Review: A new exposé is an air-tight indictment of the family behind the opioid crisis

A book jacket showing an Ionic column with two pills in the scrolls
A book jacket for “Empire of Pain,” by Patrick Radden Keefe.

On the Shelf

Empire of Pain: The Secret History of the Sackler Dynasty

By Patrick Radden Keefe
Doubleday: 560 pages, $33

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Liberals have spent a lot of time recently puzzling over the behavior and attitudes of working-class Americans. Why have they cast off civic values and embraced conspiracy theories? Why do they flock to candidates who offer little beyond a middle finger raised at elites? What is behind their seething rage?

There are any number of credible explanations, mostly based in economics and race, but one often overlooked factor is the opioid epidemic. Since the late 1990s, nearly 500,000 Americans have died, with white working people in places like Appalachia, the Rust Belt and Florida particularly hard hit. The death toll, grievous as it is, attests only to a fraction of the suffering inflicted on tens of millions of citizens.

A factory job exported to China is a crushing loss, but it cannot compare to the ravages of an addicted relative: the years of stealing and lying, the arrests, the destroyed marriages, the homes mortgaged and remortgaged and then lost to pay for rehab, the children born addicted and then thrown into foster care or the arms of stunned grandparents.


Compounding this heartbreak is the fact that the well-off and well-educated created this crisis — the scientists who developed the painkiller OxyContin, the government regulators who approved it, the sales reps who flogged the pills with lies and the doctors who prescribed them in outrageous quantities.

In his impressive exposé, “Empire of Pain: The Secret History of the Sackler Dynasty,” the journalist Patrick Radden Keefe lays the blame directly at the feet of one elite family, the billionaire owners of Purdue Pharma. The decisions that birthed and perpetuated the epidemic were not made by employees or a management team, he reveals, but by members of this cultured clan of physicians, long acclaimed for their arts philanthropy.

As Keefe ably demonstrates, it was the Sacklers who dreamed up OxyContin as a solution to an anticipated revenue decline, and it was the Sacklers who insisted their powerful narcotic, the sort of drug previously reserved for terminal patients, be marketed aggressively and widely. That decision to push the drug as a treatment for common aches and pains kicked open a door. OxyContin rushed in first, but competitors followed; eventually they were joined by Mexican cartels dealing heroin and Chinese traffickers of fentanyl.

The Sacklers’ motivation, Keefe suggests, was simple greed, and they were aided in this project by a pair of noxious family traits: the refusal to admit error and a shocking inability to empathize.

“These are criminals,” Richard Sackler, a physician and then president of the company, emailed a friend in 2001 after news reports of patients becoming addicted in West Virginia. “Why should they be entitled to our sympathies?”


The Sacklers’ attitude scarcely changed over the next two decades, despite the mounting proof that their pill was destroying legions of families — albeit ones that lived far from their mansions in Greenwich, Conn.; Amagansett, N.Y.; and Gstaad, Switzerland. Keefe quotes a 2019 email exchange among relatives in which a second-generation Sackler, Mortimer D.A., refers to “the so called ‘opioid crisis.’”

Patrick Radden Keefe, in a casual shirt, looks into the camera
Patrick Radden Keefe, whose most recent book is “Empire of Pain.”
(Philip Montgomery)

A staff writer at the New Yorker, Keefe is known for tackling mysteries. His book “Say Nothing” took on a notorious and unsolved murder during the Irish Troubles. In last year’s podcast “Wind of Change,” he tried to get to the bottom of a rumor that the CIA orchestrated a Cold War pop hit.

When it comes to the Sacklers, the mystery he sets out to solve seems to be: how could they?

A possible answer emerges in the first third of the book, an extended portrait of Arthur Sackler, the oldest brother and paterfamilias. At first glance it seemed odd to delve so deeply into a man who died nine years before OxyContin debuted, but it proves an inspired choice and the best part of the book.

Arthur Sackler climbed from an impoverished childhood in Brooklyn, where his immigrant parents had a grocery, to the Upper East Side, as Keefe observes, by always betting on himself. Whether it was selling ads on commission for his high school yearbook or marketing a new tranquilizer called Valium in exchange for a cut of sales, Arthur Sackler went “to great lengths in order to devise a scheme in which his own formidable energies might be rewarded.” Trained as a physician, he became an entrepreneur who pioneered the marketing of pharmaceuticals directly to doctors and purchased the company that would become Purdue in 1952 for $50,000.

It was Arthur Sackler’s unshakable confidence in his own abilities that made him very rich and propelled him past competitors, congressional investigators, the FDA and, it seems, any type of moral reflection.

OxyContin is a dying business in America.

Dec. 18, 2016

His younger brothers Raymond and Mortimer, along with their offspring, modeled this approach as they sold OxyContin and confronted — or refused to confront — its damage. Using internal company emails, Keefe lays out how the family micromanaged the company and demanded ever higher revenues. Executives outside the family seemed to serve primarily as fall guys and yes men who espoused the view, as Keefe writes of one official, that OxyContin was “a magnificent gift the Sacklers had bestowed upon humanity that was now being sullied by a nihilistic breed of hillbilly pill poppers.”

The book’s final part is less powerful, perhaps inevitably, as it covers the fits and starts of pending litigation against the company and its ongoing bankruptcy proceedings. Still, it is a compelling chronicle of the lengths to which the rich will go to avoid accountability and the sterling-resuméd lawyers and spin doctors eager to help.

Though Purdue had been the subject of decades of investigative journalism, the family had remained largely unscathed, with many in high society or in philanthropic circles unaware the source of their money was nicknamed “hillbilly heroin.” When my colleagues and I published several hard-hitting pieces in 2016, Richard Sackler felt insulated enough from responsibility (and infamy) to maintain a public Facebook page where he listed his relationship status as “It’s complicated.”

But after Keefe wrote about the family in 2017 in the New Yorker, essentially the hometown newspaper of the elite, the tide turned. Museums and universities started rejecting their donations and removing the family name from gallery walls and research buildings.

I wish Keefe made space in this very long book — more than 500 pages with footnotes — to describe the effect of opioids on a family that wasn’t named Sackler. He finds room for the founding brothers’ romantic conquests, Arthur Sackler’s cringey dealings with the Metropolitan Museum of Art and even a ditzy daughter-in-law’s ghastly attempts at fame. But the shattered lives remain for the most part on the margins.

That is a shame because Keefe is such a talented researcher and storyteller, and a sustained portrait of one of the multitude of families ruined by the Sacklers’ drug would have presented their callousness in even starker relief.

As it is, “Empire of Pain” seems an air-tight indictment of the family. There seems little chance any of the Sacklers will learn from it, but perhaps others striving for wealth and status will take its lessons and remember that when you bet on yourself, there is always someone — sometimes millions of someones — on the other side of the wager.