In Empire of Pain (2021), Patrick Radden Keefe narrates how the Sackler family, over three generations, grew from immigrant newcomers to wealthy philanthropists and ultimately the people behind a drug that ended up killing thousands of Americans.
Originally based on good intentions, the Sacklers developed OxyContin, a revolutionary painkiller that was meant to help people live happier pain-free lives. But what started as a noble project quickly was overtaken by greed and political corruption, making OxyContin the cause of one of the largest opioid epidemics in the US.
#1
In the early 1900s, Isaac Sackler, an immigrant from the Austrian empire, married Sophie Greenberg, an immigrant from Poland. They settled in Brooklyn, and had Arthur, Mortimer, and Raymond.
#2
Isaac successfully operated a grocery store with his brother at 83 Montrose Avenue in Williamsburg, then moved to Flatbush after making enough money to get into real estate.
#3
Arthur enrolled in Erasmus Hall High School. As the oldest child, his family was banking on him and his education. He was a diligent student. He also made money on the side by selling ads and writing for student magazines. He even was able to pass some of the work to his brothers.
#4
After failing in some business endeavors, and with the beginning of the Great Depression, Isaac’s fortunes started declining. Arthur was forced to pay for his own education by working multiple jobs. Arthur ended up enrolling at New York University as a premed student.
#5
Arthur graduated in 1933 and was accepted to medical school at New York University.
#6
Despite the financial stability that would come with being a doctor, Arthur wanted to chase his entrepreneurial passions. During college, he picked up a job as a copywriter for a German pharmaceutical company called Schering.
#1
As a German immigrant doctor, Marietta Lutze was forced to do two internships to be eligible to sit for the New York State medical boards. She found a vacancy in Far Rockaway, Queens. Marietta’s family owned a German pharmaceutical company named Dr. Kade.
#2
Mortimer and Raymond ended up interning in the same hospital as Marietta, after finishing medical school at Middlesex University in Waltham, Massachusetts.
#3
Marietta also met Arthur when she was looking for a second internship at Creedmoor Hospital, where he already worked. Raymond gave her his number to help her get the internship.
#4
Arthur had been working at a hospital in the Bronx. He also trained with Dr. Johan van Ophuijsen, a disciple of Sigmund Freud. His interest in psychiatry led him to start a new residency at Creedmoor.
#5
Arthur met Marietta in a meeting at Creedmoor for her second internship. Marietta ended up doing her second internship at Queens General Hospital, but the meeting was the beginning of their relationship together despite him being already married.
#6
Arthur administered electroshock therapy at Creedmoor, which led him to discover that it had hazardous side effects, despite it being widely used at the hospital. Arthur then recruited Mortimer and Raymond to join him.
#7
Another technique used at Creedmoor was lobotomy, which cuts selected nerves in the brain to treat depression. Such techniques horrified Arthur and his brothers, which set them on a search for more humane and less destructive methods to cure mental issues.
#8
The Sackler brothers conducted electroshock experiments on rabbits, discovering that the electric shock caused the release of histamine in the blood, dilating blood vessels and causing more oxygen to reach the brain, which in turn lowered depression.
#9
The three brothers thus realized that directly injecting histamine into the patient’s blood could bypass the need for dangerous electric shock.
#1
In 1942, due to his previous editorial and magazine work at college, Arthur was able to get a part-time side job at the William Douglas McAdams medical advertising agency.
#2
By the time Arthur was working at McAdams, the discovery of penicillin had put pharmaceutical companies on a race to discover and patent new drugs. Pfizer came to McAdams to advertise its newly discovered Terramycin.
#3
Arthur soon became the president of McAdams, directly handling the account of Pfizer. He was simultaneously still conducting his research at Creedmoor.
#4
Arthur was a big contributor to the mainstream adoption of newly found drugs, since his ad campaigns were largely successful. Arthur eventually bought the agency from McAdams who was becoming old.
#5
In February 1950, Arthur and his brothers, with their mentor van Ophuijsen, founded the Creedmoor Institute for Psychological Studies, which aimed to advance the research they had already started to find mental health cures using biochemistry.
#6
Arthur’s McAdams was not alone in the field of pharmaceutical advertising. L.W. Frohlich, owned by Ludwig Wolfgang Frohlich, was a strong contender.
#7
Despite publicly being rivals, Arthur was acquainted with Frohlich and became a major owner in his agency. Arthur would pass clients to Frohlich, giving them a certain monopoly in the field of medical advertising.
#8
Arthur and his brothers later agreed with Frohlich to fully share their agencies. After the four died, however, the companies would be handed to a trusted charitable organization, not their children. The brothers shared some socialist views, and they did not believe in hoarding wealth.
#9
Arthur then bought a small pharmaceutical company called Purdue Frederick. He assigned both his brothers to manage it while he only offered help when needed.
#1
In 1957, the competition between the pharmaceutical firms Roche and Wallace Laboratories was intense. They were both trying to discover a minor tranquilizer to deal with common anxiety. Wallace Laboratories came out with Miltown first, and it became a huge success.
#2
A chemist named Leo Sternbach who worked at Roche later discovered compound No. 0609, which was branded as Librium. It aimed to rival Miltown as a tranquilizer but without causing side effects. Roche contacted Arthur to advertise their new drug.
#3
After its release in 1960, Librium quickly became a widely used tranquilizer.
#4
Roche also developed Valium, made from another version of the same compound.
#5
Despite the drugs being nearly identical, Arthur advertised Valium for an older age range while advertising Librium for younger users. This preserved both drugs’ place in the market. By 1975, Valium had become the first drug in history to reach over $100 million in sales.
#1
Arthur was fascinated by Chinese and Asian antiquities. He ended up having one of the largest collections of Chinese antiquities, outnumbering any museum.
#2
Arthur’s antiquity collection ushered in the beginning of his orientation towards philanthropy. Arthur did not want to store the antiquities, instead he wanted to put them on display and let art historians benefit from the collection.
#1
In 1956, Arthur and Felix Marti-Ibanez, the owner of a publishing company called MD Publications, secretly sponsored the Fourth Annual Symposium on Antibiotics.
#2
During the symposium, Dr. Henry Welch, the chief of antibiotics at the Food and Drug Administration and co-editor of MD Publications, introduced the third generation of antibiotics.
#3
With penicillin being the first generation, and Terramycin the second, Pfizer’s newest antibiotic Sigmamycin was considered a third generation antibiotic.
#4
The successful ad campaigns for Pfizer enabled Arthur to buy a house in Manhattan, and move in with his second wife, Marietta, after divorcing his first wife, Else.
#5
John Lear, a science editor at the Saturday Review, stumbled upon brochures from McAdams that advertised Sigmamycin. When he tried to contact the doctors whose business cards were attached to the brochures as a reference, he got no answer back. He knew that the cards were fake.
#6
A meeting between Lear and Welch did not provide enough information and proof of the authenticity of the antibiotics advertised, which pushed Lear to further investigate.
#7
Lear then got in contact with Senator Estes Kefauver who took over the investigations.
#8
Kefauver discovered that Pfizer bribed Welch to run an advertising propaganda campaign for Sigmamycin during the Fourth Annual Antibiotics Symposium.
#9
Using the Pfizer and Welch bribery as a starting point, the investigations moved to a wider spectrum, now reaching the Sacklers and Marti-Ibanez.
#10
Kefauver and Lear then discovered that Welch would be paid a commission for articles that were published and reprinted in the two journals he edited. This led him to resign, pushing the FDA to review every drug Welch had approved.
#11
Kefauver finally subpoenaed Arthur to Washington. He appeared before a congressional committee, unlike Welch, Marti-Ibanez, and Frohlich, who all claimed they were suffering from health issues that prevented them from coming.
#12
Arthur stood and defended himself, stating that his intentions were pure and that he only wanted to get the new drugs to the patients as soon as possible to improve their health.
#13
Arthur did not deny the side effects of the medications, but he emphasized that the positives of the drugs far outweighed the negatives. The committee took no further action.
#1
James Rorimer, the Metropolitan Museum of Art’s director, was looking for funding to renovate the space and install air-conditioning units. Arthur offered to pay, and a section would be named Sackler Gallery where he could display some of his antiques.
#2
Arthur also agreed with Rorimer that he would have a private space in the museum where he could store his collection. Additionally, Arthur would get another private space at the Museum of the American Indian.
#3
Rorimer died of a heart attack, and was succeeded by Thomas Hoving, who wanted to bring the Egyptian Temple of Dendur to the museum. Egypt had offered it as a gift in recognition of US aid in preserving antiquities during the building of the Aswan High Dam.
#4
To have the temple in the museum, Hoving needed $3.5 million, which Arthur provided, in exchange for having the special wing for the temple called the Sackler Wing, and the whole area named the Sackler Gallery for Egyptian Art.
#1
As Arthur was getting more involved in McAdams, and after the death of their mother Sophie, Raymond and Mortimer, who were by now solely running Purdue Frederick, were starting to drift apart and become estranged from Arthur.
#2
Arthur met Jillian Tully in 1967. She had worked for an advertising agency in London. Arthur quickly fell in love with her, abandoning Marietta.
#1
In 1985, Arthur celebrated the opening of the Arthur M. Sackler Museum at Harvard. Soon after he was attending the opening of the Arthur M. Sackler Gallery on the National Mall in Washington.
#2
On May 26, 1987, Arthur died after having a heart attack. His death caused a wave of tributes and events honoring his good memory and philanthropy.
#1
Raymond and Mortimer’s company Purdue Frederick was flourishing, selling widely popular over-the-counter medications like Betadine, Senokot, Cerumenex, and many others. Raymond bought the most expensive mansion in Greenwich, Connecticut, for $1.3 million.
#2
Despite getting his MD degree, Richard Sackler, Raymond’s son, was more oriented towards business. He had taken a few business courses at Harvard Business School. Raymond was preparing him to be the next owner of Purdue Frederick.
#3
Mortimer’s visits were only occasional to Purdue Frederick. He acquired Napp Laboratories, with the aim of researching and producing his own new drugs.
#4
Napp made a breakthrough by discovering a special coating system called Continus that allowed a pill to slowly release its compounds into the bloodstream over a regulated period of time.
#5
Continus allowed Napp to offer a pill form of morphine, which previously was only available as a drip in the hospital. The morphine pill was called MS Contin, and was released in the UK in 1980.
#6
Purdue Frederick then started manufacturing and distributing MS Contin in New Jersey in October 1984.
#1
By the 1980s, Purdue Frederick was transitioning into pain management drugs. The International Symposium on Pain Control was organized by Richard Sackler and sponsored by the company itself.
#2
During the symposium, Richard aimed at breaking the social taboo attached to morphine and changing its reputation as a final stage drug.
#3
After Arthur’s death, Purdue Frederick was equally owned by Raymond and Mortimer. As they started to grow older, Richard and his brother Jonathan, Raymond’s children, and Kathe and her sister Ilene, Mortimer’s children, were starting to take the reins.
#4
As the patent for MS Contin was about to expire, Kathe and Richard were looking to come up with another painkiller that they could patent to keep the high profits coming in.
#5
Kathe suggested using the Contin system with oxycodone, a synthesized opioid that is more potent than morphine. Oxycodone was also suggested to Richard by Robert Kaiko, a specialist in the use of analgesic medicine who worked at Purdue.
#6
The third-generation Sacklers established a new company called Purdue Pharma, which would handle the experimental drugs, while Purdue Frederick would handle the old products like Betadine and Senokot.
#7
In 1993, Richard became senior vice president, working on developing what they decided to call OxyContin. Michael Friedman, the head of marketing, suggested that for OxyContin to sell well, it should be marketed as a general painkiller, not just for cancer patients.
#1
In the late 1890s, the German pharmaceutical company Bayer discovered heroin, which is a refined version of morphine. The company claimed that heroin had therapeutic benefits and could actually cure morphine addiction.
#2
Heroin turned out to be highly addictive, with side effects that could lead to extremely dangerous withdrawal symptoms and death. Bayer stopped making the drug in 1913.
#3
Despite OxyContin being twice as potent as morphine, Purdue wanted to market the drug as a milder, universal painkiller, which would bring higher sales and better revenue. But before reaching the market, OxyContin had to get approved by the FDA.
#4
Among the Sacklers’ widespread network of connections was the FDA reviewer Curtis Wright, who got OxyContin approved in a record 11 months.
#5
When the FDA questioned OxyContin’s addictive risks, Purdue explained that the Continus system would provide a slow release of the drug. This would prevent the peaks and troughs in its availability in the blood that would cause withdrawal symptoms and lead to addiction.
#1
At Napp, the Sacklers hired low-paid untrained workers at the chemical facility, leading to an explosion as strong as a small-scale hydrogen bomb after water mixed with hazardous chemicals in a vat.
#2
The Sacklers denied any correlation between them and the explosion at Napp.
#1
In the first week of 1996, Purdue Pharma was celebrating the official launch of OxyContin. The launch was paired with a sales campaign by a huge force of young men and women who would promote the drug to physicians, emphasizing the fact that it was not addictive.
#2
Purdue’s ad campaign also included a video of professionals and patients talking about the efficacy of OxyContin. Purdue distributed more than 20,000 copies of the video to physicians across the country.
#3
Purdue also distributed a free sample of the pill to patients who experienced daily pain. All these sales tactics made OxyContin a massive sales success, generating astronomical revenue for the Sacklers.
#1
Barry Meier, a New York Times investigative reporter, uncovered a whole black market network that provided OxyContin for abuse. It was crushed to bypass its Contin coat, then snorted or injected to experience an immediate high. He published his findings on February 9, 2001.
#2
The article created a buzz that reached Purdue, which led Richard to delegate the company’s trusted lawyer Howard Udell to investigate the issue. After checking online forums, Martha West, Udell’s secretary, did indeed find discussions about abusing OxyContin by crushing it and getting rid of its slow release coat.
#3
Richard denied any knowledge about the information presented by Meier, which was a lie. Purdue’s sales reps had been reporting since as early as 1997 stories of abuse and addiction.
#4
Richard put the blame on the abusers, saying that some people tend to have abusive personalities, which was not his company’s fault.
#5
Richard’s standpoint was soon challenged as stories emerged of patients eventually experiencing higher tolerance levels and withdrawal symptoms, leading to higher pill consumption.
#6
After his initial article, an anonymous insider from Purdue leaked a list of the top ten sales reps and the respective regions they worked in for Meier.
#7
The first name on the list was Eric Wilson, a rep who covered the Myrtle Beach area. Meier discovered that the extremely high sales numbers in Myrtle Beach were in fact caused by black market sellers, who would buy the drug using fake prescriptions and sell it to abusers.
#1
Michael Friedman, Howard Udell, and Paul Goldenheim, the company’s chief medical officer, became the face of Purdue during the crisis, with Richard staying behind the scenes.
#2
In August 2001, the three men attended a committee hearing at the US House of Representatives, convened by James Greenwood. The three men reiterated that abusers were the problem, not OxyContin, denying once again their previous knowledge of stories of abuse.
#3
Meanwhile, Rudolph Giuliani became a consultant for Purdue after resigning from his position as mayor of New York City. Giuliani, an attorney, was an addition among many others that Udell made to bolster Purdue’s position against legal claims.
#4
Richard also secretly funded and supported advocacy groups that took names such as the American Pain Foundation, the American Academy of Pain Medicine, and the Pain Care Forum. These groups were used as a social net to support OxyContin.
#5
Purdue took a distant approach, using the company’s power and money whenever possible to mute reports and legal suits. Richard denied any relation between abusers and OxyContin, always directing the blame on the abusers themselves.
#1
In 2001, John Brownlee was appointed to serve as US Attorney for the Western District of Virginia. OxyContin was viral in Virginia, which set Brownlee on a journey to find the company behind the drug.
#2
Prosecutors Randy Ramseyer and Rick Mountcastle worked for Brownlee on the case of Purdue. They both created a small team of specialists and moved to a special office which they called the Taj Mahal to work on the case.
#3
To face Brownlee, Udell retained Howard Shapiro, a powerful Washington lawyer.
#4
Brownlee and his team studied Purdue’s files and emails, uncovering that the Sacklers knew all along about the cases of abuse, but chose not to do anything since more abuse meant higher sales.
#5
The revelations and the wave of negative media led Richard to resign as president of Purdue. Friedman was his successor. Richard’s resignation was followed by the resignation of Jonathan, Kathe, and Mortimer as vice presidents.
#6
By 2006, an extensive memo had been written by Bronwlee’s team accusing Purdue in general and the three executives specifically of misbranding, wire fraud, mail fraud, and money laundering. Brownlee sent the case to the Department of Justice for review.
#7
The Department of Justice decided to charge Purdue only for felony misbranding, and Friedman, Goldenheim, and Udell each with a single misdemeanor.
#8
Despite being overrun by all the high-class attorneys and political pressure Richard could muster, Brownlee wanted to follow the case.
#9
Brownlee’s determination led Purdue and the three executives to sign a plea deal. But that cost him his job as a few weeks later he was fired.
#10
Friedman, Goldenheim, and Udell were sentenced to three years of probation and four hundred hours of community service. Purdue was fined $600 million, leaving the Sacklers’ reputation intact since the public did not know the real owners behind Purdue.
#1
After overcoming the Brownlee crisis in 2006, Purdue continued advertising OxyContin as if nothing had happened.
#2
OxyContin’s exclusive patent was nearing its end, calling the Sacklers to take action to reap as much revenue as possible before competing generics became available.
#1
In 2010, Purdue released a new version of OxyContin called OxyContin OP. The new pills were tamperproof. Abusers could not crush the pills into powder since the pills had a gum-like consistency that held the compound together, making it difficult to snort.
#2
The reformulated version of OxyContin prevented people from snorting or shooting up the pills, but it did not prevent them from swallowing too many, and failed to stop the abuse.
#3
The switch to the new OxyContin OP led a lot of addicts to switch to abusing heroin, which is closely related to Oxycontin, leading to a heroin crisis.
#1
In August 2015, Richard landed in Louisville, Kentucky, after the State of Kentucky sued Purdue over the death of a relative of State Attorney Greg Stumbo from an OxyContin overdose. For the first time since OxyContin’s inception, Richard was personally called to court. The questioning was led by Tyler Thompson.
#2
Richard paid the State of Kentucky $24 million to settle the case and seal the record, hiding all evidence found and used.
#3
In 2016, the Los Angeles Times published an article revealing that to maximize profits, the Sacklers were selling OxyContin in developing countries that did not have strict medical guidelines via a company that they owned called Mundipharma.
#4
Purdue faced a new challenge when the Centers for Disease Control and Prevention (CDC) set out to create a set of guidelines that directed physicians to use opioids as a last resort, not a starter.
#5
The CDC guidelines were protested by the Pain Care Forum, a group anonymously run by Purdue, but the guidelines ended up being released in 2016.
#6
Craig Landau, a loyal family friend, became the company’s CEO in 2017. A month later Raymond died at age 97.
#1
In 2017, Christopher Glazek posted an article in Esquire that featured a former Purdue sales rep admitting that they were guided to lie.
#2
The Esquire article also had a Stanford psychiatry professor questioning why Purdue’s owners tried to stay anonymous for a long time, relating this to their lack of confidence in their product OxyContin.
#3
This led Arthur’s wife, Jillian, to speak out, saying that Arthur himself would not have agreed to sell OxyContin the way his brothers did.
#4
Purdue continued to ignore all negative press and move forward, getting FDA approval to administer OxyContin for children as young as 11 years. The family’s extensive philanthropic and political relationships made it quite immune to such articles.
#1
By February 2018, the Sacklers were facing a big wave of criticism, their name was out there, and they were known to be the direct owners of Purdue and the people behind OxyContin.
#2
The wave of negative news and lawsuits caused Purdue to lay off half of its sales force. Despite the pullback in advertising, OxyContin was still making profits, since so many people were now dependent on it.
#3
In June 2018, the attorney general of Massachusetts, Maura Healey, filed a lawsuit that directly accused eight Sackler names on Purdue’s board: Richard, Beverly, Jonathan, David, Theresa, Kathe, Mortimer, and Ilene.
#4
The lawsuit was based on the discovery that 671 people died in Massachusetts alone during the previous decade after consuming OxyContin according to prescribed doses but still getting addicted.
#5
Healey got access to around 12 million documents related to Purdue from previous lawsuits, which allowed her to discover the full story behind OxyContin and the Sacklers’ relationship with it.
#6
Despite Purdue’s enormous effort to prevent the information from making it to the public, on January 31, 2019, Healey released a 247-page complaint including all the information that was found about the Sacklers and OxyContin.
#7
Healey also found out that since 2008, the Sacklers had been slowly siphoning their money out of the USA in fears of a lawsuit.
#8
The amount of negative news circulating about the Sacklers led many museums and organizations to stop accepting donations from the family, and a wave of social anger was rising against Purdue and the Sacklers.
#1
By 2019, twenty-four other states had joined Massachusetts in the lawsuit.
#2
The Sacklers, now represented by David Sackler, Richard’s son, were searching for a large-scale deal that could settle the myriad litigations all at once, without going through each one of them individually.
#3
In Cleveland, David met with more than 10 state attorneys to present a deal, which entailed that the Sacklers would give up control of Purdue Pharma and turn it into a public trust. The Sacklers would also donate between $10 billion and $20 billion to address people with opioid addictions.
#4
The offer was not accepted, with many states demanding much more money to resolve the opioid epidemic OxyContin had caused.
#5
Purdue resorted to filing for bankruptcy, since that would freeze all lawsuits against the company until it restructured itself. The Sacklers had left little money in the company in any case, with most of it being placed in foreign tax havens.
#1
As the bankruptcy’s legal process was taking place with Judge Robert Drain, the Sackler name was being washed off and removed from museums, schools, and clubs, amid the cheers and claps of protesters.
#2
The Sacklers had been able to move the case so it would be heard by Drain, who was close to the family. They also hired an array of elite lawyers.
#3
As the 2020 presidential elections neared, and due to the deep political roots the Sacklers had grown throughout the years, the deputy attorney general for the Trump administration, Jeffrey Rosen, announced a resolution to the Purdue issue in a press conference.
#4
In the resolution, Purdue agreed to plead guilty to conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, as well as to two counts of conspiracy to violate federal anti-kickback laws. Purdue also agreed to pay $8 billion in penalties.
#5
These charges were directed only at the company and did not name any Sacklers. However, they did agree to pay $225 million to resolve a separate civil charge related to violating the False Claims Act.
#6
As the Department of Justice settlement and the bankruptcy were taking effect, Purdue was now benched from the pharmaceutical race to find a cure for COVID, which would have been the company’s next project.
#7
Ironically, the company that Arthur, Mortimer, Raymond, and Bill Frohlich had agreed to turn into a charitable trust after their death was ultimately forced to divide its revenue and what was left of its capital among states to fund opioid addiction centers.
In Empire of Pain, Patrick Radden Keefe uses an easy -to-read expository style to lay out the history of the Sacklers and their role in the opioid crisis in the US during the beginning of the twenty-first century. Keefe bases the narrative on court documents and interviews with former Purdue employees and people who knew a member of the Sackler family. He did not get any direct input from the Sackler family, who refused to conduct interviews with Keefe.
Patrick Radden Keefe is a best-selling author, staff writer at the New Yorker, and creator and host of the eight-part podcast Wind of Change. After covering illegal drug trading between Mexico and the United States, Keefe discovered OxyContin and the opioid crisis, which led him to write an article covering the subject in the New Yorker in 2017. The article had a great impact, leading Keefe to write an extended book about the subject.
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