Book review

Year: 2021

Authors: Patrick Radden Keefe

Rating: Entertaining 5/5 | Informative 5/5 | Inspiring 4/5

For the last 20 years, the opioid epidemic has brought devastation to communities across the United States. The annual number of deaths involving an opioid in America has steadily risen, with 92,000 opioid-related fatalities in 2020—five times as many as in 1999. In his book Empire of Pain: the Secret History of the Sackler Dynasty, Patrick Radden Keefe examines the role one family had in the origins of this crisis: the Sacklers. 

The Sackler family had accumulated $10.8 billion of wealth from their ventures in the pharmaceutical industry by 2018. Most significant of these was their company Purdue Pharma, which produced the painkiller OxyContin—the promotion and marketing of which is widely considered to mark the start of the opioid crisis we see today. Until recently, however, the family were better known for their philanthropy, which led to their name being attached to some of the most prestigious cultural and educational institutions in the world. 

The book traces the family’s history over the last 80 years, and in doing so, provides a window into the changing nature of healthcare and the pharmaceutical industry. It is a compulsive read, with a storyline and cast of characters that resemble those of an intricately plotted work of fiction. Keefe’s narration, however, remains measured as he builds his case, relying on the strength of his research to illustrate the role that the Sacklers played in engineering the opioid crisis.

Keefe draws extensively on documentation from numerous court cases brought against Purdue Pharma. Such access means that, despite the Sacklers’ opposition to the book, their voices and words are a constant, vivid presence. We read for ourselves the correspondence from Richard Sackler (former president and chairman of Purdue Pharma) describing his desire to devise prescription advice that would work to ensure that OxyContin became “the most potent selling instrument”. When opioid addiction started to sweep the country, and the role of OxyContin in the epidemic began to be questioned, Richard Sackler placed the blame on the unassuming individuals suffering its consequences, with disregard for his own responsibility in deliberately manufacturing the misleading claims in the packaging.  

While maintaining an unflinching exposition of the Sacklers, Keefe also targets regulatory, educational, and legal systems that failed to protect the public. The Food and Drug Administration was a “reliable ally for Purdue over the years”, he states, and was just one such organisation with which the Sacklers maintained a disconcertingly cosy relationship. In fact, the most disquieting evidence put forward in the book is that the Sacklers did not act in isolation: they relied on powerful supporters, who enabled their actions or simply chose to look the other way.

Despite Keefe’s methodical approach, it is impossible for the reader not to be moved. Displayed here is an enormous level of destruction and an absolute refusal by this family to contemplate their role in it. Keefe permits the reader to make their own conclusions, but I challenge anyone reading Empire of Pain to not feel enraged.