An American family dynasty once known for its philanthropy and arts patronage has been tarnished by its role in creating "hillbilly heroin" and sparking an opioid epidemic that has killed half a million people, writes Kiran Dass.
Government espionage. Human smuggling. The CIA's possible involvement in the writing of a hit song in a bid to end the Cold War. Drug cartels.
Now, journalist and author Patrick Radden Keefe has trained his sights on America's raging opioid crisis and one dynastic family's hand in it.
His new book, Empire of Pain: The secret history of the Sackler dynasty, examines the multibillionaire Sackler family, owners of pharmaceutical company Purdue Pharma, which developed and aggressively marketed OxyContin, the powerful painkiller known as "hillbilly heroin".
Easily prescribed, the drug was marketed by the Sacklers as a safe, non-addictive drug. In fact, it is roughly twice as powerful as morphine and very addictive. OxyContin has generated billions of dollars for the Sacklers, and widespread addiction to the drug has ravaged America's Rust Belt and beyond.
Tens of thousands of Americans lose their lives to the drug every year, but the Sacklers claimed they had no knowledge of any epidemic connected to their product until media accounts of people throughout the country becoming addicted to the drug began to emerge in 2000.
Keefe's previous work has seen him threatened with legal action and his family surveilled. The New Yorker investigative reporter loves nothing more than delving into complex wide-angled stories. His 2019 book, Say Nothing: A true story of murder and memory in Northern Ireland, was a searing work of narrative non-fiction that, through the 1972 abduction and murder of Jean McConville by the IRA, told the wider story of the Troubles. It won the Orwell Prize for Political Writing.
"I like the challenge of something that will be difficult to report on and where I have to do a lot of digging to write a good story," he says from his home in New York.
When we speak, Keefe is recovering from a mild case of Covid, but is happy to have had his first vaccine shot. Empire of Pain isn't just an opioid-crisis book, it's an epic family saga that moves from Brooklyn in 1913 to the present day. It spans three generations, charting the bombastic rise and fall of a monolithic family who wanted to not only make their mark on the world, but also make a lot of money.
"And this is not a family that even gets along especially. They were very close when they were young, but as they got older, they splintered apart," says Keefe.
Sons of Jewish immigrants from Ukraine and Poland, Arthur, Mortimer and Raymond Sackler all trained as doctors and moved into pharmaceutical production, buying drug company Purdue Frederick in 1952. Keefe refers to eldest brother Arthur, born in 1913, as "the Don Draper of medical advertising". He found wealth by successfully promoting tranquillisers Librium and Valium for Swiss multinational healthcare company Roche in the 1960s.
Arthur died in 1987, and in 1991 Raymond's sons Richard and Jonathan Sackler, along with their cousin Kathe Sackler and her sister Ilene, formed a new company, Purdue Pharma.
With an active ingredient derived from opium poppies, Oxycodone was developed in 1916 by Martin Freund and Edmund Speyer. It was widely available as a painkiller in small doses in mild drugs such as Percodan. The Contin (continuous) system was later developed using a special pill coating to allow the slow and sustained release of the drug, which supposedly allows the patient to safely take larger doses.
Purdue Pharma went on to refine Oxycodone, producing the blockbuster slow-release version OxyContin, available from 1996. Working by binding to receptors in the brain and spinal cord, the drug effectively blocks pain signals. Fraudulently marketing it as a non-addictive drug impossible to abuse, Purdue didn't conduct any testing for the addictive nature of the drug, writes Keefe. Its argument was that the coating on the pills eliminated any risk of addiction because it enabled the drug to be released slowly into the bloodstream over a 12-hour period, unlike the sudden rush of morphine.
In Empire of Pain, Keefe writes that in order to tap into the full commercial potential of OxyContin, Purdue aspired to cast the net further than just cancer sufferers with chronic pain or those at the end-of-life stage. Purdue estimated tens of millions of Americans were living with moderate to chronic pain from sports or workplace injuries and it wanted to capitalise on that wider market.
In his 2018 book, Pain Killer: An empire of deceit and the origin of America's opioid epidemic, New York Times journalist Barry Meier writes that "in terms of narcotic firepower, OxyContin was a nuclear weapon". Doctors were traditionally conservative in prescribing opioids because of concerns about addiction. The name morphine was associated with end-of-life care. "The very name could conjure up the whiff of death," writes Keefe. So part of the Sacklers' strategy was to market OxyContin differently, as a safe drug with minimal side effects.
With an estimated fortune of US$14 billion, the Sackler name was long synonymous with generous philanthropy. They donated hundreds of millions of dollars to cultural and educational institutions, and the Sackler moniker has been emblazoned across the walls of some of the world's most prestigious cultural and educational institutions, including the Metropolitan Museum of Art, the Smithsonian, the Louvre and Harvard and Oxford Universities. There have been Sackler scholarships and Sackler prizes. Despite the family's glossy life of gala dinners and holidays in the Caribbean and the Swiss Alps, it was never really known how they acquired their wealth, because Purdue Pharma was a privately held company.
Cruelty and denial
Brazenly dismissive of the drug's underpinning of the devastating opioid crisis, the Sacklers have for decades enjoyed impunity. However, after a series of investigations, the family name is now being chipped off the elite walls it once adorned. Did these educational and cultural institutions know about the origins of the Sacklers' "dark money" and, if so, are they complicit?
"I do think a lot of them did know that there was a dark side to this money," says Keefe.
The Sackler story and their hand in the opioid crisis first flew across Keefe's radar when he was reporting on Mexican drug cartels in 2010. There had been an increase in the amount of heroin being imported into the United States. Some people who had started misusing OxyContin were moving on to street drugs such as heroin.
In 2017, Keefe wrote the New Yorker article "The Family that Built an Empire of Pain", which forms the basis of this new book. Empire of Pain looks at how death by opioid overdose is "a leading cause of accidental death in America, accounting for more deaths than car accidents and gunshot wounds". Across two decades there were nearly 500,000 deaths from opioid-related overdose. And the crisis shows no sign of abating, with about 55,000 deaths from synthetic opioids in the 12 months to October 2020, a 57 per cent jump year on year.
Conducting interviews with more than 200 people, including former Purdue employees, sales reps, doctors and scientists, Keefe also pored over tens of thousands of legal documents to piece together this saga about a family who refused to engage with him. "I felt like I knew them well enough to write this book about a family that wouldn't even speak to me."
He spoke to former Purdue employees, sales reps, doctors, scientists, and insiders close to the Sacklers. He found that even those in the medical profession could be bought for a steak dinner – Purdue had a US$9 million dining budget to keep associates quiet. He discovered that the US Food and Drug Administration officer who signed off the drug in 1995 went on to work for Purdue for a US$400,000 salary.
Scrutinising private correspondence between the Sacklers, Keefe read how the family insisted the problem wasn't OxyContin and the way it is marketed and prescribed, but the abusers. He says, at first, the Sacklers took a tough stance, vowing to "fight back".
"The things they said about addicts were very cruel and very cutting. 'Oh, they're reckless users and they're the scum of the earth.' Internal emails from Mortimer Sackler Jr saw him coldly refer to 'the so-called opioid crisis'," says Keefe.
But the Sacklers have since recalibrated their public posture, in what Keefe describes as them "performing compassion".
"There were very strange turns of phrase. For example, 'It fills me with great sadness that so much destruction and harm is connected with the Sackler name.' So much destruction in the world is connected to their product and they continue to distance themselves. It's just so callous."
Greed and stubbornness
Across the people he interviewed for the book, Keefe says, the common trait that emerged of members of the Sacker family was greed. "And a stubbornness that they are so convinced by their assumed virtue that they can't even look critically at their decisions.
"They were regarded as the paragon of philanthropy. Part of the story I wanted to tell in the book, which is probably less true in New Zealand than in the States, was how systems protect and insulate the very rich."
Although no individual Sackler family member has been held accountable, Purdue claimed bankruptcy in 2019 after state and local governments sued the company over its hand in the opioid crisis.
In December 2020, Kathe Sackler made a rare appearance at a congressional hearing against her and her family. Purdue Pharma pleaded guilty to three charges, including misleading regulators and bribing doctors to drive sales of the drug. Footage shows that, when asked if she would have done anything differently, she blithely says, "When I look back over all these years, there's really not a thing I would do differently." And when asked if she accepts that hundreds of thousands of Americans have become addicted to OxyContin, she replies blankly, "I don't know the answer to that."
Writer at work
In addition to studying history at Columbia University, gaining a master's in international relations at Cambridge University and a second master's in new media and information systems from the London School of Economics, Keefe also has a Juris Doctor degree from Yale Law School and has been a policy adviser in the Office of the Secretary of Defence. He agrees that his background arms him for his investigative reporting.
Although now a staff writer at the New Yorker, Keefe has a framed 1998 rejection letter from the magazine hanging on his wall at home and says that for many years he never thought he'd make it as a writer. "I had all these other jobs while I was freelancing, all the while wanting to be a writer and to be able to pay the bills."
Keefe spends a long time researching for his books but says the writing part happens swiftly. He wrote Empire of Pain at home, largely on his bed, during lockdown. The New York Times ran a picture of him – barefoot on his bed with his laptop, surrounded by sheafs of paper – taken by his wife, lawyer Justyna Gudzowska.
"I was glad that they put that in the paper. I felt like the image we see of writers at work is them looking off into the distance in their beautiful spaces. And, well, it ain't always that pretty!"
It would have been fascinating to be a fly on the backstage wall as the Sackler empire went into damage control to distance themselves from the opioid epidemic. It's like something from the television show Succession, the pitch-black satire about power, money and greed centred around a nasty and dysfunctional family who own a global media and hospitality empire. "Some of the people who spoke to me [for the book] told me they felt like they were in Succession," says Keefe.
In addition to the Sackler lawyers sending Keefe and his publisher letters in an attempt to halt publication of Empire of Pain, Keefe says he believes he and his family were surveilled while he was writing the book, and he has no doubts about who was behind it.
As he and his wife went to drive their young boys to school one day, a neighbour came over and said, "I don't want to freak you out, but there's a guy sitting in a car over there. So, we piled into the car and he was still there when we went past. We decided to pull a trick on him. We turned around and came back. And he had gotten out of his car as soon as we had left.
"If I had to guess who sent this person, my list would be pretty short. I asked Purdue if it knew anything about it and the company said, 'No, not at all.' Then I asked the Sacklers and they said, 'No comment.' They didn't deny it."
Asked if he ever felt unsafe, Keefe pauses and says he never feared for his safety and, if anything, the Sacklers' actions emboldened his conviction that this was a story he should tell. "This is what they do. I think it backfired on them, to be honest with you. Because part of what I was exploring in the book was their tactics. So I could just use it all as material in the book."
• EMPIRE OF PAIN: The secret history of the Sackler dynasty, by Patrick Radden Keefe (Picador, $40).