How a single family fuelled the US opiod crisis

Review: Vivien Horler

Empire of Pain: the Sacklers, Purdue Pharma and OxyContin, by Patrick Radden Keefe (Picador)

I’d never heard of the Sackler family until I picked up this book. But it seems I should have. They were famous American philanthropists whose name adorned art galleries including the Louvre, the Metropolitan Museum of Art, the Guggenheim Museum; buildings at Harvard, Tuft’s and Oxford and even a museum of art and archaeology in Beijing.

They were richer than the Vanderbilts or the Carnegies had ever been, and gave away hundreds of millions of dollars. Yet as New Yorker staff writer Patrick Radden Keefe points out, the precise origin of the Sacklers’ wealth was somewhat mysterious.

This was because they went to great lengths to avoid having their family name associated with the family business: a pharmaceuticals company known as Purdue Pharma which developed and sold a powerful anti-pain drug called OxyContin.

And while it was a very effective medication, it readily lent itself to abuse, addiction and death. Keefe quotes an estimate from the Centers for Disease Control and Prevention that in the 25 years since OxyContin was introduced in 1995, around 450 000 Americans have died of opioid-related overdoses.

These are now the leading cause of accidental death in the United States, more than car accidents and more than gunshot wounds.

Not all these people had been taking OxyContin, but it was the first drug of its kind to be introduced, and fuelled the US’s the opioid epidemic.

The family always maintained that it wasn’t their fault if people abused OxyContin, and that people who became addicts were probably predisposed to addiction anyway. No one who took the drug as prescribed by a doctor would become addicted, they claimed, despite vast evidence to the contrary.

Part of the problem was that OxyContin was marketed to suppress pain for 12 hours, so that patients would be prescribed two pills a day. But many people found the drug did not keep them pain free for 12 hours, and over time were likely to take the tablets more often.

The company knew this, its sale reps knew this, and so did the family.

Crime cartels knew it too.

Here’s how one case worked. In 2008 a crime ring persuaded an elderly doctor called Eleanor Santiago – who was not well and in debt – to set up a fake clinic in Los Angeles.

In October that year alone she prescribed 11 000 OxyContin pills, many of them for the 80miligram pills – the largest available dose – which were also the most popular on the black market. They were known as 80s and sold for $80 each. For $25 a time, the crime ring would recruit homeless people to report to the clinic, get a prescription from Santiago, and collect a bottle of OxyContin80s which the drug ring then sold on in bulk to traffickers.

By the end of that year Santiago had prescribed 73 000 pills. These were extraordinary figures, and Purdue was tracking them, but took no action. A company official later acknowledged that he spent five years investigating suspicious pharmacies, but the company never suspended the supply of the pills to a single one.

Oxycontin’s active ingredient is oxycodone, which had been available as a pain drug before OxyContin was formulated. But it was used in small doses, because a bigger dose was simply too powerful all at once. The genius of OxyContin was that the company developed a pill coating that would slow the release of the drug into the bloodstream.

The coating worked, but because the pill did not always suppress pain for 12 hours, patients and addicts soon discovered you could crush the pill and get the hit.

In 2010 Purdue Pharma reformulated the coating so the pill could no longer be crushed. But by now many people – both legitimate patients and abusers – were addicted to opioids,     and US legal authorities believe this fuelled a switch to heroin and fentanyl, another powerful and potentially habit-forming analgesic.

In 2019 a team of economists from Notre Dame, Boston University and the US’s National Bureau of Economic Research published a research paper, titled: How the Reformulation of OxyContin Ignited the Heroin Epidemic.

Things began to sour for the Sacklers as thousands of lawsuits against Purdue were registered with the courts, and as in the RhodesMustFall campaign, universities, galleries and museums removed the Sackler name from their edifices and distanced themselves from the family’s philanthropy.

Keefe traces the story of the family back to the end of the 19th century, when Isaac Sackler emigrated from Austria, married a Polish immigrant, and fathered three sons, Arthur, Mortimer and Raymond. Isaac owned a small grocery store, but all three of his sons graduated from medical school.

The brothers were, in the words of Kathe, Mortimer’s daughter, “very entrepreneurial”, and the family prospered. But their spectacular accumulation of wealth dates back just 25 years, thanks to OxyContin.

As Keefe puts it: “The saga of their lives and the dynasty they would establish was also the story of a century of American capitalism.”

Empire of Pain is detailed, richly researched and makes for both terrifying and fascinating reading.

  • Empire of Pain is one of Exclusive Books’ recommended books for June.





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