Addiction sur ordonnance: La crise des antidouleurs (Interventions) by Patrick Radden Keefe

Addiction sur ordonnance: La crise des antidouleurs (Interventions) Reviews

• 
  chai ♡

  Empire of Pain is a staggering, whipping, relentlessly infuriating book that swallows you whole as soon as you step inside. I devoured this story as if my life hung on the balance, even when I deeply, intensely abhorred it.
  
  Patrick Radden Keefe marshals a wealth of research and journalistic derring-do to tell the story of a family obsessed by greed, secrecy, immortality, and denial. For years, the Sackler family paid perfectly despicable amounts of money to emblazon their name everywhere—on art museums and universities and medical facilities around the world—while going to great ocean-spanning lengths to obscure and obfuscate their ties to and involvement in the pharmaceutical industry. Unfortunately for them, in Empire of Pain, their claims to invisibility are rendered hideously visible.
  
  Keefe’s book fastens on all the ways in which the Sackler family is (more than partly) responsible for engineering one of the worst public health crises in American history: the opioids epidemic. The Sacklers built their empire of pain, as American photographer and activist Nan Goldin hauntingly puts it, “by promoting addiction.” Purdue Pharma, the family’s pharmaceutical company, aggressively marketed and promoted their opioid painkillers, most notably OxyContin, to patients and doctors all over the country. They made billions upon billions of dollars by misrepresenting OxyContin's window of pain relief, falsely claiming its superiority to other treatments, and—most crucially—lying repeatedly about the risks of addiction. In fact, even when the Sacklers knew that people were actively dying as a result of using their drugs, they marched on, undeterred, unwilling to hold themselves even slightly accountable, or show the faintest hints of sympathy or remorse. Keefe’s book recounts a particularly blood-boiling instance when Purdue’s then-president, Richard Sackler, responded in an email to a report of 59 deaths related to OxyContin in a single state by saying: “This is not too bad. It could have been far worse.”
  
  Put simply: I think we, as a society, should bring back the guillotine.
  
  Ultimately, this is a book about the pervasiveness of moral evil, about the violent procreative indifference of the wealthy to the harm they cause, and the ways in which social systems and institutions diffuse guilt and grant protection and prestige to the rich and powerful. It is, in all ways, a great book; though your soul might just curdle from reading it.
• 
  K.J. Charles

  I've been reading a lot of non fiction because I haven't been able to read romance. After this I want to crawl into a hole with forty romance novels and never come out.
  
  Jesus.
  
  This is horrifying. As a Brit I didn't know about this horrendous story of greed and selfishness, which is simultaneously utterly compelling and unbearable to read. I don't know which are worse: the staggering greed monsters that are the Sacklers, the phalanx of lawyers and capos who helped them get away with it, the public officials and politicians who took bribes with both hands, the institutions (many British) who gave them a sheen of respectability in exchange for blood money, the doctors who knowingly pumped opioids into people and the salesmen who helped them do it. All of the above.
  
  Actually I think I hate the public officials and politicians most. They had a duty.
  
  This is a broken, broken society, capitalism at its finest, money creating monsters, and the only cure is the fucking guillotine because as this book makes clear, most of the people (rich white privileged people) who've lived high off the hog of legal drug-pushing, addiction and death just don't see they did anything wrong and don't intend to take any responsibility, ever.
  
  I lay awake last night because of this book and the enraging picture it presents of how greedy, selfish bastards get away with it thanks to a corrupt system that serves only the rich. I hope there's a hell.
  
  You should read it, and then let's go burn some things down.
• 
  Yun

  Sometimes I think I've seen it all. Certainly as a reader of fiction, I think I've read it all. But then a nonfiction book comes along, and the true tale within is so gripping, so abhorrent, as to blow all those made up stories out of the water.
  
  I'd previously read a few books and countless articles on the Opioid Crisis, so I'm not new to the subject. But Empire of Pain approaches from a different angle, focusing on the Sackler family who owned and ran Purdue Pharma. Through their insatiable greed and morally repugnant actions, they got millions of people addicted to OxyContin and hundreds of thousands killed. This is an unflinching look at their history and their legacy.
  
  From the very first page, I was riveted. The central story here is a well-known one at this point: how the Sackler-owned Purdue Pharma, at the behest of the family, aggressively marketed OxyContin as the non-addictive drug of choice for pain management. When evidence started emerging of its highly addictive properties, the family went on to obfuscate this knowledge from the public and the government, effectively contributing to the emergence of the Opioid Crisis.
  
  But this is more than just a story about Purdue and OxyContin. The book captures three generations of Sacklers, going all the way back to when the three brothers Arthur, Mortimer, and Raymond first started making money and building up the family name. To see how they approached their early businesses and their philosophy towards profit and philanthropy is to understand how Purdue eventually became the monster it did.
  
  But the fault doesn't reside entirely with one family and the book is careful to provide a nuanced portrayal of that. No doubt there was plenty of blame to go around. They had help from many different corners, including the FDA who gave their seal of approval on OxyContin, shady salespeople and doctors, and plenty of government officials who looked the other way.
  
  This easily could've become a story bogged down in the weeds, with too much detail and not enough interest. But it didn't. It was a fascinating read from beginning to end, and I couldn't turn the pages fast enough. It really speaks to the author's abilities that he was able to take such a complicated and convoluted narrative and turn it into a tale that is both cohesive and intensely compelling.
  
  This is investigative nonfiction at its best. It goes behind the scenes and lifts the veils to one of the biggest tragedies in modern American history. Though it was hard to read and stomach at times, I couldn't look away.
  
  My heartfelt thanks for the copy that was provided for my honest and unbiased review.
• 
  Regina

  Empire of Pain will easily make my list of the best books I read in 2021. My guess is if you read it, it will end up on yours too.
  
  Journalist Patrick Radden Keefe chronicles three generations of the Sackler family, the people behind Purdue Pharma, also known as the makers of OxyContin, better known as the creators of the current opioid epidemic. Their story is one of philanthropy and philandering, of pioneering and pilfering, and of grandeur and greed. It begins back in 1904 when Isaac Sackler immigrated to America, had three sons, and encouraged them to dream big and become doctors. Though the Great Depression hit him hard, he told his sons, “What I have given you is the most important thing a father can give… a good name.”
  
  Two generations later, that good name is being removed from museums and educational institutions. The 21st century Sacklers pushed their wonder drug OxyContin so hard and so recklessly that millions have become addicted and died. I personally know at least three people who have died from opioid overdoses, and I bet you do too.
  
  The marvel of PRK’s reportage though is that a book that could be so dry is utterly fascinating. While I sadly lost interest in his prior work, Say Nothing, about The Troubles in Northern Ireland, I flew through Empire of Pain in two days.
  
  For those with HBO, the two-part documentary series “The Crime of the Century” makes an excellent companion piece for this book, as does the fictional drama “Succession.” Both further showcase how greed is so intoxicating that right is indistinguishable from wrong. The pull of power and money can be so strong that the most important thing - a good name - becomes collateral damage. In the case of the Sacklers, unfortunately that collateral damage includes millions of lives lost to a crisis they helped to create by recklessly pushing sales of their pain medication.
  
  The Sacklers continue to try to hide behind the Purdue Pharma corporate name, but thanks to journalism like Empire of Pain they’re becoming increasingly exposed. Kudos to Patrick Radden Keefe for bringing this story to light.
  
  Blog:
  https://www.confettibookshelf.com/
• 
  Traci Thomas

  This is A+ reporting and storytelling. The story of the Sackler family is expertly laid out for the reader. Riveting and sickening. Investigative journalism at its best. Read this book.
• 
  Matt

  “Originally, there had been three Sackler brothers, [Kathe Sackler explained]. Arthur, Mortimer, and Raymond. Mortimer was Kathe’s father. All three of them were doctors, but the Sackler brothers were ‘very entrepreneurial,’ she continued. The saga of their lives and the dynasty they would establish was also the story of a century of American capitalism. The three brothers had purchased Purdue Frederick back in the 1950s. ‘It was a much smaller company, originally,’ Kathe said. ‘It was a small family business…’”
  - Patrick Raden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty
  
  Despite being overshadowed by the coronavirus pandemic, the opioid epidemic remains one of the largest public health emergencies in recent American history. Since 1999, almost 500,000 people have died from overdoses involving an opioid, with another couple million people classifiable as having an abuse disorder. Along with the human carnage comes economic and societal costs that are hard to quantify, but some have reckoned as high as $2 trillion.
  
  The Sackler family – owners of Purdue Pharma, makers of OxyContin – did not create the crisis on their own, and cannot be apportioned all the blame. Many factors have to move simultaneously for a catastrophe of this magnitude. Nevertheless, they deserve to shoulder a huge portion of the responsibility, as the creation of their wonder drug, its aggressive marketing, and its ridiculous ubiquity has established it as a major catalyst in the calamity.
  
  Throughout most of Purdue Pharma’s lifespan, the owners did their best to keep their names out of the limelight. Whenever a Sackler was mentioned, it was typically in connection with large charitable gifts to medical schools, art galleries, and museums, for which they demanded and received due credit.
  
  In Empire of Pain, journalist Patrick Raden Keefe fixes to change all that. By the time you reach the last page, if you ever hear the name Sackler, you will think of only two things.
  
  ***
  
  Empire of Pain is an instant classic. It is beautifully written, marvelously structured, deeply reported (with Keefe’s source notes presented like a legal brief, to ward off the threatened litigation he faced), and passionately argued. Beginning in 1913 – with the birth of Arthur Sackler – and ending in the present day, with Purdue Pharma in bankruptcy and COVID-19 raging, Empire of Pain has the sweep and scope of a great epic, and more than a few elements of a tragedy.
  
  While there are some very good books on this subject – to Keefe’s credit he mentions these titles, and makes no pretense to “breaking” this story – Empire of Pain towers over all others, not just in terms of sheer ambition, but in terms of near-perfect execution.
  
  ***
  
  Maybe the most important thing to know going into Empire of Pain is that it is not solely – or even mostly – focused on the United States’ ongoing addiction to prescription painkillers and their street-drug equivalents (namely heroin). Instead, it is divided into three rather different sections. Sometimes the different parts inform each other, sometimes they do not. In any event, they all hold together beautifully.
  
  ***
  
  The first third of Empire of Pane is biographical, focusing on Arthur Sackler and – to a much lesser extent – his brothers Raymond and Mortimer. It closely follows Arthur’s rise as the son of a middle-class grocer to become a fantastically wealthy doctor, adman, and business owner. Keefe has done something extremely rare, which is to create a characterization that is so vivid and tactile that you feel you are with the person, that you understand what they’d think or say in a given situation. And he does it all in just over a hundred pages. It is a testament to how well Empire of Pain worked for me that even a chapter on ancient Chinese furniture – which became one of Arthur’s abiding passions – entirely held my interest.
  
  Arthur played a huge role in the marketing of Thorazine and Valium, helping to create the idea that prescription drugs were just like every other American commodity, something to be mercilessly marketed and sold to as many people as possible. Yet Arthur is not presented as some embodiment of evil. He was an extremely hardworking man who began his career as a psychiatrist, a field of medicine that even today is slighted in comparison to other disciplines.
  
  Despite the amount of space given to Arthur, his role in the oncoming epidemic is contextual only. He may have created a blueprint for selling medications to patients who did not necessarily need them – and who might be harmed by them – but he was dead by the time OxyContin hit the bloodstreams of the body public.
  
  ***
  
  Empire of Pain’s middle portion follows the rise of Purdue Pharma. This company, spun off from Purdue Frederick (which Arthur purchased, and which made every day over-the-counter medicines, such as Senokot laxatives), controlled a small drug company in the United Kingdom that had created a timed release morphine pill called MS Contin. Since morphine is addictive, and had been used mainly for end-of-life pain management, such a pill seemed to have limited application. The “genius” of Purdue Pharma was to rebrand MS Contin as something that could be used to treat all manner of pain. Later, Purdue Pharma did the same thing with the much more powerful OxyContin, selling it – with the FDA’s questionable approval – as a safe painkiller that could be widely deployed to fight the “pain epidemic” purportedly afflicting the nation.
  
  The main character Keefe follows through this section is micromanager extraordinaire Richard Sackler. A physician himself, Richard’s peculiar talent was recognizing that he had stumbled on a single billion-dollar idea, which he thereafter clung to with remorseless intensity.
  
  While Richard is always around, Keefe starts to broaden his story, moving away from the Sackler’s to encompass many other topics, including the creation of both MS Contin and OxyContin, the history of opium, the Napp Technologies plant explosion, and the tactics used by the Purdue Pharma salesforce to achieve $35 billion in Oxy sales over two decades. Though Keefe sometimes veers off the trail –for example, Napp Technologies was owned by the Sacklers, but he doesn’t connect them to the negligent day-to-day operations that led to the disaster – the narrative is still absolutely engrossing.
  
  ***
  
  The final third of Empire of Pain deals with the fallout. Here, the storyline becomes more diffuse, as Keefe no longer follows any of the Sackler family members with the previous intimacy he showed for Arthur and Richard. Instead, he expands his coverage even further, to include federal prosecutors, state attorney generals, journalists, and activists who tried to bring down the Sackler dynasty. With effortless dexterity, Keefe is able to navigate the numerous lawsuits in a way that is understandable, accurate, and dramatically compelling. He also follows the wave of un-naming ceremonies, as all the institutions that gladly took Sackler money in the past, erased the Sackler name from those gifts (without, it seems, paying the money back, which is a quintessential modern example of confusing the signaling of virtue with being virtuous).
  
  Keefe is not able to give us the final word, as the wheel is still in spin (a judge recently rejected a global bankruptcy settlement for Purdue Pharma). Whatever happens, nothing is going to bring back Purdue Pharma. We are left now to deal with its devastation.
  
  ***
  
  Empire of Pain is about many things, which is why it is so magnificent. Chiefly, though, it is a morality tale about the corporate erosion of social institutions. A corporation is a legal fiction, a business entity that takes on the character of an immortal person. It is a made-up thing that does not exist in nature; it is not a mountain or a tree or a banana or a human being. Despite this, it is treated by the law as some immutable universal truth. In the 21st century, a corporation has many of the important constitutional rights of a flesh-and-blood citizen, but none of the ethical responsibility. A corporation, after all, exists only to enrich its shareholders. More importantly, a corporation does not face any consequences. If you or I break the law, we go to jail. But you can’t put an orange jumpsuit on a corporation. In the case of the Sacklers, the corporate form allowed them to make billions of dollars, to take that money out of the corporation like an ATM (to the tune of $10 billion in disbursements), and then leave the empty husk of Purdue Pharma to be picked over by creditors.
  
  The corporate veil will shield the Sacklers from any criminal exposure, and will most likely shield the vast majority of their fortune, which is sloshing away in offshore accounts. Empire of Pain raises important questions about who the law is supposed to protect. Legal genuflection to the corporate form is not, obviously, a new condition, and it did not start with Purdue Pharma. Sometimes, though, it takes an infuriating and appalling situation to change the status quo, and maybe this can be the beginning of the end.
  
  But probably not.
  
  ***
  
  This isn’t a knock on Keefe or Empire of Pain (who is upfront about the type of story he is trying to tell), but the opioid epidemic the Sacklers fueled is a bit abstracted here. There are no portraits of shuttered factories, dying towns, or desperate men and women looking for an out; there are no shooting galleries, drug dealers, swollen jails or overtaxed rehabilitation clinics; there is a chasm between us and the broken lives and the naloxone advertisements at the bus stop and the addict dying alone with his brain so addled it’s not monitoring carbon dioxide buildup or sending messages to his diaphragm.
  
  In short, this is a strangely sterile and sanitized look at the ravages of OxyContin and its ilk, viewed from the same distance as the Sacklers viewed it. To that end, I’d recommend further reading, such as Beth Macy’s Dopesick. Other angles of the epidemic are also ignored, in the interest of space and coherence. For instance, Keefe admittedly does not attempt to deal with the complicated issue of chronic pain management, an issue that is going to get a lot harder as opioids are forced into retreat.
  
  ***
  
  Ultimately, the Sackler family will be just fine. And by fine, of course, I mean that they will continue to sit on a pile of cash big enough to make Scrooge McDuck blush; they will continue to have multiple mansions in the best parts of the globe; they will continue to have access to private planes and private beaches and massive yachts and exclusive resorts; they will eat lobsters stuffed with steak and truffles and diamonds; they will spend more in a month than most people make in a year or a decade or a lifetime. None of them will ever have to do a day’s worth of actual labor. Their descendants for untold generations into the future will accept the dividends of this wealth as something they have earned and to which they are entitled. For all of this, they will continue to see themselves as the real victims.
  
  The only thing they have really lost is their good name. This was an obsession that started with Arthur Sackler, and that has continued to be of utmost importance to every wing of the family. Every time they gave a dime, they wanted a sign saying “Sackler.” They wanted their name to live forever.
  
  Now it will. No one will ever forget this family, but not for the reasons they intended. Forevermore, the name of Sackler will mean greed. Forevermore, the name of Sackler will mean death.
• 
  JanB

  As the title suggests, this book is a deep dive into the Sackler family. Most of us know they own Purdue Pharma and their role in producing and promoting OxyContin, but perhaps fewer people know their history and how they got to this point.
  
  The story starts with the patriarch Arthur. He and his two brothers were the children of Jewish immigrants, and all three became physicians. They were pioneers in the field of psychiatric medication, which ended the barbaric practice of lobotomies. I loved this part of the book and as a nurse, appreciated the background into many familiar medications and how they were named.
  
  In the 1950s, the brothers acquired Perdue, a small pharmaceutical company, and grew it into a lucrative, innovative company. Arthur was the one who devised advertising campaigns for drugs and began marketing directly to physicians. An idea that we now know was ill-conceived and had unintended consequences.
  
  An avid art collector, Arthur donated much of his collection to museums, along with millions of dollars to philanthropic endeavors, with the Sackler name prominently displayed on wings and galleries around the world.
  
  Arthur died in 1987, and part two shifts the attention to the brothers. I found this section less compelling and of less interest, with much of it a bit of a slog to get through all the detail. The latter part of the book picks up when it highlights the downfall of the family as they began producing and aggressively marketing OxyContin as non-addictive, despite knowing those claims were false. Their deceptive practices and cover-up of the facts fueled the opioid epidemic and made the family billions of dollars.
  
  Those of us who follow the news also know that the court case holding the family responsible for their contribution to the opioid crisis is far from settled and remains tied up in the court system.
  
  Museums, universities, and other institutions have announced they will refuse further donations from the Sackler family, and the Sackler name has been removed from countless galleries and wings funded by the family. I don’t agree with cancel culture but the Sackler name is so tainted it threatens to hurt their mission.
  
  The Sackler family is not single-handedly responsible for the opioid epidemic. To assume so is to ignore the scientific community’s claims at the time, the FDA, and the government campaign in 1996 to consider pain as the 5th vital sign, compelling physicians to aggressively treat pain. It was a perfect storm of events, combined with unethical business practices, that led to the current crisis. The current opioid deaths are caused by fentanyl, produced in China and smuggled from Mexico, but the majority of addicts started with prescription opioids.
  
  It’s a complicated issue and there’s plenty of blame to go around, and none of it absolves the Sacklers or Purdue Pharma. Certainly the Sackler name is one that should always be remembered as a symbol of unbridled greed and corruption that killed many people and destroyed countless lives.
• 
  Beverly

  Patrick Radden Keefe is a brilliant journalist and writer. I read Say Nothing by him, also, which is another top notch non-fiction book that recently won a prize.That book was about the abduction and murder of Jean McConville who was the sole support for her 10 children and who was later found to be innocent of spying for the British. She was executed by the Irish Republican Army in 1972, anyway, and as far as I can tell, nobody gave a damn. I was riveted by that story and by this one too.
  
  In an interview for The Guardian, Keefe, who is American, said that he's always been interested in secrecy and with the Sacklers, he hit the mother lode. This family, who was known for being philanthropic, held a tight grip on the source of their immense wealth for many decades. Even close friends didn't know what they got rich off of. Keefe went right back to the beginning to proud Jewish immigrants who instilled in their 3 sons a belief in education, hard work and paradoxically the value of a "good" name.
  
  The eldest son, Arthur was the dynamo who started the family in the drug business after he got his medical license. Arthur Sackler discovered what he was really great at was selling. He, singlehandedly, reinvented how the public is sold pills. He began the horrible, pushy sales reps who hound doctors. It is no secret that these pill pushers are attractive, young people. Free gifts, dinners for prescribers, all that was started by Arthur. He even won awards for his selling techniques. What made his fortune was Valium.
  
  His brothers surpassed him by using his sales techniques to push a new drug that their company invented, a little opioid called OxyContin. This pill took off so well that between 1999 and 2019, 500,000 Americans had overdosed on it. The family never felt or expressed any remorse for this Hell they unleashed and were still trying to come up with a new version of it---for children, when their business finally imploded. There is no vindication though. Their company took bankruptcy, but they got to keep their billions.
• 
  Henk

  A sobering account of greed and the lack of morals extreme wealth and a legion of lawyers brings with it. Human health and welfare are consistently, through generations and decades, subordinated to money
  It is a peculiar hallmark of the American economy that you can produce a dangerous product and effectively off-load any legal liability for whatever destruction that product may cause by pointing to the individual responsibility of the consumer.
  
  
  Empire of Pain: The Secret History of the Sackler Dynasty reminded me uncomfortably of
  Bad Blood: Secrets and Lies in a Silicon Valley Startup, but then on a much larger scale and timeframe. Again greed is much more important than human welfare.
  
  The founding brothers
  
  Patrick Radden Keefe skilfully details the start of the opioid crisis through the family dynamics, that start with three brothers in the early 20th century: Arthur, Mortimer and Raymond Sackler. Arthur especially being very entrepreneurial, with his student work in the Depression leading to his parents being capable of buying a store in those troubling times.
  
  Discrimination against Jews in university access (some years 60% of medical students applicants being Jewish) leading to the younger brothers studying in Scotland. All of them end up being a psychiatrist and Arthur also an ad executive handling the Pfizer account under 30.
  Ambition is everything, choosing between the founding of an institute or watching your first son being born is something that Arthur doesn't find hard, decidedly choosing for the founding speech.
  Even Andy Warhol ended up producing art for adverts of the Sackler firm.
  
  But attracting big names is not enough: Arthur goes on to finance his biggest ad rival secretly to circumvent competition rules. Another option is founding journals, that, being dependent of ads, led them to be uncritical of new wonder products against anxiety and depression, with the Cold War being an important driver of psychological tension.
  
  Women being the most targeted by advertising of tranquilizers, the penicillin for the blues and Pfizer marketing specifically a tranquilliser for kids.
  
  The Sackler family used their connections with Big Pharma to gain a commission on the first $100 million drug, Valium, with Roche only giving up defence against regulation of prescription due to side effects when the patents expired.
  
  And if all else fails Pfizer can do the following: just pay the FDA head of antibiotics approvals 16 times his annual salary by buying up medical magazine issues he edited and had commission rights on. The same person his speech was edited by Pfizer, who used his statements as an endorsement of new drugs. All the while the Sacklers add company handles the campaigns of Pfizer and the funding of said medical magazine.
  
  At a certain moment money is no longer enough: respectability needs to be gained. Buying the Asian collection of the Met at the cost price (mostly 1920’s amounts) then donating it back to the museum and deducting the donation at current prizes from tax combines both money and prestige.
  Arthur ends up just storing his own Asian collection at the Met in an “enclave” based on dangling the potential donation of the pieces to the museum.
  
  Arthur is also not above buying a Renoir and a Monet for his ex-wife.
  His ex-wife attempting suicide by sleeping pills when she doesn’t get traction on her divorce settlement is something of money not being able to buy everything, as does the suicide of a nephew of Arthur.
  
  Opioids take precedence
  MS contin being a special coating on morphine, which ends up being a $170m drug, is a game changer to a sleepy part of the business endeavours of the Sackler's: Purdue Pharma.
  Denying the addictive qualities of this new oral release mechanism of the drug, soon to be recycled in OxyContin, a trend soon emerges.
  Arthur his branch of the family is being bought out of Purdue Pharma for just $22m just before the succes of the new coating mechanism. This is interesting when compared to $7m lawyer bills of infighting family members.
  
  Daughter Cathy and Mortimer (a-side shares) and son Richard and Raymond (b-side shares) being the remaining shareholders, having a tumultuous relationship with each other and dominating boardroom dynamics.
  
  En passant the author shows us that dangerous drug being marketed to the masses is not something incidental: heroin for instance was being mass marketed by Bayer in 1910’s.
  There are only so many cancer patients - on not marketing OxyCotin, twice as powerful as morphine, just to cancer pain.
  
  OxyCotin being approved in 11 months, with the FDA regulator joining Purdue little more than a year later at a $400.000 annual salary during the 1990’s. Purdue spending Over $9 million dollars of meals per year bought for physicians to market the drug.
  Already in 1997 abuse cases came to light from sales representatives, even though they were handsomely rewarded for looking the other way, with bonus plans without caps, and people getting $170.000 bonuses per quarter.
  Rudy Giuliani is, when trouble becomes more pronounced, hired by Purdue to bolster their reputation.
  Foundations to represent patients, being led by lobbyists paid by Purdue also help.
  
  All the while questionable sales practices keep aggressively being pushed: for instance free starter coupons for a month of OxyContin being on offer. Plus hiring McKinsey to turbocharge the sale of the drugs.
  
  And this has success: in 2006 more than $9billion sold of OxyContin, with sales of $100million per month.
  In that context a fine of $600million and some executives pleading guilty is only a very minor setback. In the same year of the fine a $325million dividend to the Sackler family was approved and annual $700million disbursements to the family were forecasted in the next 10 years after 2010.
  
  FDA withdrawing options for a generic version of OxyContin, based on that the product was “unsafe” only at the day of expiration of the original product, while Purdue kept selling the product still in Canada for a year, where the sales of the old product quadrupled.
  
  Course changes and decline
  A quarter decrease of revenue after the reformulation of the product, making it harder to snort and inject, giving an indication of the substance abuse spread.
  The cost being overdose deaths tripling since 1990, and for Purdue spending $700million between 2006 and 2015 on lobbying, 8 times as much as the entire gun lobby. 150 people dying in 2015 each day of opioid overdoses and for instance Ohio having 20% of adults exposed to opioids.
  
  But the company was also looking into new revenues: Pain treatment and addiction are naturally linked as an executive noted on an especially cynical project to enter into addiction treatment drugs.
  
  Meanwhile let's not forget that Johnson & Johnson was producing 85% of poppies devoted for Purdue’s production in Tasmania and also made handsome profits. Despite the book focussing on Purdue, this company had only a market share of 27% of the heavy opioid doses pills. But then again, the Sackler family did own the 7th largest generic drugs producer, thus even capturing more of the market.
  
  Selecting an own bankruptcy judge for Purdue through administrative minutiae is the latest in the extremely cynical tale of the Sackler dynasty. Their removal from the walls of museums and universities is a very scant consequence, given that their dividends are hidden through companies in multiple tax havens, hence not hitting them for what they truly care for. A sobering tale of greed over multiple generations, and complicity by broader society and people in power.
• 
  Marialyce (absltmom, yaya)

  It has taken me awhile to formulate my thoughts about this amazing book Empire of Pain. This nonfiction, written by Patrick Radden Keefe, will not only inform you of three generations of the infamous Sackler family, it will also made you incensed that their company, Purdue Froelich initially, later entitled Purdue Pharma was able to ensnare the public to the drug OxyContin.
  
  The family became enormously wealthy donating to a plethora of institutions including hospitals, universities, museums, etc with always the one caveat, their name must appear on the donation. Across the world the name appeared which would one day be removed because of the insidious practices of their company. They were a family who flew under the radar, one that always remained in the shadows, never affixing their name to any company they owned and clandestinely operated. The family's beginnings were traced back to Issac Sackler, who in 1904, immigrated to America, He sired three sons, encouraged them to become doctors which they did. He also told them "“What I have given you is the most important thing a father can give… a good name.” Unfortunate, in so many ways, his ensuing progeny didn't consider his words as they did everything, they could to push their wonder drug OxyContin.
  
  Labeled as an answer to pain sufferers dream, this drug's side effects were hidden, as undocumented studies were used and often quoted in selling the drug. ...and selling they did.
  Offering huge benefits to doctors who prescribed the drug and a sales staff that was trained well, the drug became a word wide phenomenon. FDA approved added that additional push to Oxy's fame and the money poured in making the Sackler's one of the richest families in our nation. They encouraged their sales staff to target poor areas under the guise of knowing the spots where pain was most prevalent thus hooking countless people onto this drug requiring more and higher dosages to abate their pain.
  
  The Sackler's knew what was happening. The drug they claimed was nonaddictive was, but as their sales increased and millions were amassed, they didn't care. Lawsuits that came in, were put down quickly by teams of high-powered attorneys who would dig into the past of the plaintiff to disgrace them. The kicker to me was that the company (aka the Sackler's) said that the people who became addicted were those who had an addiction flaw in their nature, already were addicts, not that the drug made them so.
  
  The thousands who died because of their drug is immeasurable. Parents lost children, couples lost each other, children lost their parents, and the suffering mounted up for the people who were sucked into the Sackler web of deceit and deplorable practices. There is an excellent chance you know someone who perished, or is currently fighting their addiction.
  
  It took many a year for the drug to be understood and although Purdue did try to make a pill that couldn't be broken down, their initial push of this drug, started many down the path to heroin and morphine.
  
  Thanks to the investigative talent of both the author and others, the Sackler family no longer remains hidden. The very infuriating thing was that they knew the end was coming so they pulled millions out of Purdue Pharma, hid the money in untraceable accounts, and finally declared bankruptcy for Purdue. However, in a turn of their need to be philanthropically recognized many institutions pulled their name from structures as well as refusing future donations. It seems the one good thing that Issac gave his family, they successfully destroyed.
  
  ****As a caveat, there is so much money to be had in this industry, that many can be "bought" both in government agencies and legal services. Most concerning of all to me is that drug companies have been indemnified by our government, meaning that they can't be sued or held accountable for the havoc that might ensue. Makes you wonder does it not? Hopefully the Sackler's will have a wing in hell with their name over it awaiting their arrival!
  
  A most excellent book that will infuriate you as well as fascinate you with the family's arrogance and evilness. Kudos to Patrick Keefe for writing this masterpiece.
• 
  Elle

  Congrats to the 2021 Goodreads Choice ✨WINNER✨ in History & Biography!
  
  A painstaking account of the very beginnings of the Sackler family business, starting with the founding and acquisition of several companies by Arther, Mortimer and Raymond Sackler, to present day where their name is being scraped off of the side of institutions they donated millions to, Patrick Radden Keefe has provided the ultimate guide to the people behind the pills at Purdue.
  
  Obviously they are not the first to market unsafe pharmaceuticals to a vulnerable population, or the only players in this massive industry. The politicians in the pocket of big pharma, the medical providers and doctors who facilitate these massive drug schemes, the regulators who look the other way—there’s a lot of culpable parties. But I feel like Keefe draws a clear line between not just the Sacklers and Purdue taking advantage of these systems, but actively making them worse for the public. They laid the groundwork for future companies to follow, all with seemingly no consequences. Between this and COVID, I don’t know how anyone can look at our healthcare system and not be repulsed.
  
  The amazing thing to me about the ultra-wealthy is that it does not take an unattainable amount of brilliance to stay rich, just a moderate level of competence. There was one, maybe two true visionaries in this family, despite that vision being morally bankrupt, and after the companies were built there wasn’t much left to do. The rest of the family members were little more than warm bodies who coasted by on accumulated wealth, too wrapped up in their own self-importance to even attempt to care about the devastation left in their wake. What the Sacklers did have in spades was an unmatched level of egotism and callous win-at-all-costs mentality, both of which eventually contributed to the downfall of Purdue after years of being the things propping it up.
  
  A perhaps an unexpected result, but there’s nothing that gives this more credibility to me than the first few sentences of A Note on Sources at the end of the book. “The Sackler family did not cooperate with my efforts to research this book. None of the Sacklers who feature prominently agreed to grant interviews.” I would be immediately skeptical of any work that they willingly involved themselves with. I’m sure this was frustrating for a writer, but still probably anticipated by Keefe. Everything in his reporting would suggest this is a family that does not engage in anything unless they are in full control of the narrative.
  
  Lately I’ve been thinking about objectivity in journalism, as well as reading reporters share their own feelings on the subject. Much of the complaints by the Sackler clan against those who have reported on their family’s misdeeds have led with an accusation of the journalist in question being “biased” or motivated by some other self-serving desire. This premise is both ridiculous in the context of the case, but also broadly speaking. And this kind of demand for absolute neutrality from those reporting the news is unrealistic, but also sanitizes the crimes of the powerful. It’s the way we get phrases like “officer involved shooting” that exist entirely in a passive voice. And with over 800,000 Americans dead and millions left reeling in the fallout of the Sacklers’ greed, the last thing that I want in any analysis is passivity.
  
  And now I’m going to do something I rarely do, which is give credit to a publisher. I’ve criticized publishing houses for not supporting their authors, giving book deals to known liars with dubious fact-checking or possibly the worst offense: printing book club ‘stickers’ directly onto covers. But putting out a nonfiction work like this, especially one that so directly shines a light towards organizations that have used their over-powered legal forces to silence and punish critics, does take a certain level of nerve and belief in their authors’ work. Keefe directly named Bill Thomas, Daniel Novack, Kimon de Greef and Julie Tate among a dozen others for their efforts, so credit to them and the rest of the team involved.
  
  One of the refrains that David Sackler repeatedly echoed was his desire to “humanize” his family. With this book, I believe that Patrick Radden Keefe accomplished that goal for him. The author, with the help of previous efforts by journalists like Barry Meier, prosecutors like Maura Healey and activists like Nan Goldin, has fully removed the veil obscuring the Sackler name from their deadly legacy.
  
  It’s my belief that even after everything, they’re going to get away with it. But it will come at a cost, possibly the only thing they value near as much as money: their reputation. And now embossed in gold lettering, a New York Times Best Seller, their name in the subtitle The Secret History of the Sackler Dynasty will forever follow the phrase Empire of Pain. If the shame does not devour this family, I hope it perpetually shadows them.
  
  
  
  If you liked this book by Keefe, I’d also highly recommend
  Say Nothing: A True Story of Murder and Memory in Northern Ireland by him as well.
  
  **For more book talk & reviews,
  follow me on Instagram at @elle_mentbooks!
• 
  Elyse Walters

  Audiobook….narrated by Patrick Radden Keefe
  …18 hours and 6 minutes
  
  The billionaire Sackler family - three generations-and a forth-guy…..
  The fates of Purdue have been the closely watched companies in the pharmaceutical industry seeking to hold them accountable for the epidemic of opioid addiction in the United States which has claimed more than a half million lives.
  
  This audiobook was packed filled with interest - historical details - dates- timelines -devastating facts -
  family history—family drama—family fortune— organizational developments…
  multiple and multiple investigations….
  
  An Un-put-down-able gripping audiobook listen.
  I never expected it to be ‘this’ GOOD — for lack of a better Poignant affecting word…..(thank you Margie- I owe you one!!!)….
  
  ….penicillin for the blues?/!?…
  Tranquilizers, Valium, profits, advertising,, commitments with the brothers, important clients, management, employees……
  Convincing the world and patients that their drugs were different—
  Crazy lies to the public for different ailments that their drugs were the best thing to
  prevent muscle spasm, stress relief, sports medicine…..etc.
  
  Who remembers the book
  “My Lobotomy”, by Howard Dully??….
  A true story that took place - parts up the street from my house…
  I couldn’t help but think of that tale too.
  
  Valium and Lithium was recommended to cure everything under the sun…..
  recommended to women much more often than men.
  The perfect Valium candidate/client was:
  “35, single, and slightly neurotic”.
  I still remember when several of my women friends took Valium like gumdrops when we were students at UC Berkeley.
  The women I knew were much younger than 35 too.
  Me…
  I was a straight-arrow gymnast. I didn’t even drink coffee-or take an aspirin-
  let alone try drugs of any kind.
  But —I clearly remember ‘many’ drug users during 60’s and 70’s….
  We all knew somebody’s brother or cousin - or friend of a friend who died — didn’t we?
  
  Librium was the most overly subscribed medicine in America at one point. (late 60’s)….
  Money was pouring in.
  Year after year the volume kept rising.
  
  The advertisements for these ‘cure all’ drugs were ridiculously above and beyond normalcy….
  The focus was to educate physicians that their happiness pills 💊 were not addictive.
  Ha!
  
  Corruption—OxyContin addiction—the opioid crisis—millions of lives loss ….was/is a travesty…..
  
  “Empire of Pain” is brilliantly documented—
  Enraging and brutal - reads like a thriller……(gripping engaging)…..
  But….unfortunately it’s also MADDENING a little all too true!!!
• 
  Michael Perkins

  How it all started.....
  
  
  https://www.vox.com/2017/6/5/15111936...
  
  ======================
  
  The article that the book expanded from.
  
  
  https://www.newyorker.com/magazine/20...
  
  =====================
  
  New documentary....
  
  
  https://www.youtube.com/watch?v=SkU75...
  
  ============
  
  sociopaths....
  
  
  https://www.npr.org/2021/06/02/100208...
• 
  Barbara

  Huge shout out to GR friends Elyse and Stacey B who wrote a fantastic reviews on “Empire of Pain”. I chose to listen to the audio, narrated by the author Patrick Radden Keefe. What’s interesting is that he was initially interested in drug cartels, and through his research on the cartels, he found the Sackler family.
  
  Keefe provides the history behind the three generations of Sacklers. It starts with the founding fathers: Raymond, Mortimer, and Arthur. The three Sacklers were physicians which is remarkable given the anti-Semitism at elite medical schools at the time. Arthur had an interest in psychiatry after working at a mental institution. Arthur was convinced mental illness was a chemical imbalance in the brain and conducted research in drug trials. He struck gold in creating Valium. With the Valium funds, he bought an advertising firm and a small drug manufacturer, Perdue. Arthur brought in his two brothers to run the business.
  
  Arthur was the brother who found the holy grail of advertising. In fact, I believe Arthur is the pioneer of medical advertising, especially “creative” advertising. He knew ads sold, and he especially targeted physicians.
  
  The three brothers also started collecting art when their fortunes were high. They were noted as big philanthropic giving to many institutions.
  
  Meanwhile, Purdue created the opioid OxyContin. They marketed it as non-addictive and the gold standard of pain relief, especially for chronic pain suffers. Their business mission was to alleviate chronic pain.
  
  What I learned from this is how big pharma gets away with advertising and political connections. The FDA doesn’t come out too well here. I am overjoyed that Keefe exposed the history of the Sackler family and how they made billions of dollars. I don’t think this flagrant abuse of power ends with the Sackler family.
  
  I am hoping that this story ignites a fire in all of us to question what these pharmaceutical ads are doing. Advertising directed at physicians tilt their opinions of the necessity of some medications. And the public sees the advertising and agree with the physician.
  
  What this book exposed is the drive to make money. Pharmaceutical companies create drugs to sell. They find target markets and more importantly, create markets. What might start with a pain reliever for cancer patients, a creative pharmaceutical company “targets” other medical specialties that treat pain. Sacklers went after pediatrics as well as orthopedics. The ethics of marketing pharmaceuticals needs an overhaul. What Keefe showed is that the FDA is not to be relied upon nor are they the ethics of this industry.
  
  Pain management continues to haunt our society. The Sackler family advertised themselves as the saviors to these sufferers. They strongly believed their product did good when taken as directed. Even with obvious evidence that their drug had a high addiction rate. As of this date, there are no easy answers, and there are many chronic pain sufferers that have no relief. And as of this date, there are no ethical group governing the industry. It wasn’t until the state governments got involved, especially Maura Healy, the Attorney General of Massachusetts, and other government officials in other states came down hard.
  
  The Sacklers capitalized on marketing, making billions of dollars. They got caught. I’m left with wondering what other big pharma is pushing their drug and creating more harm than good. There are bad drugs out there that doctors, media, and advertisers push to the public. I hope these stories educate us to be a bit wary of meds. Sacklers aren’t the only ones motivated by greed.
  
  The audio is a bit over 18 hours. The author narrates it, and he is a perfect narrator. This is a story that begs to be told. Listening to the book is easy, and I highly recommend it.
  
  
• 
  Stacey B

  Simply stated, I stumbled over an intriguing headline written about the Sackler Family which was way before I knew anything relating to a book. I assumed the article had to do with philanthropy unaware a new story broke. Honestly, a feeling of nausea came over me thinking about the those who fell victim to this drug. At the same time I didn't want to be that person, the one who believes everything they read in print, so I read more articles
  I wouldn't know then which articles were made up drama or half-truths for the media to glob on to or what was true.
  But what I wanted - was to get past this family arrogance to understand at what point greed became the first addiction for the Sackler Family.
  Solely based on the author's reputation, I was hoping he would give this book 110% accuracy in research, but more so that Keefe could write it fairly.
  Bravo!
  Sadly, yet in a convoluted way, this story reminds me of the Madoff family.
  
  UPDATE 11/21
  A few days after I wrote this review I received a pm from a GR's
  member regarding this book.
  It is a heartfelt story that I promised to share as the person felt it necessary to show a different POV. Understanding the focus of the book was written about the abuse of this drug, this story is from one who has legitimate doctors and justification. It is self explanatory. Names and the like are omitted for confidentiality.
  
  " Stacey,
  I wanted to offer you another way of looking at this issue- including law suits against Purdue (I'm just one of thousands, or perhaps millions) because I've been taking OxyContin (actually now OxyNeo, which can no longer be abused by nefarious addicts) for about 15-20 years for severe chronic pain. Because of this, I have a slightly different viewpoint, although I'm certainly NOT excusing anything this family has done!!
  I realize this drug has ruined countless lives, but in my case, it has been a godsend. I struggled for many years with severe pain and my doctors and I tried everything possible to find a way to alleviate my pain - all with very little success. We tried many different medications, physiotherapies, injection therapy, exercise, you name it. About 20 years ago, I was at a point where, if I couldn't find something to help me, I was going to have to quit my job and go on permanent disability, which I did NOT want to do! As a last resort, my doctor prescribed some stronger medications, like Percocet, for example. Still no luck, until the Dr. prescribed OxyContin. For the first while, it didn't help much at all, but suggested we increase the dose - titrating it upward - until we found a level that worked. It turns out I have remarkably high metabolism resulting in my need for much higher than normal doses of every medication I take and have taken in the past. So, we finally found a level that almost completely relieved my pain and Stacey, it changed my life!!! Before long, I had my life back! I could do things again, I could move and work with a level of pain I could live with. And my depression started to lessen until I was finally happy again! It truly gave me my life back!! That's the honest truth.
  I will probably have to take it for the rest of my life, but that's something I have to accept if I want to continue living without pain. It's a small price to pay, in my opinion. I'm finally the person I used to be X years ago, before the pain started. I'm able to live a normal life again and that makes me very, very INCREDIBLY grateful! Without this medication, I'd either be dead, or sitting alone in a house, in a wheelchair, unhappy and with no reason to want to continue living.
  I wanted you to hear the other side of the story. I know there are countless people whose lives have been lost or dreadfully affected due to addiction to this drug, but there are MANY people like me, who take it responsibly and rely on it for the ability to live a normal, or near-normal life. "
  ///
  Today, re-reading this members story made me tear up.. In- between those lines lies another story of what the ramifications could have been from those so desperate for relief but fail at finding it.
• 
  Wynne Kontos RONA READS

  Have you seen Anya Taylor-Joy in the THE WITCH? Perhaps you washed pan seared gnocchi down with a crisp French 75 at The Smith. Did you attend Columbia, NYU, Yale, Harvard, or Tufts? Have you been to the Egyptian room at the Metropolitan Museum of Art? What about an exhibit by a woman artist at the Brooklyn Museum? Ever been to the Tate Modern in London? What about the Dia Art Foundation? The National History Museum? Have you ever taken Senokot for constipation? Do you know a Vietnam war veteran treated with antiseptic while serving? Have you seen the HBO original film O.G. starring Jeffery Wright?
  
  If the answer to any of the above is yes, you can thank the Sackler family. They donated too, funded or directly created all of the above experiences. If you've lived in New York City in the past thirty years, this might not be new information. But whether it's new info or another reminder, it hurts all the same. (That pan seared gnocchi hits me especially hard.)
  
  The Sacklers are a New York family who until the last 5 or so years were mostly known for their philanthropy in the arts and sciences. Arthur, Mortimer and Raymond Sackler were all medical doctors who since the 1940s worked together to create medical and advertising businesses that made them obscenely wealthy.
  
  In 1996, after careful deliberation and deviously applied tactics from the Sackler family, Purdue Pharma released an upgrade from their time release morphine pill (MS Contin) that would make the Sacklers billionaires many times over. The drug was called OxyContin.
  
  Despite egregious ethical and medical malpractice, the Sacklers continued to work for and on the board of Purdue Pharma while OxyContin sold across the US and eventually worldwide. According to Purdue Pharma’s advertising spiel, the pill's time release coating made it not addictive and opiates were safe for all kinds of pain, not just end of life treatment.
  
  Even typing those statements onto the screen seems strange, since we know they're all lies. The Sackler's campaign to market and manufacture OxyContin through Purdue Pharma using this misleading or false advertising helped create the opiate crisis. A crisis in 1996 and then again in 2010, when the drug was "reformulated" in order to make it harder to abuse. Unable to crush the pills, opiate users turned to heroin.
  
  In a world where the Sackler name is so tainted, when the ravages of opiate abuse are so apparent, what else could be said? It turns out a lot.
  
  In 2017, Patrick Radden Keefe wrote a startling expose on the Sacklers and Purdue Pharma for THE NEW YORKER. This emboldened the photographer Nan Goldin and her activist group, PAIN, to protest in many of the famous galleries around NYC who had received substantial donations from the Sacklers. Not until that article was published (several books and journalism stories had been written about the Sacklers for decades with little fanfare) did the tides seem to shift for the Sacklers.
  
  What came before and after the 2017 article will blow your LID OFF. I'm serious. I've always been fascinated by addiction research and when I was still practicing as a social worker in New York would regularly attend workshops and symposiums on my own dime in order to best stay informed. (The day I found out The Smith restaurants were Sackler funded was a dark, dark day.)
  
  But even with all I thought I knew about Purdue and the Sacklers, the behavior of this family and the influence of money across literally every single entity of our lives as Americans (and quite frankly, human beings) is startling. The FDA bribery, the corruption of the court system, marketing and advertising, state and government jurisdiction, pharmacies and insurance companies. I mean to quote THE REAL WORLD: you think you know, but you have no idea.
  
  My first recollection of opiate medication came very early, when my mother was being treated for cancer. Always a calm and collected woman, when my mother drove her forest green Jetta into the seventh grade parking lot and shouted for me to hurry out of her passenger's side window, I knew something was up. At the time, my mother was taking an experimental drug that was covered on a trial type basis through her insurance. Even a single dose was thousands of dollars, and my mother took the drug several times a week (by the end of her life she'd take it several times a day.) She'd been charged full price for the drug by accident and we had only an hour or so until the insurance office closed. Needless to say, we were in a hurry.
  
  But this wasn't the first time my mother had dealt with bureaucracy in getting her medication. The first time was a couple years prior when she'd been prescribed OxyContin. The drug was so regulated by the local pharmacies, that she could only fill the prescription through one (even though for a time, my hometown boasted three drugstores all on opposite corners of one another.) We drove in literal circles while my mother called representative after representative. No one could get her the person she needed to dispense the medication. It was a new prescription, given to her by her oncologist and the oncology team she'd seen since the onset of her illness. The regulations exhausted my mother, so finally she put a call in to her oncologist and said to scrap it. This rigamarole had set off my mother's alarm bells. What medication was warranted this type of trouble?
  
  It took me until adulthood to understand why these memories stuck out for me. In each instance, my mother's temperament was changed. She was visibly frustrated and angry, confused and combatant. She was rarely these things and typically only expressed these feelings to close friends and family. Living as she had with cancer for so long, was a long line of indignities. Driving from pharmacy to pharmacy for a schedule II narcotic was just the icing on the cake.
  
  Much later, after she had died, I saw the Oxy memory in yet another light. What if my mother didn't have an oncologist she trusted? What if he had insisted she get the medication filled that day? What if he'd prescribed her an 80 milligram dose for the foreseeable future? (This was the preferred prescription sale of the Sackler family.) What if the pharmacies in my hometown weren't regulated? What if the pharmacist on call took pity on my mother and relented, filling the prescription against protocol?
  
  By then my mom was divorced from my father, parenting me as a single mother while working a rigorous full time job. She did her upmost to shield me from her illness, but terminal cancer is a hard thing to shield someone from. I didn't have much to compare it to. It was the only life I knew and sometimes, it was a hard life. But the only thing that could've been worse than terminal cancer to a 12-year-old, is having your terminally ill mother addicted to opiates. It's laughable to think of my mother as a drug addict, I'm sure anyone who knew her would say the same. But we know enough about addiction in 2021 to know that it just doesn't discriminate. According to Keefe's reporting in EMPIRE OF PAIN, patients became physically addicted to OxyContin just from taking it regularly, even if they didn't feel the mental compulsion of addiction.
  
  The entire trajectory of my life--of my mother's life--was so fragile that cloudy day in Indiana. Keefe's writing only drove that home in a profound way.
  
  The fact that Keefe can write about this type of heavy, depressing topic and keep the pace of EMPIRE OF PAIN as breakneck as he does is proof of his talent. This reads like an inverse thriller, one where you sort of know the ending but you're racing along trying to determine how it will all unfold. Sort of like the film MEMENTO but...narrative fiction. I was very interested in reading this, but figured it would be dense and hard to get through. On the contrary, I was able to read a lot in single sittings.
  
  The beginning of the third section does drag a bit. At that point in the narrative we've met all our players and are sort of watching all the debauchery unfold in a big, rotting mess. This is the only time where the subject matter did indeed feel heavy and a little redundant. It's all necessary, but it slows. Other than that, I was really impressed. I tend not to do well with nonfiction. But I sped through this.
  
  Aside from my own personal reflections, there's so much EMPIRE OF PAIN can teach us about confronting authority. Not just our state and local governments, but the gigantic institutions that tell us what to think and feel. Advertising agencies, museums and scholarship funds, publications and fashion and what's "cool." Not a single slice of American cultural life went untouched by the Sacklers. How rich people (mostly white men) have corrupted our system in such inexplicable ways taught me, yet again, how to be a critical consumer and reader. Nothing we do, however altruistic in its intent, can subsist without this rigorous criticism. Without this criticism is how a doctor disgusted by electroshock therapy and determined to uncover a dignified, medical cure for mental illness becomes a blood baron of prescription opiates.
  
  It's how we can discuss a book about destruction through unregulated wealth on a website owned by Am*zon. But that's for another review.
  
  It's true that none of the Sacklers were charged with any crimes. They barely have lost a dime after all of this. They're living amongst us, selling us delicious (such delicious) gnochi, they're producing films and social media apps, they're directing films and founding fashion lines. (You won't have to wonder which, Keefe names names, hallelujah hallelay!)
  
  Since Arthur Sackler died in 1987 before the on-set of Purdue Phara and its OxyContin hey-day, many of his heirs say they do not bear the responsibility of the opiate crisis. But Arthur created (literally) big pharma as we know it. Drug salesmen? Profits for selling a particular drug? Drug advertising? The mass production of Librium and Valium (another addictive drug the Sackler marketed as safe without doing any research.) That's all Arthur. His daughter, Elizabeth, a notable benefactor of the Brooklyn Museum, is a big fan of this defense.
  
  Every single member of the Sackler family, including the grandchildren, has taken Purdue Pharma money. It's on record. Madeline Sackler and her documentaries about the unjust prison system. Michael Sackler and his initiatives into safe digital media and regulation (and producing bangers like THE WITCH,) Joss Ruggles and her athleisure clothing line...all of it is Sackler blood money.
  
  The Sacklers like to live deliciously, as Satan famously said in Michael's movie. It's the rest of us who get the bitter pill.
  
  
  
  ______
  Want more book recommendations? Be sure to follow #RONAREADS on Instagram @ronareads4u or visit our digital storefront on Bookshop:
  https://bookshop.org/shop/ronareads
• 
  Lisa

  A comprehensive, well-researched book on the Sackler family and their huge role in the opioid epidemic as founders of Purdue Pharma. The greed (and depravity) of this family is astounding - all glossed over with their art philanthropy. Keefe is very thorough, sometimes too detailed for me. (I found the same problem with "Say Nothing") But overall, an excellent, educational book.
• 
  Meike

  Now a Finalist for the National Book Critics Circle Award 2021 (Nonfiction)
  Holy hell, this book is terrifying: In this meticulously researched account of the roots of the opioid epidemic, Patrick Radden Keefe tells the story of the Sackler family. While the first generation were struggling immigrants, the next made it to med school: Arthur, Mortimer and Raymond Sackler worked with psychiatric patients and bought a pharmaceutic company, Purdue. Arthur then revolutionized medical advertising, masking ads as information, and if you think that's bad enough, nope, Purdue also threw OxyContin on the market, the heavily addictive opioid which was aggressively marketed with (intentionally!) false claims. The dynasty became overtaken by greed, hooking people on painkillers while giving money to noble causes to enhance the family's lore and reputation.
  
  And the cynicism with which the Sacklers proceeded is staggering; but per usual, a handful of terrible people doesn't make a national crisis: No thorough drug regulation, apathetic politicians and state attorneys, doctors who turned their offices into pill mills, doctors who were eager to believe that opioids aren't heavily addictive...the system fails so easily when there is a lot of money involved. If this was a novel, I would have criticized that the plot sounds contrived. This reality sounds unreal, but the sad reality of the opioid epidemic is very real indeed.
  
  Patrick Radden Keefe's research is fantastic, his tone is engaging, but not tinged by moral outrage, which renders the text all the more effective. This book shows what journalism is all about, and how it can defend communities against those who hold too much power, and abuse it.
• 
  Malia

  Well, this was worth the hype! Though it's far from uplifting and quite a dense, long read, it is written so well, I couldn't stop reading. I read Radden Keefe's previous, "Say Nothing", which was impressive, but this one, to me, was even more compelling. He writes in a way that makes this disturbing nonfiction tale read like a shocking family saga. Fascinating, sad and educational, this is truly worthwhile! Easily one of the best books I've read this year!
  
  Find my book reviews and more at
  http://www.princessandpen.com
• 
  Perry

  Compelling story and swirling subplots around the Sackler men and women whose billions were gained on pain and abusive practices concerning opioids, as well as of some heroes who brought the Sacklers to heel.
  
  Comprehensive history of the Sackler dynasty, the descendants of Polish Ukrainian Jewish immigrants to Brooklyn, largely hidden behind their company, Purdue Pharma and its prized Oxycontin, et al.
  
  Coherent argument for the family's primary responsibility for the North American opioid crisis.
• 
  Mara

  4.5 stars - This book most held my interest when it was delving into the business wheelings and dealings of the Sacklers through their various corporations, but overall, an insightful portrait of capitalism unfettered from proper oversight and a compelling implied argument as why "profit above all else" doesn't belong in an industry that directly deals with people's health.
• 
  Jen

  What's in a name?
  
  Arthur Sackler’s father Isaac valued giving his family a good name and reputation above all else. He may have lost his money in an economic downturn, but he took great pride in knowing he provided his children with a namesake they could be proud of. A fortune you can rebuild, he’d said, but once you lose your good name, it’s gone forever. Decades later the Sackler name wasn't just something to be proud of, it was synonymous with philanthropy. Wings of museums bore the name, as did numerous structures on college campuses, yet very few people knew much about the Sacklers or where their great fortune came from. Recently however, it has come to light that their fortune was built on the back of big pharma and more specifically the oxy and opioid crisis. A name once famous, now infamous…
  
  Patrick Radden Keefe is quickly becoming one of my go-to authors for investigative nonfiction. I absolutely devoured this, as well as his previous
  Say Nothing: A True Story of Murder and Memory in Northern Ireland, both of which I listened to in audiobook format. I find listening helps to make the size and depth of the material feel a bit less intimidating.
  
  This truly is a look into the family dynasty, almost a multi-biography, moreso than just a history of Purdue Pharma and the massive and devastating effects it has had on prescription drug advertising, pain management and the opioid crisis. Because of this, I sometimes felt the real meat here, the fascinating subject matter, got a bit lost in side tangents and personal stories. Did I *really* need quite so much detail about Arthur Sackler’s proclivity for Chinese art collection, or Richard’s odd choice of research project with a college roommate? With the Sacklers in particular, who have been notoriously private and closed off, much of this information is coming to light for the first time due to the author's research, so I do certainly understand the urge and reasoning behind including such detail. For me personally though, it was really my only criticism here.
  
  I'd highly recommend this book to pretty much anyone and everyone, but if lengthy nonfiction is not your thing, hey, I get it. If nothing else, pull up John Oliver's brilliant Sackler Gallery project where you can watch some serious and some less serious dramatic readings of Richard Sackler being deposed. I dare you not to hear the words "I don't know" in Richard Kind's voice from now on whenever you read them.
• 
  Simone James

  Brilliant, thorough, engrossing, unputdownable, and upsetting. If you or a loved one was affected by the opioid epidemic, give yourself space for this one because it will hit deep. An incredible book.
• 
  Kiekiat

  A work of investigative journalism that chronicles the misdeeds of three generations of the Sackler family, and a peek into the chicanery regularly employed by their company, Purdue Pharma, in creating and hawking Oxycontin, a highly addictive and sometimes deadly synthetic opiate. Author Keefe does an outstanding job of showing how Purdue Pharma sales reps hoodwinked physicians into believing Oxycontin was a safe alternative for patients with chronic pain and concocted an Orwellian narrative alleging that opioid addiction was actually impossible if Oxycontin was taken as prescribed.
  
  This false narrative resulted in countless cases of addiction, which was possible even if the drug was taken as directed. Oxycontin was hyped as a drug a suffering patient only had to take twice a day, with a 12-hour duration of pain-free bliss that allowed people having chronic pain to lead normal lives. This was not actually true, of course, and the reality is that the drug did not stymie pain for 12 hours--which encouraged users to take more, resulting in thousands of people becoming addicted and Oxy becoming one of the most abused opiates in America.
  
  Meanwhile, the Sackler family made billions of dollars from sales of this powerful opiate, which they had marketed as being less potent than many other pain pills. Keefe digs deep to dredge up the family's complicity in creating the country's latest opioid crisis and provides a compelling account of the family's fall from grace, culminating in Purdue Pharma's demise due to dozens of lawsuits filed by many state attorney generals on behalf of families and patients whose lives had been ruined by Oxycontin.
  
  Keefe is a great writer and only occasionally did the book become a bit tedious, usually when he wandered into chapters about various Sackler family members who had reaped the profits of the family business and were completely out-of-touch regarding the sorrow wreaked by their roles in the opioid crisis.
• 
  Roman Clodia

  The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert public institutions. Just as the FDA was compromised and Congress was neutralised or outright co-opted with generous donations, and some federal prosecutors were undermined with a back-channel appeal to Washington while others were mollified with the promise of a corporate job, just as state legislators and the CDC [Centre for Disease Control] were hindered and sabotaged when they tried to curb opioid prescribing, the DEA was not immune to these pressures and proceeded to soften its position under a steady barrage of industry encouragement.

  
  
  This is a just jaw-dropping exposé of the Sackler family and their rapacious drive to become multi-billionaires and global philanthropists on the back of their opioid drug, OxyContin. The family had form even before their most infamous drug as Arthur Sackler, the effective patriarch of the dynasty, cut his teeth with shady practices in the marketing of Valium, including mass advertising disguised as scholarly medical papers, back-handers to doctors and regulators, and actions that were ethically, if not always legally, wrong. For all that, there's a question mark over to what extent Arthur, the self-made son of Jewish immigrants, might have condoned what happened with OxyContin.
  
  The second section moves on to the second generation of Sacklers, brought up with an acute sense of wealthy entitlement, and inheriting Purdue Pharma from their now billionaire father and uncles. This is where the horrific story of OxyContin and the way it kick-starts the opioid crisis is recounted - and the greed, corruption, veniality and illegalities, the lies, the cover-ups, the aggressive attacks and the politicking (all the way to Ronald Reagan in the White House) are unfurled.
  
  The third section recounts the 'fall' - though given that Purdue is declared bankrupt but the Sacklers were not indicted personally and had already milked the company of multi-billions which they stashed away as personal fortunes in investment portfolios, property, off-shore tax havens and the like, there is no justice in this story. While petty drug dealers on the streets are given mandatory ten-year sentences, this white-collar crime is almost recrimination-free - legal process, it seems, is nowhere near democratic. And how nice to see our friend Donald Trump make a flash appearance towards the end stopping any prosecution of the Sacklers.
  
  Patrick Radden Keefe tells this complicated story with panache and narrative pace. He has marshalled a huge amount of information in digestible form and keeps a cool voice when recounting even the most distressing of tales. As was the case with his previous
  Say Nothing: A True Story of Murder and Memory in Northern Ireland, I could barely put this book down. An unedifying narrative of capitalism at its finest!
• 
  Em Lost In Books

  4.5*
  
  Money and greed is what makes some sensible and clever people create an empire on dead bodies and the power of same saves them from punishment and jail time.
• 
  Krista

  According to the Centers for Disease Control and Prevention, in the quarter century following the introduction of OxyContin, some 450,000 Americans had died of opioid-related overdoses. Such overdoses were now the leading cause of accidental death in America, accounting for more deaths than car accidents — more deaths, even, than that most quintessentially American of metrics, gunshot wounds. In fact, more Americans had lost their lives from opioid overdoses than had died in all of the wars the country had fought since WWII.

  
  There is a Chinese proverb that says, “Wealth does not pass three generations”, and in a way,
  Empire of Pain: The Secret History of the Sackler Family explores this adage. Journalist Patrick Radden Keefe takes a deep dive into explaining how three Depression-era brothers created an empire from nothing; how their children rapaciously turned a multi-million dollar conglomerate into a multi-billion dollar one; and how the third, current, generation is so entitled and out of touch that they insist on enjoying their family’s vast fortune while disavowing any connection to its accumulation. The book ends with the bankruptcy of Purdue Pharma — the exclusive manufacturer of OxyContin, wholly owned by the Sackler family — and universities, galleries, and museums around the world removing the Sackler name from their buildings. The Sackler family may have funnelled much of their wealth into offshore accounts in anticipation of their current legal imbroglios, but their name will be forever linked with the devastating opioid crisis that they knowingly unleashed on the world and it remains to be seen whether the current generation will have the knowhow to generate more wealth, or simply blow through what they have.
  
  I most enjoyed the early parts of Empire of Pain: the story of two Eastern European Jewish immigrants who travelled to Brooklyn in pursuit of the American Dream and the work ethic that they instilled in their three sons; each of whom became a medical doctor, entrepreneur, and philanthropist. The eldest, Arthur, was a polymath, aesthete, and the most striving of the brothers (he would pay for his own and his brothers’ educations with his side hustles while in med school himself) and it was Arthur who would come up with the idea of owning each arm of the octopus that is drugs manufacturing and marketing. As Radden Keefe writes, “They could develop a drug, have it clinically tested, secure favorable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.” And while this first generation of brothers wasn’t entirely likeable or honorable, they did seem to work quite hard and commit themselves to philanthropic acts (even if, as Arthur’s lawyer once explained, Philanthropy wasn’t charity. It was a business. It was all about the tax write offs, the purchase of prestige, and the Sackler name above the door.) When the narrative gets to the second generation — those who developed OxyContin and unleashed a massive salesforce to push it on initially reluctant prescribers — the Sacklers appear to have entirely lost their humanity in the pursuit of colossal wealth.
  
  

  In the 1940s, Arthur Sackler had watched the introduction of Thorazine. It was a “major” tranquilizer that worked wonders on patients who were psychotic. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. The beauty of the minor tranquilizers was that they were for everyone. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. Now Arthur’s brothers and his nephew Richard would make the same pivot with a pain-killer: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. And cancer was a limited market. If you could figure out a way to market OxyContin not just for cancer but for any sort of pain, the profits would be astronomical.

  
  The details of this story are maddening — the pill mills, the corruption at the FDA, backroom deals at the Justice Department — and if I had a complaint it would be that there are simply too many details. Radden Keefe quotes everyone from doormen to other journos and countless unnamed insiders; there is an entire chapter (in an already long book) about Richard Sackler’s college roommate (who would find the man who eventually became the main driver behind OxyContin’s marketing push to be unempathetic and out of touch). And if I had another complaint: The main defense that the Sacklers seem to offer is that they were small players in the opioid market (they claim a 4% market share; Radden Keefe says that calculated in a different way, they were closer to 30%), yet the thrust of this book is that this one family and their small pharmaceutical company are entirely responsible for the opioid crisis (including the ensuing rise in heroin and fentanyl abuse in America), and I don’t know if the author proved that to me. (The Sacklers’ other defense is that they can’t be responsible for how addictive types might abuse their otherwise valuable medication and that leads to the interesting question of whether opioid manufacturers should be treated like Big Tobacco [who knowingly marketed a lethal product and ended up paying the price] or like the Gun Lobby [who get away with insisting that responsibility for the use of guns is entirely in the hands of the user.] I honestly don’t know the answer, but it’s an interesting question.) As an investigative journalist, Radden Keefe has found a great hook with the Sackler family — the humble beginnings, the genius and quest for respectability of the founders, the greed of the next generation that led to the accumulation of billions and the disgrace of the family name — but I wish he added more perspective on how they fit into the bigger picture of a genuine health and social crisis. This is an exhaustive story of a family, but it didn’t feel like the whole story.
  
  

  As they sought to hide from a historic crisis of their own creation, the Sacklers could sometimes seem like Pandora, gazing, slack-jawed, at the momentous downstream consequences of their own decisions. They told the world, and themselves, that the jar was full of blessings, that it was a gift from the gods. They opened it, and they were wrong.

  
  I might come across as nitpicking but this is still a 4+ star read; Radden Keefe tells a fascinating story about an urgent topic, and while it might be a bit long, I was never bored. One thing for certain: Were the Sackler wealth not to pass the third generation, there would be few tears outside the family.
• 
  Adam Dalva

  Capital E Extraordinary work of research, storytelling, insight, and horror - PRK is, of course, one of our very best writers, and from the start my understanding of both the rise of opioids and the pernicious underbelly of the Sacklers was due to his reporting. And yet, somehow, this still astounded me. The strength of the book is in the way that every aspect of it WORKS - the rise of the Sacklers in the 30s' and 40's, Arthur's art collecting, the oxycontin epidemic and subsequent trials, the sometimes wry humor that sneaks in. To read it is to better understand American enterprise -and the characters are just as good, worthy of an epic novel.
• 
  lisa (lewis hamilton's version)

  Being a geopolitics major, I have read my fair share of abhorrent reports, but this book is one that provoked a multitude of emotions, especially anger, to the point where I snapped the spine of my book while reading it.
  
  The Sacklers family is described by a lawmaker as "the most evil family in America" and I stood by this statement. Here are some examples amongst others:
  
  * In reaction to fifty-nine deaths from opioid overdoses in one single state, Richard Sackler, the director of Purdue at the time, said in an email: "This is not too bad. It could have been far worse.3
  * For their advertising campaign, they hired a pain expert who administered 1,000 milligrams of oxycodone to her patients every day.
  * Despite datas and warnings about the pill mill way before its shutdown by the authorities, Purdue allows the physician to prescribe one milllion (yes, 1,000,000) pills of Oxycontin despite the crisis in the region.
  * They strived to (successfully) open OxyContin in 80mg pills and less to children as young as eleven because they want to extend their monopoly on the market, despite the high rate of addiction in teens and young adults.
  
  The sheer apathy of these people are both equally baffling and morally repugnant in the worst way possible. I left this book wondering how many people would still be alive if the Sacklers stood up to own their responsabilities.
  
  In some way, this report is also one of unbriddled capitalism and faulty democracy. Driven by greed and the desire to enrich the family fortune, name, and legacy, they destroyed the life of millions of Americans, a quest in which public authorities were accomplices.
  
  Overall, this is the best book I have read this year, and certainly one of the most gripping and monumental non-fiction I have ever read. It unveils the abhorrent involvement of the Sacklers in one of the worst crisis ever happened in America. There you have it, go read it now and lose faith in humanity all together.
  
  
  ---------------------------------------
  
  pre-review:
  
  An absolute monumental work of investigative journalism.
• 
  Tim

  “It felt as if the skin had been peeled right off”
  
  That’s how opioid withdrawal felt to Nan Goldin, a photographer who developed an addiction after being prescribed OxyContin.
  
  This is the story of how Purdue Pharma aggressively marketed OxyContin, claiming that its “controlled release” feature makes addiction very rare. It’s the story of how for millions, an OxyContin prescription began a path of addiction with devastating consequences. The stories of people who moved to heroin after their OxyContin ran out were particularly devastating.
  
  The story is focused on the Sackler family (the owners of Purdue Pharma) and its responsibility for the opioid epidemic. The book at times seems written with the goal to make you as angry and disgusted with the Sacklers as possible. Sometimes that means going beyond the scope of the opioid epidemic and into their personal scandals. It’s a pretty juicy read.
  
  The Sackler family’s involvement is a story worth telling, but I came away more curious about the bigger picture. What were the structural incentives that made it profitable to recklessly market and sell opioids that are so addictive? Why didn’t regulatory bodies, doctors, or distributors push back more?
  
  The CDC estimates that 50 million Americans suffer from chronic pain. There were enormous profits waiting to whoever could figure out a way to market opioids as an effective way to address this. While the Sacklers were pioneers in this area, they weren’t the only ones. Even if they never existed, it seems like it wouldn’t have been long until someone else figured this out and took the lead.
  
  The FDA didn’t do their due diligence, partly because they just didn’t bother, and partly because the pressure from Purdue was enormous (including letting it be known they could help regulators move to higher paid jobs in the private market).
  
  Doctors massively overprescribed. They were wooed by sales pitches and found OxyContin a convenient way to make their patients happy and end appointments quickly. Some doctors engaged in outright fraud, prescribing high amounts to dealers in exchange for kickbacks.
  
  Distributors recklessly sent the pills all over the place, not thinking twice if a pharmacy in a small town got enough orders to literally give everyone in town hundreds of pills.
  
  What are the lessons for how to prevent the next time we get inundated with an exciting new product that turns out to be destructive? I suppose an obvious candidate is to beef up our regulatory bodies, but I’m not sure how much benefit there would be. Industry is always going to be more knowledgeable and more resourceful than regulators. They also have much more incentive on the outcome of regulatory decisions than any individual regulator.
  
  Then there is the danger of regulatory bodies swinging too far in the direction of preventing life-saving products from reaching the market. A lot of smart people believe we are already there, like Alex Tabarrok*. Look at how the FDA dragged its feet on COVID tests and vaccines**. Look at how they are still dragging their feet on approving cheap at-home COVID tests***.
  
  Am I being contradictory by saying regulation is not going to catch bad behavior, but will also over-regulate safe products? That’s a fair question, but I think regulatory bodies can both (1) provide too little oversight on issues that are not highly publicized (like OxyContin when it started), and (2) overweight “drug risk” relative to “disease risk” on issues that are highly publicized (like COVID vaccines and tests) as they are deathly afraid of being blamed for the side effects of a drug they approved.
  
  What about lawsuits? Ideally the potential for lawsuits would be a disincentive for reckless behavior, but that didn't seem to happen here. I think if the money is rolling in people tend to think they are invincible. The book describes the lawsuits in some detail, and it is quite messy and hard to follow. Much of the billions of dollars recovered is supposed to go toward public health programs. I hope that really happens and it helps people.
  
  I know some people will use this case as evidence that we should just scrap Capitalism completely. I don’t agree, but I have to admit I don’t know a way to prevent these situations from happening in the future.
  
  Finally, even if we figure out how to get OxyContin prescribed more responsibly and reduce opioid addictions, that's no solution to the people out there suffering from chronic pain. I hope better solutions are developed for them.
  
  *Alex Tabarrok summarizes research and concludes the FDA is too conservative on approvals
  
  https://marginalrevolution.com/margin...
  
  **Scott Alexander also concludes the FDA is too conservative on approvals, and describes COVID tests and vaccines as examples
  
  https://astralcodexten.substack.com/p...
  Key quote: “By March 1, China was testing millions of people a week, South Korea had tested 65,000 people, and the USA had done a grand total of 459 coronavirus tests. The pandemic in these three countries went pretty much how you would expect based on those numbers.”
  
  ***Propublica article on the FDA delays in approving cheap at-home COVID tests
  
  https://www.propublica.org/article/he...