Empire of Pain — the story of the Sacklers and OxyContin

In 1980, a small UK drugs company launched a painkiller for patients suffering from cancer. The slow-release morphine pill called MS Contin was developed at the prompting of Cicely Saunders, a leader of the hospice movement, to help them die with dignity at home, rather than on a morphine drip.

Four decades later, MS Contin’s successor pill, OxyContin, is one of the most notorious medicines in US history, having helped to unleash an epidemic of opioid-related overdoses from OxyContin and rival drugs that claimed nearly 500,000 lives, many in rustbelt towns in Appalachian states such as West Virginia. The families that turned OxyContin into a blockbuster, making billions in the process, were named Sackler. 

For a long time, the Sackler dynasty, spanning the families of three brothers from Brooklyn, was acclaimed for philanthropy. Many museums courted their donations and named projects and buildings after them, from the Sackler Center for Arts Education at the Guggenheim museum in New York, to the Serpentine Sackler Gallery in London (later renamed).

Less publicised was how the money for many of the donations flowed from Purdue Pharma, a Connecticut-based drugs company owned by two of the Sackler brothers and their families (who also owned the UK maker of MS Contin). Its biggest product by far was OxyContin, which instead of morphine contained oxycodone, a more potent opioid.

It is a shocking saga, not least because of the adamant refusal of the Sacklers to shoulder the blame. Richard Sackler, the leading figure behind the painkiller, was “able to sustain an impressive degree of emotional and cognitive detachment from reality”, Patrick Radden Keefe writes drily. Purdue’s chief lawyer had an ironclad philosophy: “Concede absolutely nothing.”

The story of the Sacklers and OxyContin is a parable of the modern era of philanthropy being deployed to burnish the reputations of financiers and entrepreneurs. Pliant regulators, a flawed healthcare system and greed allowed a family enterprise to spread its pills, helped by advisers including the consultancy McKinsey & Co. Opioids were sold across the world, but the US epidemic was unmatched.

The drug wasn’t the problem, Richard contended. The problem was the abusers

Responsibility extends beyond the Sackler dynasty. The US Food and Drug Administration made what its commissioner during the 1990s later called one of the “great mistakes of modern medicine” — the legitimisation of opioids. “I’ll die young, but it’s like kissing God,” the comedian Lenny Bruce said of his heroin addiction, and many Americans made the same fatal bargain.

But among the revelations in Keefe’s tour-de-force account is the degree to which the Sacklers pioneered the aggressive advertising and direct selling to doctors of the US pharmaceutical industry. Purdue popularised OxyContin with tactics similar to those Arthur, the oldest brother, had devised to get doctors to prescribe Roche’s tranquillisers Librium and Valium in the 1960s.

Arthur Sackler brought “the full power of advertising and promotion to pharmaceutical marketing”, read his citation in the Medical Advertising Hall of Fame (sic). Decades later, at the 1996 launch of OxyContin, his nephew Richard promised that Purdue would promote it so heavily that it would unleash “a blizzard of prescriptions that will bury the competition”.

Purdue pushed for OxyContin to be prescribed not only for cancer but the much larger market of chronic pain — bad backs, arthritis and the aches of manual labour. OxyContin was the remedy “to start with and to stay with”, it promised, and found an eager audience: patients testified that it had let them return to work, or pick up their grandchildren. The drug seemed to work miracles.

Keefe, a New Yorker writer whose previous book Say Nothing told the story of a hushed-up IRA killing in 1970s Belfast, brings to Empire of Pain the same coolly prosecutorial prose style, backed by voluminous research. The families refused to be interviewed and boycotted his final fact-checking efforts, replying through lawyers that his questions were “replete with erroneous assertions built on false premises”.

If anything, there was too much material disclosed in court cases. “This was the first project I’ve ever undertaken in which there were really too many documents. I felt . . . overwhelmed by paper,” he writes. It is a long book and he walks a fine line between nailing down the facts and keeping the reader engaged.

It was a classic Arthur Sackler play: innovative, showy, a little bit shady

But by talking to more than 200 people who knew generations of Sacklers, he brings to life the obsessive personalities and ferocious energy of some members, exemplified by Arthur’s “life force, his won’t-take-no-for-an-answer tenacity, his vision”. Arthur, who trained as a psychiatrist but went on to own an advertising agency and a medical publisher, innovated and cajoled his way through the worlds of medicine and art.

He gave money to the Metropolitan Museum of Art in New York in 1961 in return for a gallery and all of its paintings bearing his name, plus some tax benefits. “It was a classic Arthur Sackler play: innovative, showy, a little bit shady,” Keefe writes. He later went bigger, pledging $3.5m to have a new wing of the Met containing the Temple of Dendur called the Sackler Wing.

Arthur died in 1987, when MS Contin was still new in the US and OxyContin had not yet been invented. The families battled over his inheritance, and Arthur’s children sold his Purdue stake to his brothers Mortimer and Raymond for $22m. It was “a spectacularly foolish transaction” for the former in financial terms, but it insulated them from the disaster that followed.

Raymond’s son Richard, regarded by Purdue employees as “a bit of a princeling, an entitled dilettante”, took charge of the company, although he sheltered behind a circle of executive courtiers when the going got rough. Ripples emerged soon after OxyContin’s launch, with the first wave of overdose deaths.

Some victims were addicts who crushed the pills to release their drugs and sniffed them like heroin. Many were people who found that the pill’s slow release did not relieve pain for the promised 12 hours, and increased their dosage. Purdue remained unmoved: “The drug wasn’t the problem, Richard contended. The problem was the abusers.”

The Purdue-owning Sacklers had an incentive to keep selling OxyContin, even after a 2007 case in which Purdue pleaded guilty to a federal charge of misbranding and paid a $600m settlement. They voted to pay themselves $325m that month, and took out a total of $4.3bn in OxyContin proceeds between 2008 and 2016. Withdrawing the medicine would have meant ending a bonanza.

As the controversy grew, Arthur’s family took to dubbing their namesakes the “OxySacklers”, while younger cousins in London and New York acted as though it had nothing to do with them. The empire finally toppled: Purdue declared Chapter 11 bankruptcy in 2019 and the owner Sacklers made a settlement offer to 24 states and the District of Columbia of $4.3bn this March.

The Sacklers emerge as a shameless bunch, but Empire of Pain also poses troubling questions about the US healthcare system that permitted them to flourish. Arthur died before OxyContin, but Keefe writes that he “created the world in which OxyContin could do what it did”. It remains a world of lavish marketing and regulatory loopholes.

“In some parts of Appalachia, people would pair an OxyContin with a Valium — one of Richard Sackler’s pills and one of his uncle Arthur’s. They called it ‘the Cadillac high’,” Keefe records. Tranquillisers and opioids quelled the pain for a while, but it always returned.

Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe, Doubleday $32.50/Pan Macmillan £20, 560 pages

John Gapper is FT Weekend business columnist

Data visualisation by Liz Faunce, Keith Fray and Alan Smith

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