Empire of Pain - Book Summary

A family's name etched in gold and tainted by scandal

Isaac Sackler's words to his sons seemed almost prophetic — a good name could be the most valuable legacy one leaves behind. Yet, the meteoric rise of Arthur, Mortimer, and Raymond Sackler bore the potential to outshine any warnings. The Sacklers moved from inheritance hopefuls to billionaire benefactors, their name engraved on the walls of the world's most respected institutions. They were the architects of an empire that stood on the foundations of philanthropy and pharmaceutical innovation.

Yet, behind the gilded facade of donations and sponsorships, the Sacklers' true source of wealth was shrouded in secrecy. It wasn't until the mid-90s that the veil began to lift, revealing a Pandora's box of pain and addiction.

On the face of it, OxyContin seemed like a miracle — a painkiller that promised freedom from suffering, with a supposedly low risk of addiction. Purdue Pharma, the Sackler-owned pharmaceutical giant, unleashed this new drug upon the world, and the dollars began to pour in.

But this revenue stream flowed from a well of despair. As OxyContin prescriptions skyrocketed, so did addiction rates. Communities across America were ravaged, their streets lined not with gold but with the fallout of the opioid crisis. What cost $80 on the street was paid for with countless lives — a trade-off far more expensive than any could have foreseen.

Investigations would uncover a disturbing truth — the family behind Purdue Pharma wasn't blind to the devastation. In fact, they were complicit, pushing for higher doses and broader prescriptions, all the while profits climbed.

Once celebrated names etched on the walls of the learned and cultured began to be stripped away, as institutions sought to distance themselves from the now-infamous Sackler family. This is a tale of a legacy unravelled — a good name irrevocably tarnished and an empire of pain left in its wake.

Chapter 1: Arthur's Ambition and the Birth of a Dynasty

In the throes of early twentieth-century America, a young man named Arthur Sackler displayed an entrepreneurial spirit that seemed to defy the crushing weight of the Great Depression. While others were tightening their belts, Arthur was ambitiously expanding his horizons, turning his high school paper into a profit-making venture by mastering the art of ad sales—a skill that would later define his fortune and that of his brothers, Mortimer and Raymond.

Saving and scrapping, Arthur surged through college, not just earning a degree but amassing enough wealth to bestow his parents a Brooklyn grocery store. It was his entry into NYU's medical school, however, that laid the groundwork for what would become a monumental shift in the pharmaceutical landscape. Here, he led a double life as a relentless student by day and a daring entrepreneur by night, juggling a punishing workload with an array of side jobs.

Arthur's relentless work ethic didn't dissipate post-graduation. By day, he sharpened his medical acumen at a state psychiatric hospital, while the evenings and weekends found him soaring through the ranks of William McAdams, a medical advertising firm. Within an astonishing two years, Arthur claimed the presidency and eventually, ownership of the company.

Possessing both medical insight and marketing genius, Arthur pioneered an advertising approach that revolutionized how pharmaceuticals were sold. He directly engaged doctors through ads in medical journals and literature mailed to their offices. At times, he would employ reputable, and sometimes fabricated, doctor endorsements to amplify sales.

Arthur’s prowess reached its zenith with the tranquilizer Valium, catapulting it to the title of America’s most prescribed drug and fattening his wallet in return.

For Arthur, his brothers Mortimer and Raymond were more than siblings; they were apprentices in a burgeoning empire. Securing them positions at his psychiatric hospital, the trio endeavored into research, eager to exchange archaic methodologies like shock therapy and lobotomies for pharmacological alternatives.

1952 marked a pivotal moment when Arthur, ever the visionary, acquired a small pharmaceutical company that resounded with an air of nobility—Purdue Frederick. Little did anyone know, this modest enterprise would balloon into a behemoth under the Sackler name, weaving into the fabric of their fate a tapestry of both unbridled success and daunting controversary.

Chapter 2: Laying the Cornerstones of an Empire

It started humbly enough, with Purdue Frederick's portfolio boasting nothing more eye-catching than common laxatives and ear wax removal solutions. Yet, by the mid-1960s, these modest offerings had set the stage for a Sackler saga of immense wealth and influence.

Arthur, the eldest Sackler brother, continued to conquer the world of medical advertising, leaving the helm of Purdue to Mortimer and Raymond. The brothers split ownership evenly, yet Arthur's strategic eye never really left the company's horizon.

Mortimer, the middle Sackler, embodied a cosmopolitan spirit, crisscrossing the Atlantic to cultivate the family’s pharmaceutical footprints on European soil. His fiery temperament went hand in glove with a lifestyle awash in continental luxury, with a collection of residences from the French Riviera to London, echoing an appetite both for business adventures and cultural extravagance.

Unlike Mortimer, Raymond fostered a quieter life, the diplomat among siblings. Establishing his roots in Connecticut, close to Purdue's beating heart, he balanced the pressures of his burgeoning business with a more settled family life, as a husband and father to his two sons.

Yet, Arthur's masterclass in multitasking and monopoly was nowhere more evident than in his myriad ventures that looped back into one another—a web of interlinked enterprises that spanned from a medical newspaper replete with his agency's ads to a research institute that seamlessly dovoted drug studies back into the Sacklers’ commercial embrace.

But the real game-changer for the Sackler brothers was their acquisition of the British company that had innovated a time-release morphine tablet. In an era where opiates were the last resort, reserved for the most grievous bouts of pain usually by cancer patients, this development was groundbreaking.

Where once pain relief was tethered to the hospital, now it could be delivered steadily and consistently, freeing patients to manage their pain in the comfort of their own homes. This catalyst in pain management bore the name MS Contin, and from it, the Sacklers' pharmaceutical dominion would grow, not only broadening their wealth but also setting the stage for a looming health crisis that would envelop nations.

Chapter 3: The Sacklers' Silent Signature on Society

Prestige in New York is often measured by the cultural marks one makes in the city, and the Metropolitan Museum of Art is one of its most luminous badges of honor. Arthur Sackler, his name already in permanent residence at the museum’s Chinese art gallery, had aspirations that soared even higher. And so with this ambition, the grand Sackler Wing opened in 1978, a testament to his vision. It was an architectural marvel framing the relics of an ancient temple, symbolizing the Sackler name secured in the annals of philanthropy.

The Sacklers' benefaction was wide-reaching, a philanthropic touch that graced many a global institution — from Oxford's storied libraries and London’s prestigious galleries to New York's cultural bastions. Encountering the Sackler name was akin to witnessing a trademark of influence and generosity.

Despite this omnipresence in the realm of charitable giving, the Sacklers maintained an enigmatic distance from their corporate empire. They veiled their business dealings in secrecy, consistently avoiding the public gaze and the probing scrutiny of the media. Perhaps it was Arthur's intent to blur the lines among his complex mesh of ventures, or maybe it was to shield the aggressive marketing strategies that proliferated the use of drugs such as Valium, adding to the family coffers.

Meanwhile, back at Purdue Frederick, trouble lurked on the horizon as their flagship drug, MS Contin, drew the unwanted attention of the Food and Drug Administration (FDA). Flirting with regulatory infractions, the company had begun marketing the drug without formal FDA approval. To quell concerns, their lawyer, Howard Udell, argued against the need for approval, citing morphine's long-standing medical history.

The Sacklers' penchant for privacy, especially regarding their business interests, has left more questions than answers. Perhaps it was a calculated shield that allowed them to quietly steer their company away from scrutiny until the storm clouds gathered around OxyContin—a storm that would transform the whisper of their business dealings into a roar heard around the world.

Chapter 4: A Dynasty Divided and the Rise of OxyContin

The demise of Arthur Sackler in 1987 marked the onset of a turbulent era for the Sackler empire, with his passing igniting an incendiary battle over his complex legacy. Not only did Arthur leave behind a family tree branched with multiple spouses and descendants but also a labyrinth of business ties steeped in secrecy. The division of his estate became a bitter feud, culminating in the sale of his share of Purdue Frederick. The rift this caused among the three branches of the Sackler family turned out to be as deep as it was wide.

Inside the boardroom of Purdue, old frictions gave way to new factions. Mortimer's and Raymond's lineages—holding A and B shares, respectively—became symbols of a corporate house divided. Often, their board meetings devolved into acidic exchanges and even physical confrontations—a striking contrast to the company's formerly composed public persona.

The 1990s saw the younger generation of Sacklers join the fray, establishing Purdue Pharma and marking a new chapter in the family's pharmaceutical narrative. Among them were Ilene and Kathe, Mortimer's daughters from his first marriage, and Richard and Jonathan, Raymond's sons, who would play pivotal roles in forging the company's future.

Purdue Pharma's fortune was sudden and steep, propelled by the success of MS Contin. Yet, the specter of patent expiration loomed large, a ticking clock that threatened their medicinal monopoly. A forward-thinking solution was needed—a panacea for Purdue's impending predicament.

The origins of what would become OxyContin—a time-release version of the powerful opioid oxycodone—are mired in familial contention. Kathe Sackler maintains it was her dinner-table epiphany shared with cousin Richard, who in turn dismisses this narrative. Nevertheless, it was Richard who doggedly took the helm of its development, driving the research team with an intensity reminiscent of his late uncle's own relentless work ethic.

Richard's managerial style echoed Arthur's—private, single-minded, and exacting. He was a man absorbed in his mission, detached from the humanity at the core of his work.

Therein lay the crux of their new challenge. A 'very confidential' memo from 1994 outlined strategic plans to market OxyContin not only for cancer-related pain but far beyond, into the vast realm of general pain treatment. Facing an industry wary of opioids — and oxycodone's formidable potency — Purdue Pharma found itself on the brink of redefining pain management. To tap into a broader, more profitable patient population, they had to alter the very narrative surrounding the use of such drugs. The stage was set for a seismic shift, but the consequences were yet uncharted.

Chapter 5: The Marketing Muscle Behind OxyContin

As Purdue Pharma prepared to launch OxyContin, their path bristled with regulatory thorns. The FDA loomed large, a gatekeeper with the power to either unleash or stifle their ambitions. Purdue had danced around FDA regulations before with MS Contin; this time they focused on Curtis Wright, the man at the helm of pain medication oversight.

The negotiations over the drug's labeling were intricate and intense, but through these exchanges, a worrisomely close relationship developed between Wright and Purdue. So close, it seemed, that Wright's subsequent departure from the FDA to a lucrative position at Purdue Pharma cast a shadow of doubt over the entire approval process.

Once OxyContin hit the market, the company deployed a veritable sales force armed with talking points designed to dispel any lingering fears doctors had about prescribing such a potent opioid.

Their primary argument hinged on OxyContin's controlled-release mechanism. Purdue claimed that by releasing the drug over a 12-hour span, it bypassed the instant gratification and subsequent addiction that so often accompanied opioid use.

Yet, their evidence was questionable at best—a mere citation of the "less than one percent" addiction rate statistic that originated from a brief, non-peer-reviewed letter rather than extensive studies. Despite this lack of rigorous research on addictive properties, sales representatives persisted, hailing OxyContin as a versatile solution, ideal for a variety of pain issues, both acute and chronic.

To quash any remaining doctor doubt, the sales reps brandished their trump card: the FDA-approved label itself, which noted that the delayed absorption was "believed" to reduce the liability of abuse. The word "believed" was the crafty hedge on which much rested.

But Purdue's influence didn't end at the physician's office. They financed organizations such as the American Pain Foundation and the Pain Care Forum, which, while outwardly appearing as champions for pain management reform, functioned as front groups that lobbied for pharmaceutical interests.

Purdue's relentless campaign bore copious fruit. Within just four years of its debut, OxyContin's sales had eclipsed one billion dollars annually. It was a payoff that would ultimately amount to a staggering $35 billion profit from this blockbuster drug, a testament to the power of an all-consuming marketing drive that skirted the line between ambition and ethics.

Chapter 6: Ignoring the Warning Signs of an Opioid Epidemic

The turn of the millennium saw Maine's federal prosecutor, Jay McCloskey, sounding an alarm that would resonate through the corridors of Purdue Pharma. Letters flooded the mailboxes of physicians, cautioning them of OxyContin's perils, as the opioid crisis ravaged the state. Maine was not an isolated case—similar stories of addiction and abuse were emerging nationwide.

Yet, Purdue's legal counsel Howard Udell would later contest in court that this warning was their first inkling of OxyContin's misuse. The truth was far more damning. In actuality, a whole year prior, Udell had charged his secretary, Martha West, with digging into the burgeoning abuse issue. Her findings—a litany of users sharing methods to undermine the drug's time-release coating online—were escalated to Purdue's upper echelons, including Sackler family members themselves.

Since 1997, Purdue's sales representatives had recorded testimonials of the drug's inadequacies, namely that it failed to sustain its effects for the advertised 12 hours, plunging patients into withdrawal.

The company's solution? Introduce the concept of "pseudo-addiction." Purdue dismissed patients' suffering as mere pain recurrence rather than withdrawal symptoms, prompting doctors to raise dosages rather than address potential addiction.

Faced with growing censure, Purdue shifted blame to lawbreakers, framing OxyContin abuse as a law enforcement matter. Addicts, they implied, were misusing the drug, often with a backhistory of substance abuse. The language was carefully chosen to preserve the narrative that many in pain still relied on OxyContin as their lifeline.

The inaugural criminal probe into Purdue's practices took shape under the guidance of John Brownlee, a US Attorney in an opioid-afflicted Virginia. His team painstakingly pieced together a prosecution, pouring over a trove of the company's internal communications.

In 2007, Purdue sidestepped a highly publicized court battle by entering a guilty plea and settling for a $600 million fine. The call for accountability was quieted, documents were sealed, and political maneuvering spared the Sacklers from indictment. Instead, three executives, including Udell, were designated as scapegoats, spared felony convictions.

For a company with billions to its name, this resolution was no harsh comeuppance but rather a gentle rap on the knuckles, allowing the behemoth and its owners to continue largely unscathed.

Chapter 7: A Name Falls from Grace

The hallowed halls of the Guggenheim Museum, normally home to the murmur of admiration and the soft padding of footsteps, were that evening disturbed by an unexpected downpour — not of rain, but of protest flyers and accusatory banners denouncing the Sackler family. Nan Goldin, a renowned photographer with artwork gracing those same walls, had catalyzed a movement that would echo through the echelons of elite patronage.

The Sackler name, once a symbol of largesse and high culture, became the target of widescale public repudiation. Institutions across the globe began to interrogate the ethics of keeping the Sacker name emblazoned upon their edifices.

By the year 2019, Purdue Pharma found itself ensnared in a legal labyrinth, the defendant in cases brought forward by nearly every state in the US. Significantly, fourteen states went beyond corporate accountability, pointing fingers directly at individual Sacklers. An avalanche of lawsuits from counties, cities, and medical facilities threatened to smother the company entirely.

In what appeared to be a late pivot towards responsibility, Purdue unveiled a reengineered OxyContin that resisted crushing — a feature that would thwart its misuse. Critics, however, noted the finely-tuned timing: Purdue's patented monopoly had only just run its course.

Purdue's insistence on halting production of the original OxyContin formulation — citing newfound "safety concerns" — came with an appeal to the FDA to block generic variants. Yet this newfound shield of safety proved futile in quelling the crisis. Addicted individuals, now cut off from the reformulated drug, diverted their cravings towards illicit substances like heroin and fentanyl, an unintended ripple effect exacerbating the very epidemic Purdue's products had kindled.

Facing a mounting legal siege, Purdue Pharma brokered an encompassing deal with the states. The company accepted bankruptcy and transitioned into a public trust, a resolution cushioned by a multi-billion dollar contribution from the Sacklers, drawn from the sale of their international wing, Mundipharma. The settlement left the family unscathed by admissions of guilt or personal charges.

For the states embroiled in the legal melee, this agreement, while less than ideal, was perceived as the optimal outcome. Since the 2007 investigation, the Sacklers had been systematically siphoning Purdue's wealth into the obscurity of offshore accounts, rendering the company a hollow shell.

In this somber denouement, the Sacklers relinquished Purdue but cleaved to their fortune. The name that once commanded respect and recognition had become indelibly marred, a name synonymous not with patronage and progress, but with a public health catastrophe of unprecedented scale.

The Rise and Fall of an Empire Entwined with America's Opioid Epidemic

At the core of this narrative lies the saga of a family that transcended its modest roots to carve out a colossal empire through the aggressive marketing of pharmaceuticals. The Sackler brothers, Arthur, Mortimer, and Raymond, laid the groundwork for Purdue Pharma's explosive growth, which gained momentum with the arrival of Arthur’s nephews on the Purdue board. This growth was propelled into the stratosphere with the introduction of OxyContin. Its release into the market unleashed a tidal wave of abuse and dependency, igniting an opioid crisis with a death toll in the hundreds of thousands.

Throughout their ascent, the Sacklers championed philanthropy, adorning the halls of esteemed institutions and accumulating prestige. Yet, underneath this veneer of benevolence, Purdue Pharma's tactics insidiously fostered widespread addiction. As the grim realities of OxyContin's impact surfaced, the Sacklers' legacy began to fracture, plagued by lawsuits and public outcry demanding accountability.

Despite the maelstrom of litigation and settlements that sought to hold them to account, the Sacklers have never faced criminal charges. By strategically extracting and sheltering their wealth, they have managed to safeguard their personal fortunes, surviving the wreckage left in their path largely intact. Today, their name is a double-edged sword, synonymous with both vast wealth and one of the most harrowing public health crises in modern American history.