Empire of Pain by Patrick Radden Keefe

Empire of Pain: The Secret History of the Sackler Family by Patrick Radden Keefe is an exploration of three generations of a family responsible for revolutionizing the advertising and distribution of pain medications that led to the opioid crisis in the United States.

Let me be frank with you. This book is long. The Goodreads blurb refers to it as "exhaustively documented and ferociously compelling" and I'm 50% in agreement with this. It's definitely exhaustively documented. It's also *whispers quietly* boring. I know, I know. Everyone LOVES this book. It's important and sobering and mandatory reading for the modern age. But do yourself a favor and listen to Keefe on Fresh Air instead of reading this and save yourself hours and hours and hours of reading.

This is the story of corporate malfeasance. Just as Radium Dial Company knew that radium was dangerous for its employees and customers years before it did anything in Radium Girls, Purdue Pharma under the Sackler family leadership knew that OxyContin was being used dangerously in off-label ways years before the company admitted guilt. Why stop the cash cow just because people were dying by the literal thousands?

All that's important. It really is. The book is well-researched, well-organized, and it's hard to pin exactly what my beef is with it. I'm glad I read it, but I really don't think you need to do so unless you're really invested in this story for some reason. 

Basically, this guy named Arthur Sackler starts a pharmaceutical company with his two dopey younger brothers, Mortimer and Raymond. Arthur changes the way advertising was done in this market by focusing on jazzing up advertisements and selling directly to physicians. Before the Sacklers, pharmaceutical reps weren't quite as ubiquitous as they are now. The company started by selling Valium as a tranquilizer, but soon switched to MS Contin, which was a pain reliever that allowed people in chronic pain to receive treatment outside of a hospital context. Eventually, the Sacklers released OxyContin which had a time-release element so the painkilling effects lasted for hours.

But the Sacklers lied about OxyContin's effectiveness, addictiveness, and strength (they marketed it as weaker than morphine). And then they kept lying. Corrupt officials in the FDA allowed it to get federal approval. Ruthless doctors ran pill mills and wrote prescriptions for thousands of pills a day.  People started snorting the drug and when Purdue Pharma eventually changed the formulation to make it impossible to snort, people turned to heroin for an equivalent high and now we have a heroin/fentanyl crisis in the US. Now you know the story. The kids and the kids' kids of the original three brothers continue the lies, all the way using their money in philanthropic ways, getting university buildings and museum wings named after them.

3/5 stars

Lines of note:

If the true personality of oxycodone was misunderstood by America's doctors, the company would not correct that misunderstanding. Instead, they would exploit it. (30%)

It had now become undeniable that the drug was causing some people to overdose and die. But the drug wasn't the problem, Richard contended. The problem was abusers. (36%)

But the reality was that a lot of these people were already addicted. Many had been for years. They had passed a point of no return. And as it happened, there was an inexpensive substitute for OxyContin that was cheaper and stronger and widely available: heroin....For some users, the reformulation of OxyContin triggered a transition to other, more readily abusable prescription opioids. But many graduated to heroin instead. (49%)

African Americans had been spared the full brunt of the opioid epidemic: doctors were less likely to prescribed opioid painkillers to Black patients, either because they did not trust them to take the drugs responsibly or because they were less likely to feel empathy for these patients and want to treat their pain aggressively. As a result, levels of addiction and death were statistically low among African Americans. It appeared to be a rare instance in which systematic racism could be said to have protected the community. (50%)

Purdue and other drug companies that manufacture opioid painkillers spent over $700 million between 2006 and 2015 on lobbying in Washington and in all fifty states. The combined spending of these groups amounted to roughly eight times what the gun lobby spent. (54%)

Things I looked up:

Desiderius Erasmus Roterodamus - Fifteenth century Dutch scholar who prepared important editions of the New Testament that would be influential in the Reformation.

Aristotle Contemplating a Bust of Homer - Oil-on-canvas painting by Rembrandt that shows a gold-chained wearing Aristotle looking at a bust of Homer. 

By Rembrandt - Unknown source, Public Domain, https://commons.wikimedia.org/w/index.php?curid=15417386

Maenads - In Greek mythology, maenads were the female followers of Dionysus and the most significant members of the Thiasus, the god's retinue.

Ziggurat - (in ancient Mesopotamia) a rectangular stepped tower, sometimes surmounted by a temple

Nan One Month After Being Battered (1984) - Color photograph of artist Nan Goldin showing her with two black eyes, but wearing lipstick and wearing dangly earrings and a necklace. I was going to put an image of it here, but it's pretty disturbing.