The Great American Novel – brought to you by OxyContin™

By Danielle Packard
Reader Contributor

Amid the sea of books and films that have recently been released on the American opioid crisis, Empire of Pain, by Patrick Radden Keefe, stands out for a few reasons. First, it takes a novel approach (literally), concentrating solely on the creators of OxyContin, rather than the millions of addicts their products have created. Second, it manages to make a meticulously researched and cited book addictively readable. 

The Empire of Pain opens with the plot of a sweeping American novel, tracking the meteoric rise of Arthur Sackler and his younger brothers, Mortimer and Raymond. First-generation Americans, the three brothers overcame adversity to become wealthy doctors, philanthropists and owners of Purdue Frederick, later called Purdue Pharma. Keefe brings the reader inside Purdue Pharma, the Sackler family-owned enterprise that has been involved in many of the most controversial opioid painkillers ever created. 

The cover of Empire of Pain by Patrick Radden Keefe.

Arthur, the eldest brother and scion of the family, is a cross between Jay Gatsby and Michael Corleone. Driven, secretive and obsessed with leaving a lasting artistic legacy to immortalize the Sackler name, Arthur earned millions by using his advertising company to sell his pharmaceutical products and endorsing them through his medical trade journal. He then spent those millions buying art and donating it to museums and colleges throughout the U.S. and Europe.

By the time Arthur died in 1987, the Sackler name had become synonymous with art, culture and education — a tradition continued by his brothers and the second generation of Sacklers. 

Yet, parallel to this very public tradition of philanthropy, was the deliberate secrecy of the Sackler family, as it tried (but failed) to bury its connection to the opioids that fueled its wealth. Keefe establishes the deliberate and sustained separation of the Sackler name from the products it sold — a practice that continued into the next two generations. The deceptive marketing tactics Arthur used to push Valium and other opioid-based painkillers served as an inspiration to his nephew and OxyContin creator Richard Sackler.

The second section of the book, “Dynasty” details the creation and marketing of OxyContin, a pill as addictive as heroin, twice as potent as morphine and, according to the Centers for Disease Control and Prevention, was a contributing factor in an estimated 586,000 opioid-related deaths from 1999 to 2020. 

Keefe focuses on the Sackler family and how it deliberately created a marketing “blizzard” to reward pharmaceutical representatives and doctors for prescribing more and higher doses of OxyContin to patients. Even as the repercussions of those marketing practices became evident in the form of addiction and overdose, the Sacklers refused to diversify their products, spending millions to block legal or governmental oversight. 

Keefe cites a study by the Associated Press and the Center for Public Integrity, finding that, “Purdue and other drug companies that manufacture opioid painkillers spent $700 million between 2006 and 2015 on lobbying Washington and in all 50 states. The combined spending of these groups amounted to roughly eight times what the gun lobby spent.”

In the final section, “Legacy,” the Sackler family scrambles to deal with the decline of OxyContin in the U.S. by expanding its marketing to other countries and pushing OxyContin to younger and younger patients. 

“For example, in August 2015, over objections from critics, the company received FDA approval to market OxyContin to children as young as 11,” Keefe writes. 

Despite the now common knowledge of the addictive nature of OxyContin, the Sackler family continued to earn billions from its opioids. 

As Keefe argues, “The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert government institutions.” 

Ultimately, Purdue Pharma declared bankruptcy though the Sackler family kept its wealth, though publicly shamed and dubbed by Congress as “the most evil family in America.”

Keefe ends the book by detailing all of the many museums and colleges erasing the Sackler name from their galleries, dorms and medical centers.

As Keefe explains in conclusion, “My intention was to tell a different kind of story, however, a saga about three generations of a family dynasty and the ways in which it changed the world, a story about ambition, philanthropy, crime and impunity, the corruption of institutions, power and greed.” 

In short, Keefe writes the great American novel — it just happens to be nonfiction.