In ‘Empire of Pain,’ Patrick Radden Keefe tells a sweeping immigrant story about the family at the centre of the OxyContin crisis

Patrick Radden Keefe has a knack for getting inside a story. Big, sweeping stories, the ones that help us understand the world we live in and the issues we face. He does it not by weighing us down with facts, but by incorporating them into a compelling narrative that focuses on the people who live the stories.

He did it in his previous book “Say Nothing,” about the Troubles in Northern Ireland, by looking at the killing of Jean McConville and the resonance on her family. The result is a marvellously balanced book that was readable, accessible and compelling.

And he does it in his newest book, “Empire of Pain,” taking a story with deep political and social ramifications and getting to its heart by examining the lives and motives of the family at the centre of the OxyContin crisis.

As with “Say Nothing,” “Empire of Pain” (out Tuesday April 13, from Doubleday Canada) came after a large investigative piece for the New Yorker, where Radden Keefe is a staff writer. “The Family That Built An Empire of Pain” came out in the October 2017 issue.

That piece introduced three Sackler brothers who built Purdue Pharma, Arthur, Mortimer and Raymond, and the idea that “the greatest trick (the family) ever pulled was to write the family out of the history of the family business,” a business whose most profitable product was OxyContin. Which is, Radden Keefe says, where he was going to leave it. “I wasn’t going to write a book after my piece came out because I thought that I couldn’t get close enough to the family to tell a really compelling story.”

We are talking on the phone from his home in the suburbs outside of New York.

There had already been good books written about the opioid crisis, he says, so he didn’t want to do a broader book about the crisis. It was the family story that intrigued him. But he also didn’t want the characters to be caricatures; “I wanted them to seem like real human beings and have the reader have a sense of what they sound like and how they talk and how they see themselves.”

Two unlikely research troves helped him out: a wave of lawsuits against Purdue Pharma, and the habit of people of a certain stature in society to share their archives. There’s a lesson here for ultra-wealthy people, very private people, who don’t want their business aired: Don’t attract lawsuits and be careful who you write to.

“There are a dozen archives that I accessed during the research for the book. And so in many cases, I would find these very intimate letters from the three brothers and then birth announcements and Bar Mitzvah invitations and wedding invitations. And so that kind of thing gave me a more vivid sense of what their lives were like back in the ’50s, and ’60s.”

The next generation of the Sackler family has been just as protective of their privacy as their forebearers. When states and other agencies began suing Purdue Pharma and the Sacklers for their role in the opioid crisis beginning in 2017, “a huge amount” of private emails became available, and Radden Keefe realized he could write a book that gave a more intimate look at the family.

“And so there are there moments in the book where I quote really heartfelt emails that David Sackler writes to his father, Richard Sackler, or quite private correspondence that has come into my possession whether it’s through litigation or because somebody leaked it to me. And that I think helps to paint the portrait.”

The portrait of a family — and a blueprint for what would become today’s pharmaceutical industry.

The Sackler story is, among other things, an immigrant story; Isaac Sackler came to America in 1904, grew up, got married, set up a grocery business in Brooklyn and had three sons: Arthur, Mortimer and Raymond. He encouraged them to dream big: He wanted them to be doctors.

Isaac worked hard, moved to Flatbush, bought properties and prospered. And then came the Great Depression. He avoided going bankrupt, but couldn’t pay for his sons’ schooling. He came to terms with it by saying this: “What I have given you is the most important thing a father can give … a good name.”

Arthur, his eldest son, too, was ambitious and hard-working, too. He would keep that good name, and provide for the rest of the family.

One of the biggest decisions Radden Keefe made in the book, he said, was to not even get to OxyContin until nearly halfway through because he felt it was important to understand this prehistory in order to see how it laid the foundation for what came next.

“It was intriguing to me that there was a backstory dating back to the Great Depression and into the “wonder drug” era, the 1950s medical advertising, and that there was a way to tell that larger family saga that would actually illuminate how we find ourselves in the place we do today,” he says. “It’s kind of the prehistory for the opioid epidemic.”

Arthur Sackler became a psychiatrist and took on a full-time job working at the Creedmoor Psychiatric Centre in Queens. But advertising also interested him, and he took on a part-time gig with the William Douglas McAdams agency, where he’d work on evenings and weekends. It’s where he began perfecting medical marketing — from encouraging pharmaceutical companies to fund studies in journals, to upping the ante in medical journal ads. In his first real effort, he made the antibiotic Terramycin a best-selling drug for Pfizer by calling it a “broad spectrum” drug in advertising — the first time that term was used.

“It was Arthur Sackler who would be credited not just with this campaign but with revolutionizing the whole field of medical advertising,” Radden Keefe writes. Or, as a McAdams employee said, “Arthur Sackler invented the wheel.”

He would go on to buy the paper “The Medical Tribune” and use it as a direct-marketing vehicle to doctors; he bought a “clandestine stake” in the advertising agency L.W. Frohlich; and he bought Purdue Frederick, “a patent medicine business with a few run-of-the-mill products,” which he would co-own along with Mortimer and Raymond.

“I think he was just somebody who didn’t really know limitation,” says Radden Keefe. “You saw that in his family life with his various wives, but also in business where he wanted to be a physician and a researcher, and involved in medical advertising, and involved in pharmaceuticals, and involved in publishing and the press.”

There were clearly conflicts of interest everywhere he turned. And he was just as brilliant at masking “some of what was problematic about this mingling of medicine and commerce.”

“Arthur felt as if he had seen the future,” Radden Keefe writes, “and it was a future in which drug companies and drug advertisers would bring fantastic innovations to the public — and make a lot of money at the same time.”

And he and the family became rich.

Until recently, the Sackler name was well-known because of the family’s philanthropy — it was seen on museums, hospital wings, scholarships. Arthur Sackler’s pride was The Sackler Wing in the Metropolitan Museum of Art in New York.



“He desired posterity, but not publicity,” Radden Keefe writes, and so all of the brothers were named; it “posited a family fortune that appeared fully formed, as if the Sacklers were not three upstart brothers from Brooklyn.”

One of the many archives Radden Keefe accessed for his research was Columbia University’s, which contains all of the old correspondence between the Sacklers and the university in terms of their donations.

“It is interesting seeing the power imbalance between the wealthy donor and the university. We’re used to thinking of that as just a kind of simple, wholesome benefit.”

But when you look at the paperwork and behind the scenes, he says, it’s “much more fraught and complicated in terms of the demands that are made.” There were specifics about how the name was to be mentioned, how works of art were to be attributed.

For all that this is an immigrant story and a story about the rise of the pharmaceutical industry, it’s also a bigger story about power and wealth.

“I’ve tried through this specific story to get at the whole matrix of power and influence that is available to the enormously wealthy,” Radden Keefe says.

All three of the original brothers have died — Arthur in 1987, before OxyContin was launched in 1996 with an aggressive marketing strategy that included targeting chronic pain sufferers, not just those suffering from cancer, and targeting physicians.

OxyContin, Radden Keefe writes, generated some $ 35 billion (U.S.) in revenues. In the 25 years after it was introduced, “some 450,000 Americans had died of opioid-related overdoses.”

Purdue, meantime, kept trying to diversify its product offering, but opioids were always the most profitable product.

There is a point in the book where Craig Landau, the chief executive of the Canadian operations, suggests in around 2017 that “the company should pursue an ‘opioid consolidation strategy’ as other firms ‘abandon the space.’ ”

That is: other companies leaving the space “was an opportunity for Purdue,” Radden Keefe writes.

Throughout the saga the Sackler family worked hard to distance themselves from the opioid crisis.

When Kathe Sackler, Mortimer’s daughter, appeared at congressional hearings into the opioid crisis in 2020, Radden Keefe quotes her as saying “I’m angry that some people working at Purdue broke the law,” she said.

David Sackler, Raymond’s grandson, Radden Keefe writes, “talked about his desire to ‘humanize’ his family.”

“Part of what I wanted to do in the book was try and capture what it looks like from their point of view,” Radden Keefe says. “I happen to think that they’re pretty deep in denial. And their point of view is mostly wrong in terms of where culpability lies, and the notion that they are blameless. But I find it really intriguing that they see themselves as victims in the story.”

And now, as institutions are beginning to refuse Sackler philanthropic donations, as the name is being removed from some museums, they might not be able to pass on what Isaac had taken such pride in and Arthur had brought to such prominence: the good Sackler name.