Nursing Book Club

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe

A deep dive into the loathsome family at the heart of the opioid crisis

Until recently, the name Sackler might have been unfamiliar to you unless you were well-versed in philanthropy.

Estimated to be one of the 20 wealthiest families in the U.S., the Sackler name can be found on some of the finest art, medical and educational institutions in the world. There are Sackler museums at Harvard and Peking University; a Sackler Library at Oxford; a Sackler school of medicine in Tel Aviv; and, until 2019, a Sackler wing of the Louvre.

Such was the family’s generosity that few asked: Where did all this wealth come from? That’s the question journalist Patrick Radden Keefe set out to answer in his new book, Empire of Pain: The Secret History of the Sackler Dynasty.

Keefe begins with the three brothers: Arthur, Mortimer and Raymond Sackler, sons of an immigrant grocer in Brooklyn. Like many children of immigrants, their dreams involved getting a good education and working hard to build their fortunes.

The oldest brother, Arthur, became a psychiatrist and convinced his brothers to follow in his footsteps. However, Arthur Sackler also found a different focus. The ‘30s and ‘40s were a period when new developments in medication were becoming central to medical treatment. Arthur saw untapped opportunities in medical advertising, so he went to work in a small ad agency, which he later acquired.

Before OxyContin — Valium

Among the agency’s clients was the firm of Hoffman-La Roche, which developed the benzodiazepine sedatives Librium (chlordiazepoxide), which received FDA approval in 1960, and Valium (diazepam), which followed in 1963.

Arthur Sackler’s aggressive marketing tactics — which included advertising directly to doctors — made Valium a household word and the biggest new drug success story of the ‘60s and ‘70s.

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Meanwhile, Mortimer and Raymond were running their own pharmaceutical company: Purdue Frederick, which the Sackler brothers had purchased for $50,000 in 1952. Originally, the company made everyday, over-the-counter medical products. It wasn’t until the early ‘90s, a few years after Arthur’s death, that Purdue found a product that could be just as popular and widely prescribed as Valium: OxyContin.

Sadly, we all know what happened next: Using the lessons Arthur Sackler had learned about pharmaceutical advertising and big data, the highly addictive pain medicine overran America. The late ‘90s OxyContin boom marked the beginning of an ongoing epidemic, resulting in 450,000 overdose deaths and billions of dollars in profit for Purdue Pharma shareholders.

Motivated by Greed

Even if you already know the basics,  Keefe has pulled together many little-known, often shocking facts about three generations of the mysterious Sackler family and their role in the opioid crisis.

Emails and internal documents revealed through the various lawsuits and Purdue’s bankruptcy proceedings have shown that although the company touted OxyContin as safe and abuse-resistant, the Sacklers were well aware of the addictive character of their product, as well as the way physicians misused their prescription power to write more opioid scrips.

The more pills the company was able to sell, the more money the Sacklers made.

It is thrilling that someone has researched this secretive story so carefully. Even now, as cultural institutions have begun to refuse the Sacklers’ donations and strip their name from schools and museums, the family has continued to deny and downplay their role in the opioid crisis, insisting that they’ve done nothing wrong. (An attorney for Raymond Sackler’s family responded to this book by insisting that “Sackler family members who served on Purdue’s board of directors acted ethically and lawfully.”)

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The crisis has lately been pushed out of the news by the pandemic, but will soon be front and center again as the lawsuits and Purdue bankruptcy proceedings wind their way through the courts. We can only hope that the Sackler family will be forced to acknowledge the grief they have knowingly caused.

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe (Doubleday, 2021).


Sidebar: Why Purdue Pharma Steered Clear of California
By Aaron Severson

While the opioid crisis has become a national problem, it was slower to emerge in certain states, including California. According to a 2019 working paper from the National Bureau of Economic Research (NBER), one reason was now-rescinded state requirements for special triplicate prescription forms for Schedule II prescriptions.

Never popular with doctors, triplicate forms (which California required until 2004) provided a paper trail for all narcotic prescriptions, with copies separately retained by the prescriber, the pharmacy and the state. The costs and additional scrutiny involve in using those forms appears to have been a significant deterrent to writing prescriptions for controlled substances, including oxycodone, the active ingredient in OxyContin.

Internal company documents reveal that Purdue Pharma considered triplicate requirements a major obstacle to the marketing of OxyContin — so much so that the company decided to concentrate its early marketing efforts elsewhere.

Spared the full brunt of Purdue Pharma’s aggressive marketing, “triplicate states” saw fewer OxyContin prescriptions and significantly fewer opioid-related overdose deaths than those without triplicate requirements. That reduced impact was still visible in overdose mortality trends long after the triplicate form requirements gave way to less-onerous electronic prescription monitoring systems.


Christine Contillo, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics.

Aaron Severson is a freelance writer, editor, and writing consultant as well as the associate editor of Working Nurse. 


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