blocked before even getting to a court. "Everyone lawyered up - and not with your average estate attorneys, either, but with high-end white-shoe gunslingers. ... There were lawsuits and countersuits, affidavits and depositions, dozens of lawyers, thousands of billable hours, endless vituperation." And that was not to mention the PR and the articles written by friendly "experts" in journals owned by the family.

By this stage, Arthur Sackler was dead, but Mortimer and Raymond were making names for themselves overseas, each earning a knighthood from the Queen and a Legion of Honour from France. But they had drifted apart and their children were divided between the Mortimer faction and the Raymond side. When things became tough and they realised that the good times would not last, each group began taking money from Purdue. At one stage, Mortimer's son complained because the amount they were siphoning in one quarter fell from $320 million to $260 million.

This is a big book and tells a gripping story that draws the reader in to the narrative with a style that is not common in such books. Each chapter reads like a new story, with new characters whose role in one of the family companies is explained. And towards the end, there are many "good guys" - actually mostly "good girls" - who dared to take on the behemoth of Purdue and had to put up with the humiliation of being overruled by someone in the court system or the government.

Towards the end, as Raymond and Mortimer entered their mid-90s, they had to suffer the humiliation of having their contributions to the arts or education refused and finding the Sackler name removed from buildings or scholarships. No Sackler of any generation ever apologised for their role in promoting drugs; as far as they were concerned, some people simply had addictive personalities and that was not their problem. Each generation always used their medical degrees as a badge of propriety; after reading this book, you might easily find yourself casting a colder eye on your own medical practitioners.

An absolutely fascinating read, the kind of book that gives investigative journalism a good name.

This story A cold eye on hallowed profession first appeared on The Canberra Times.