Patrick Radden Keefe’s account of the family behind the opioid epidemic

By his own admission, the intrepid reporter Patrick Radden Keefe, a staff writer for The New Yorker, has never taken OxyContin, the highly addictive painkiller introduced 25 years ago by the drug manufacturer Purdue Pharma.

But Keefe is more intimately acquainted with the narcotic — and the shocking story behind it — than most. His deeply reported new book, Empire of Pain: The Secret History of the Sackler Dynasty, lays out with damning specificity how the Sacklers, the family behind Purdue Pharma, built a pharmaceutical juggernaut while fueling the opioid epidemic that has claimed more than 450,000 lives since the late ’90s.

“Prior to the introduction of OxyContin, America did not have an opioid crisis,” Keefe writes in his detailed historical account, released this week by Doubleday. “After the introduction of OxyContin, it did.”

The 44-year-old author and journalist admits he was “shocked” to discover that the Sacklers, until recently better known for their cultural philanthropy, were responsible for the powerful narcotic relentlessly marketed by Purdue Pharma despite clear evidence of OxyContin’s widespread abuse. Some family members are now in legal peril as they seek to fend off a barrage of lawsuits.

“There was a kind of initial revelation,” Keefe told Jewish Insider in a recent interview, “which was, there’s this name that I see when I go to the Metropolitan Museum of Art, and actually, this fortune is associated with this drug that has created a lot of carnage.”

In the interview, Keefe, whose previous books include Say Nothing: A True Story of Murder and Memory in Northern Ireland, discussed the Sacklers’ fall from grace and his own experience digging into the family’s past.

The interview has been edited and condensed for clarity.

JI: You’ve previously reported on the Mexican drug trade. How did you hit upon this story?

Keefe: For a long time, I’ve been really interested in the role that drugs play in American society, whether they’re legal or illegal. I had written a couple of big pieces about the Sinaloa drug cartel, and about the consequences of drug prohibition, really — that you have this huge, multi-billion-dollar, cross-border trade between Mexico and the U.S. in illicit drugs. I did a big piece for The New Yorker, probably in 2014, and then I also did one, possibly the same year, about the legalization of cannabis in Washington State. That was so fascinating to me because you’re looking at what had been this big, clandestine pot economy that then gets legalized kind of at the stroke of a pen. What’s it going to resemble? More like alcohol? More like cigarettes? How do you police it? How do you control marketing?

Those themes were always really interesting to me. I had always felt that with the Mexican drug cartels, a lot of the press coverage — this is going to sound more glib than I mean it — but for understandable reasons, the press coverage focuses on the grisly murders and the illegality of what’s happening. I was kind of interested in them as businesses — the ways in which these drug trafficking organizations actually kind of resemble big commodity businesses. And so, getting to Purdue, what happened was I noticed the uptick in heroin coming into the U.S., wondered about that, started to educate myself on the opioid crisis, and then it doesn’t take long when you start reading about the opioid crisis to come upon OxyContin and Purdue Pharma. And the big revelation for me was the Sacklers. 

JI: It must have been somewhat striking to realize that the name we associate with philanthropy and the arts was behind this sort of epidemic of addiction. What was that like for you to peel back the layers?

Keefe: I was really shocked. When I started reading up on it, I read Pain Killer by Barry Meier, which had been published all the way back in 2003, and Sam Quinones’s great book Dreamland, which also talks about the Sacklers. So there was a kind of initial revelation, which was, there’s this name that I see when I go to the Metropolitan Museum of Art, and actually, this fortune is associated with this drug that has created a lot of carnage. The second revelation was that, actually, this was kind of an open secret — it had been written about before — and I couldn’t really understand how it was, given the fact that it was already in the public record that the Sacklers owned Purdue, and that the company had pled guilty to felony charges in 2007. I was just surprised that the questions hadn’t caught up with them, and that their money still seemed to be pretty widely accepted. In 2017, it was a name that connoted prestige in elite circles.

JI: Is the implication that the Sackler family is kind of like a modern American drug cartel?

Keefe: No, I mean, I think [that’s] kind of pushing it too far, and I wouldn’t go that far. I guess this is what I would say: I’ve always been interested in the ways in which illegal drug organizations resemble legal businesses, and I became very interested in some specific ways in which legal Big Pharma practices sometimes resemble those of drug cartels — for instance, offering free samples to an addictive product. In the case of Purdue, they offered these coupons for a free prescription, and that’s something I know because I’ve looked into it at great length. When the Sinaloa cartel decided that methamphetamine was going to be their big new product, they started sending free samples to Chicago so that people would try it. But I think sometimes people get a little carried away with the rhetoric and they try and draw too precise an analogy there. Let’s remember, nobody’s suggesting that the Sacklers, or Purdue, had roving gangs of armed assassins, right? I mean, I think this is a business that did break the law and engage in crime. They pled guilty again in 2020, just a few months ago. So there’s illegality there, but it’s of a different category than the Sinaloa cartel, and I wouldn’t want to suggest otherwise.

JI: You do suggest that Purdue Pharma tried to strong-arm you as you wrote about them. You mention in the book that it seemed as if you were being surveilled, though the company denied it. A lawyer for the Sacklers also told the Times that you’ve “refused to correct errors” in your “past reporting and “blatantly violated journalistic ethics by refusing to meet with representatives for the Sackler family.” But no one in the Sackler family cooperated with you for the book. How did you navigate all that, and was it different from previous reporting experiences?

Keefe: I’ve written about very wealthy people before who have tried to manhandle my reporting and the way the piece would be written. I’ve written about some fairly scary figures from the criminal underworld. This was a different kind of experience. Part of the story I try and tell in the book is that it’s not an accident that even after Barry Meier’s reporting and even after the guilty plea in 2007 and even after Sam Quinones’s book, the Sacklers still enjoyed a pretty good reputation. People hadn’t really made that connection between them and OxyContin. I think the reason is that they have had, for 20 years, this apparatus of lawyers and PR hatchet men who, any time journalists start writing about this stuff, they just come down on them like a ton of bricks. 

For years, it worked. I tell the story in the book about how The New York Times took Barry Meier off the story after Purdue Pharma intervened. They did what the Sacklers always do: They’re always saying, “Can I see your manager?” They love to go to people’s bosses. They did with me. They’ve written notes to The New Yorker about how irresponsible I am. It was frustrating to have to work on the book and be dealing with that kind of static all along the way — and particularly frustrating given that I gave them a fair shake. I sent them a really long list of very detailed queries from the book asking them to confirm or deny, and initially, they said, “Oh, we’re going to give you very detailed answers,” and then they waited. They asked for more time — they got five weeks — and then they came back with just like a page and a half saying, “Your book is full of lies, we’re not going to cooperate.” So it’s frustrating to me that they wouldn’t engage in a kind of good faith way. Instead, what they were often trying to do was question my journalistic integrity. But both in the context of this book and in my prior work, I feel like at this point my record speaks for itself.

JI: You mentioned in a separate interview that you wrote most of this book sitting in bed. What was that like? How did you keep track of all the documents you consulted for this research-heavy book?

Keefe: It was a strange process. There was about a year when I was working on the book before COVID hit, and that was a lot of reporting and going to archives and going out and meeting people. When the pandemic started, I was just sort of grounded, but by that point, I had a lot of the documents already, and so I kept reporting. I was calling a lot of people. My wife and I share a home office, and she has a job that normally takes her into the city every day, but she wasn’t doing that. So I got the bed. It worked out strangely fine, in the sense that because there were so many documents, I found that the bed was a useful place to lay everything out. Everything was right there within easy reach, and I still have a little bit of a mild back pain to show for it. But that’s the worst of it.

JI: You devote a substantial portion of the book to Arthur Sackler, the family “patriarch,” as you describe him. His heirs aren’t affiliated with Purdue Pharma and have tried to distance themselves from the controversy surrounding the company. How much do you blame Arthur for the opioid epidemic?

Keefe: It’s a very complicated and nuanced question, and this is part of the reason that I devoted a third of the book to Arthur. Arthur died in 1987. His children and his widow point out, rightly, that he wasn’t around when OxyContin was invented, he didn’t market the drug, and in fact, they sold their stake in Purdue before the drug was rolled out. So today, the descendants of Arthur Sackler are not beneficiaries of OxyContin in any sense, and I make all that clear in the book. Having said that, as I think I also make clear in the book, Arthur Sackler pioneered a certain template for the marketing of pharmaceuticals, particularly pharmaceuticals that are potentially addictive. When you look at the various drugs I describe in the book — Librium, Valium — these drugs were marketed by Arthur, where you see the seeds for what happens decades later with Oxycontin. 

To me, the book is about kind of gradations of complicity, and I think of it as concentric circles. Richard Sackler is just the red hot bull’s-eye of complicity, and then you have these other characters who are kind of arrayed outward in those circles. The suggestion that Arthur Sackler’s heirs make is that he’s nowhere on the target at all, that there’s no relationship to this story whatsoever. They say, like, “It should just be the Raymond and Mortimer Sackler family.” It always makes me chuckle because I think about that, you know, there are two other Koch brothers who might not want to be referred to as the Koch brothers. With Arthur, the way we evaluate morally what he did vis-à-vis this drug that was introduced after he died, it’s no comparison to the people who were working at Purdue when they rolled out OxyContin or, in fact, to the people who today are very rich, even if they didn’t work at the company, because of OxyContin sales. But I also think that it’s important to look at him, and I think that he ended up having a really significant impact on the way in which drugs are sold in this country and kind of creating the universe in which Oxycontin could happen.

JI: Despite that things went so wrong, Arthur does seem like an archetypal sort of Jewish-American striver.

Keefe: To me, this is a book, in a way, about the American dream, and there’s a kind of almost mythical, archetypal, Horatio Alger quality to the early story, where you have this immigrant family that comes with nothing, and they work incredibly hard, and they invest in education, and they have higher ideals, and they have great ambitions. In some ways, it’s a cautionary tale about where ambition can take you. But I do think that there’s no way that it didn’t really forge the identities of those three brothers that they lived in a world in which — glass ceiling isn’t exactly the word that I want — but there were these little reminders everywhere that no matter how far you come, you could still be excluded on the basis of the fact that you’re a Jew. Even if you’re not all that observant, even if you could pass as a gentile, as Arthur sometimes did, there were these moments of exclusion, and how could it not have profoundly influenced Mortimer and Raymond that, when they want to apply to medical school, they can’t? They can’t go in this country. They have to leave the country because of Jewish quotas. 

And Arthur, I think, felt conscious that — even as he ascended the New York aristocracy — there would be these moments where he was kind of brought low. The most dramatic one for me — and this was something that’s nobody ever written about — was that early congressional testimony where Arthur’s trying to get funding for his program at the asylum, and this senator starts talking about The Merchant of Venice. And I don’t know, I feel a huge amount of empathy with Arthur in that moment, because on the one hand, he’s kind of arriving and he’s just on the cusp of this great life and he’s testifying in the U.S. Senate, and this guy, like, accuses him of being a Shylock, and it’s a senator. 

Who wouldn’t come out of that with a kind of hypersensitivity to whether or not you’re in the club? I think you see it later where Arthur felt that the Met wouldn’t give him a board seat because he was Jewish. There were Jewish board members and there were a number of senior officials who were Jewish who said, “That’s just paranoia.” There were other concerns that people had about Arthur. But I just think that experience of social exclusion, notwithstanding all of the incredible work and how brilliant they were, could only have affected them.

JI: The Sacklers last month offered to pay around $4.3 billion to end the many lawsuits being brought against them. How do you expect this legal saga to end?

Keefe: I think the end game is going to play out in the next few months in this bankruptcy court in White Plains. The Sacklers have proposed to pay about four and a quarter billion dollars — and I think their hope is that they would do that, all of the cases against the company would be resolved, and they would basically get a release from roughly two dozen states that are suing not just Purdue but the Sacklers. And whether or not that happens remains to be seen. It’ll depend on whether or not the states sign off on the plan, and there’s a piece of legislation that’s been introduced on Capitol Hill called the Sackler Act. If it were passed between now and August, that would actually prevent the bankruptcy judge from giving a release from all those lawsuits to the family, so that’s also kind of hanging in the balance. It’s a strange aspect of this book, where I hope that the book feels somewhat conclusive, because I think the broad outlines of how this story is going to end are pretty clear already. But it’s also the case that there will be a big postscript in the next couple of months. 

There’s a related question, too, which is, the Sackler name is still on the Sackler wing at the Met and a variety of other institutions, and it’ll be really interesting to watch those institutions. The Met has said, I think the word they use is, “we’re reassessing” or “assessing whether or not we’re going to keep the name.”

JI: Do you intend to continue covering the story as it progresses, or are you done with Sacklers for the time being?

Keefe: You know, one of the weirdest things about doing this kind of work is that people keep coming out of the woodwork. Even just in the last few days of the publicity with the book, I’ve been getting notes from people who worked at Purdue, people who know the Sacklers — which is tempting, to keep gathering string. But I think for now, unless something changes my mind, I’ve kind of said my piece on this and I’ll defer to other journalists.

JI: Is there anything else you’re working on now?

Keefe: I don’t have anything. It’s very strange. In a fairly short order, I published a book two years ago and then I did a podcast that came out last spring and then this book. So I’m just going to kind of take a deep breath and figure out what’s next. I don’t have anything on the agenda, and it’s making me feel a little anxious.

JI: Have you ever taken OxyContin?

Keefe: That’s amazing. Nobody has asked me that yet. I thought I would get the question at some point. I have not. I’ve taken milder opioids after procedures and what have you over the years. But no, not OxyContin, ever.