Empire of Pain by Patrick Radden Keefe review – all the moral power of a Victorian novel

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This prizewinning account of a band of brothers who struck gold with the opioid OxyContin is a masterfully told story of corruption and greed


The worthy winner of the Baillie Gifford prize earlier this month, Patrick Radden Keefe’s Empire of Pain is a work of nonfiction that has the dramatic scope and moral power of a Victorian novel. It’s about corruption that is so profitable no one wants to see it and denial so embedded it’s almost hereditary.

The book focuses on the Sackler family, who, for the second half of the 20th century and for much of the 21st, were very wealthy and very secretive. It would turn out that they had a lot to be secretive about.

Keefe begins his story with Arthur Sackler, the eldest of three boys born to a Ukrainian Jewish grocer in Brooklyn in 1913. Arthur was an extraordinary figure, highly gifted and even more motivated. He funded himself through college and medical school, partly by his work as an advertising copywriter, trained as a psychiatrist and became a leading medical publisher.

He also paid for his two younger brothers, Mortimer and Raymond, to attend medical school and the three of them bought or set up a number of businesses, one of them being Purdue Frederick, a small pharmaceutical company that would later change its name to Purdue Pharma.

As the owner of a medical advertising agency, Arthur aggressively marketed Valium direct to physicians with misleading and false information. A drug that, in contrast to Arthur’s claims, led to high dependency, Valium became one of the bestselling medicines of the 1960s and 1970s and Arthur made sure that he received a healthy percentage cut on sales.

The brothers were feted the world over and no one worried too much about how they came by their money

As he grew increasingly rich, he liked to remain in the shadows, often keeping his name away from the businesses he owned or controlled. But he was also a keen philanthropist with a consuming determination to get his family name inscribed on the walls of the most important art galleries, museums and universities in the world.

In this combination of commercial furtiveness and philanthropic attention-seeking, Arthur was matched by his brothers. And so it was that the Sackler name became prominent in the Louvre, the Tate, the Metropolitan and the Guggenheim galleries, as well as at Yale, Harvard and Oxford universities and a number of medical schools.

The brothers were feted the world over and no one worried too much about how they came by their money. But if Arthur made his first fortune from the questionable marketing of Valium, his brothers went on to make an even larger one by employing those tactics to sell a drug called OxyContin.

Twice as powerful as morphine, OxyContin was developed and patented by Purdue and aimed at anyone who suffered from pain. Morphine was the drug used to treat cancer patients and was viewed by the medical establishment as too strong and addictive for general patients. But Purdue claimed the new slow-release drug was less addictive than other opioids and it was approved by the Food and Drug Administration (FDA) without the company’s claims being tested.

The decision was taken by an FDA official who turned up a year later working for Purdue Pharma with a starting package worth nearly $400,000 a year. At that time, Purdue was under the guidance of Richard Sackler, son of Raymond. He was an exacting boss, constantly demanding more sales from his salespeople and seemingly unconcerned by growing accounts of addiction and deaths that accompanied OxyContin’s massive marketing success.

Keefe paints devastating portraits of the main Sacklers, their greed, pride and monumental sense of entitlement. In many respects, they are reminiscent of the appalling Roys in the TV series Succession, galvanised by astonishing profits but fundamentally removed from the world they are busy despoiling.

As opioid addiction became an epidemic in the US, the family that had become multi-billionaires as a result of its sales and abuse made sure to remain hidden from view. A battery of lawyers was on hand to prevent the curious from venturing very far. When a New York Times journalist who’d been following the story wrote a book about the opioid crisis that named the Sacklers, the family used its muscle to ensure that the newspaper removed him from writing any further on the subject.

Meanwhile, as the death toll continued to grow (it’s estimated that more than 450,000 Americans died as a result of various opioids, of which OxyContin was the bestselling), the Sacklers took out an estimated $14bn from Purdue, which then passed through a multiplicity of offshore shell companies and bank accounts to furnish their private tastes and, of course, philanthropy.

When eventually, under public pressure, the government caught up with Purdue, the company filed for bankruptcy and, protected by some of the best lawyers in the business, the Sacklers walked free of any criminal charges, still adamant they had done nothing wrong.

Empire of Pain is a gripping tale of capitalism at its most innovative and ruthless that Keefe tells with a masterful grasp of the material. Purdue Pharma promised a life free of pain. But as the author notes, while the company knew everything about how to get people on to OxyContin, they seemed to have little idea of, or interest in, how to get them off it.

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe is published by Picador (£20). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply

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