Empire of Pain: The Secret History of the Sackler Dynasty

Keefe, a New Yorker writer, wrote a three-generation history of the Sackler family and of Purdue Pharma, working from litigation documents, depositions and interviews, with the family and the company declining to cooperate.

The first generation is Arthur Sackler, a psychiatrist who built the modern pharmaceutical marketing industry. Keefe documents his innovations: advertising prescription drugs to physicians through medical journals he also controlled, funding research that supported the products he marketed, using apparently independent medical experts as promoters, and the Valium campaign that made it the most prescribed drug in the world. These methods, developed in the 1950s and 1960s, are the direct ancestors of what Purdue later did.

The central narrative is OxyContin. Purdue launched it in 1996 with a marketing campaign asserting that the extended-release formulation made addiction rare, a claim resting on a single sentence in a letter to a medical journal that had no supporting study. The company funded pain societies and continuing medical education that promoted aggressive opioid prescribing, deployed a large sales force with volume-based incentives, and targeted high-prescribing physicians. Keefe documents that the company had internal evidence of abuse and diversion early and continued.

The legal history covers the 2007 guilty plea by the company and three executives to misbranding, the fine paid without individual imprisonment, the subsequent continuation of the same practices, the litigation by states and municipalities, the bankruptcy filing used to resolve claims, and the settlement structure that protected family members who had not filed for bankruptcy themselves.

Keefe writes with a clear position and the family disputes his account. The documentary basis is extensive. The book is the standard account of how a marketing campaign produced a public health catastrophe and of how the legal system handled it.