The recent opioid epidemic is a huge and complex topic. Empire of Pain focuses on the pharmaceutical company that started it all with it's "slow release" pills of strong narcotics, and the greedy Sackler family owners who raked in the money. Keefe tells the story of three generations of the Sackler family, beginning with three brothers (Arthur, Mortimer, and Raymond) coming of age during the Great Depression. At first I was only impressed by the oldest brother, Arthur. He managed to get a medical degree and earn enough money for his parents to purchase a business during the Great Depression. He singlehandedly took care of his entire family under very difficult circumstances. After medical school, he worked at an asylum, not happy with the care the mental patients received. He wanted something more caring and more humane and helped develop some of the first psychiatric drugs.
But Arthur also callously cheated on two of his wives, mostly disregarded his children, and first made his fortune by falsely advertising the uses and benefits of valium, buying the FDA along with it. His accomplishments were impressive, but he was very shady as well. Initially deeply involved in drug advertising, he secretly invested and owned the primary rival advertising firm in NYC, so he could corner the market without worrying about conflicts of interest. One thing Arthur did with this money was buy his brothers a small pharmaceutical company for them to run: Purdue Frederick.
Arthur, Mortimer, and Raymond's families expanded quickly with a number of wives and children, and they were all very rich. But Purdue Frederick was just a normal pharmaceutical company making normal profits until Raymond's son, Frederick, and Mortimer's daughter, Kathe, became involved with the idea of taking morphine and covering it in a time release capsule. The Sacklers wanted to make morphine more widely used by making it more accessible. Taking a little pill is a lot easier than injections, and they worked to change the idea that morphine is for cancer patients--saying that it's appropriate for all kinds of pain, large and small. This pill was advertised as not addictive even though they had done no clinical trials regarding addiction and had evidence to the contrary.
When their morphine pill was wildly successful, they decided to take oxycodone and do the same thing--cover it with a time release capsule, and aggressively sell it to everyone they could--as oxycontin. In their research they found that doctors erroneously perceived oxycodone as less potent than morphine even though it is at least twice as powerful. By buying doctors, FDA officials, outright lying in their literature, and aggressively pushing oxycontin with thousands of sales reps, they quickly made a fortune.
There had already been numerous indications of addiction with their morphine pill, and things only accelerated with the more powerful oxycontin. Purdue Pharma (new business) denied any kind of addiction problems, even as they said that patients might need more and more of the drug to contain the pain. They also had terms like physical dependence and pseudowithdrawal to explain away the very real addiction that people were suffering from.
When communities and families devastated by the opioid epidemic began looking into the Sacklers and Purdue Pharma, the prosecutors found a lot of damning evidence. But with aggressive lobbying, the Sacklers avoided criminal liability in the mid 2000's, instead letting the company plead guilty and pay a $600 million fine. And then they continued doing the exact same illegal practices they'd been doing before--but this time also expanding to the rest of the world.
In the end, the Sackler's were able to avoid criminal liability entirely, walking away with a large majority of the profits. In public as well as private communications, they never expressed any remorse. The most accountability they really faced was many of the museums and universities eventually took the Sackler name off of their buildings and wings when it became untenable to continue to memorialize them.
I definitely had some schadenfreude when people finally started calling out the Sackler family for their deeds. It was frustrating and fascinating to see the second and third generations of Sacklers parading around with this obscene amount of money and power they didn't earn. There were some that had nothing to do with Purdue Pharma, breaking out on their own, but they still benefitted off the many millions of dollars they received from the company each year. It was an awkward dance to watch them distance themselves from the company while refusing to acknowledge, or possibly even admit to themselves, the wrong done by that company.
I thought this book was well-written, relatively easy to follow given the subject matter, and simply an important topic to understand. Having read about Theranos and Weinstein, the way Purdue and the Sackler family avoided accountability was very familiar: buy high priced lawyers; push people around with your money; disseminate false information; and use/buy connections in the government. It's frustrating how much power a company/person can have in this supposedly equitable nation.
Highly Recommended.
CBR15Bingo: "Edibles" - because this book is all about drugs
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