Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe
(This summary is really long as was the reign of the Sacklers who brought OxyContin to the world.)
This book examines the Sackler family and its role in creating the opioid crisis that has descended upon the country. The Sacklers were very good at flying under the radar screen concerning what their company actually did in its drug production business. On the other hand, many of the Sacklers adored being adored and were very high-profile in their philanthropy, which often resulted in a building or a museum exhibit being named after someone in the family. The Sacklers gave away hundreds of millions of dollars over the years and the author compares them to the Vanderbilts and Carnegies in terms of their conspicuous donations.
The first chapter recounts a big meeting of twenty law firms in the spring of 2019 about a class-action lawsuit that involved thousands of clients and dozens of attorneys general and other law enforcement agencies. The Sacklers invented and aggressively marketed OxyContin, a controlled substance that provided pain relief. It also provided a pretty easy path to addiction and death, with 450,000 Americans dying of opioid-related overdoses in the 25 years the drug has been available. As Kathe Sackler, one of the bigwigs in the family was questioned about the role of Oxy as the taproot of the opioid epidemic, she increasingly swelled with pride as she pointed out that Oxy was a great, safe drug and. Any negative outcomes were entirely the fault of the users who shouldn’t have become addicted. This was the essential defense of the family against any charges - that personal and moral weaknesses drove misuse and that the family’s company, Purdue Pharma, was completely blameless for any bad outcomes. Until this meeting, that defense had worked brilliantly for decades. But things might be about to change.
The Sacklers were a classic Brooklyn immigrant success story. The parents of the three sons -–Arthur, Mortimer and Raymond – owned and operated a small grocery store. The boys were bright and excelled at the local public high school, Erasmus Hall. They tested into the accelerated program at Erasmus. Arthur, the oldest son, sold advertising for the school newspaper and was a natural hustler. He went to NYU and NYU medical school. He did public relations for a German medical company while he was in med school and made a lot of money while improving his marketing skills. HIs two younger brothers, Mortimer and Raymond, also became doctors.
After Arthur became a doctor in the 1940s he went to work full-time for the German medical firm. He did research as well as continuing to help the company sell products. Arthur was interested in mental health, particularly in the fact that, besides electroshock and lobotomy, there weren’t many treatments. The more Arthur worked with mentally ill patients the more he came to believe that the problem might be a chemical imbalance in the brain that could be fixed by the right medication. His brothers joined Arthur and did research on brain chemistry. They isolated a chemical that helped a lot of patients improve outcomes and they began to believe that chemistry was the key to effective treatment.
Arthur liked advertising a lot more than he liked being a doctor, so he went to work part-time for McAdams, an ad agency that represented Pfizer, a German company that was developing antibiotics that needed to be sold to doctors to prescribe to patients. Arthur came up with the idea of taking out ads in medical journals to push products. He often wrote ads that looked like they were reporting the results of some high-end clinical trial when they weren’t, but the drugs flew out of the warehouses. He also produced slick brochures, again without a lot of substance behind them, that he brought to doctors’ offices. Finally, he invented the concept of hiring attractive men and women to directly sell drugs to doctors. They were good-looking (they still are) and trained to explain the amazing benefits of whatever they were selling. They’d leave lots of free samples and buy lots of lunches for the doctor’s support staff. It worked. Docs prescribed these drugs to patients.
Arthur was such a good ad man that he became president of the McAdams agency, theoretically a part-time gig since he still worked at Creedmoor Hospital, a mental health facility. Arthur started his own medical publishing company and journal so he could expand his ad reach to doctors. Arthur captured even more of the drug sales market and eventually quit Creedmoor when he and his brothers bought a small, fledgling drug company, Purdue Pharma, in 1952.
In the mid-1950s, pharma companies were trying to develop drugs to treat relatively minor issues. The recently-developed Thorazine was good for people with major mental health disorders but most people with some mental issues did not need such a powerful drug. The Roche company developed Librium, a minor tranquilizer. The company hired Arthur Sackler to market it. Librium made people with all sorts of conditions feel better - anxiety, depression, phobias, obsessive thoughts - so there was a huge potential market for it. Arthur decided to market the drug directly to consumers so he got a favorable story in Life magazine, which was read by tens of millions of Americans each week. Roche sent vinyl record recordings of positive testimonials directly to doctors all across the USA. Roche soon developed Valium, which was very similar to Librium, but they could market it differently and expand the overall market. Although these drugs were pitched to treat different ailments, they really didn’t treat different ailments. The tranquilizers were directly marketed to housewives who had anxiety, depression, or alcohol issues – “being female” was the overall theme of the disorders. Both drugs were very successful. Tranquilizers like Librium and Valium became “penicillin for the blues.” Arthur was the marketer behind these successful promotions.
Arthur was married to Else and he had a steady girlfriend, Marietta. He eventually married Marietta after divorcing Else, to whom he remained close. Although, he wasn’t home much, as he enjoyed the company of Else as well as Marietta.
Back in the early 1960s when tranquilizers were the rage, no one worried about addiction. A few years later, that changed. The federal government started to study the impact of taking lots of tranquilizers on a person's health. The feds got Roche to agree to list Librium and Valium as controlled substances, but that did little to limit their distribution. By the mid-1960s, twenty million people were on these wonder drugs and they became the most widely abused drugs in history. The Rolling Stones’ hit Mother’s Little Helper was about the routine use of such drugs by stay-at-home mothers.
Arthur became interested in Chinese art and started buying lots of it. He was obsessive about buying stuff. Eventually the Sacklers would set up exhibits of their art treasures as a way to boost their branding. In 1962, Columbia University was the first place to give the Sacklers a place to hang their brand. Over the decades, many other prominent institutions would welcome the Sackler/Purdue Pharma money with open arms and wallets.
Henry Welch was a major player in the US Food and Drug Administration. He also had a secret side job editing a private medical journal for a drug manufacturer. Welch’s keynote speech at a 1956 national drug conference extolled the virtue of new drugs that would treat mental disease. This wasn’t uncommon back then. There was no oversight of federal officials and they could pretty much do what they wanted to do.
A magazine reporter, John Lear, wrote an expose about how drug companies essentially made up studies to support the effectiveness of whatever they were selling. Someone blew the whistle on Welch, and Lear interviewed him about his work with a medical journal that pushed the products of a drug company. Welch said that he wasn’t paid for the work and it was a very small part of his professional life.
Estes Kefauver was a US Senator from Tennessee who was a southern liberal and a potential presidential candidate. In the late 1950s, he started looking at the pharmaceutical business. Kefauver was impressed by how much like the mafia the drug industry was in terms of doing everything to obscure investigation and dissemble. He was particularly impressed by how easily the pharma business hoodwinked government regulators. It was not a fair fight. Former FDA regulators testified that there was virtually no oversight of new drugs. Whatever findings the drug company presented, they were not questioned. Drug marketing was a joke, with claims being made by the companies that had no basis in fact. Pfizer’s own data showed that 27% of the patients who used their drugs had serious side effects/addiction issues, but that was never made public.
Pfizer was pulling the strings behind FDA administrator Welch. The company gave him talking points pushing their drugs that he would include in his supposedly objective review of pharmacopoeia.
Journalist Lear figured out that the Sacklers were a part of this drug seller conspiracy. Arthur was called to testify. It was not a fair fight. Arthur stonewalled the questioners and presented his view of what a benefit these new wonder drugs were for the mentally ill. He charmed the committee and skated.
Henry Welch wasn’t as lucky. He was shown to have pulled in hundreds of thousands of dollars from the drug companies that he was supposed to be regulating. He was on their payroll. He avoided prison but left his FDA position as a disgraced man.
Arthur liked to accumulate things, including the Egyptian temple of Dendur that he wanted to move to the NY Metropolitan Museum. The Sacklers gave the museum $3.5 million and lobbied Washington to get the temple into the Big Apple. The Sacklers put the museum where they wanted it; but, despite the $3.5 million gift, Arthur was not appointed to the institution’s board, a big disappointment to him. Spending money can only take you so far.
Mortimer Sackler's son, Robert, struggled with addiction. His father was not much of a father, and Bobby fell nine stories to his death in 1975. He took many drugs, including heroin. Thereafter the family essentially made Bobby a non-person. After his death, no one talked about him.
Arthur was getting older so he found a younger girlfriend, Jillian, and he told his wife, Marietta, about her. Theirs was an open marriage. A bit later, Marietta got sick of playing second fiddle and filed for divorce. She ended up with the NYC apartment, but Arthur had movers take away every bit of furniture and art that was in the condo. He was a swell guy,
The Metropolitan Museum refused to put Arthur on the board but he was able to get even. In 1987 he took his exhibit to the Smithsonian in Washington. He gave the Institution $75 million worth of art as well as $4 million in cash. The Smithsonian opened up a massive wing displaying Sackler’s stuff. A year later, Arthur gave Harvard $10 million to open the Arthur M. Sackler Museum to display more of his stuff. A few months later, he died at age 73.
Richard Sackler, the next major player in the saga, was the son of Raymond Sackler. While at Columbia University, he roomed with a student named Richard Kapit. Over time, Kapit saw that Sackler had no empathy for humans. He did lots of mean things and seemed clueless about his behavior’s impact on people around him. That lack of awareness/sociopathology seemed to run in the family.
Richard graduated from NYU Medical School and went to work for his father, Raymond, who ran Purdue Pharma. Richard’s job was essentially being Raymond’s son, so he spent his time wandering around the company, telling people how to do their jobs. He was a jerk but he had a vision that the small company could become a major player in the drug business. Purdue made pedestrian drugs to treat diarrhea and treat skin conditions. The company bought Napp Laboratories which produced pain treatment medication including a morphine pill (MS Contin) that was time-released to give lasting relief. This was a breakthrough although sales were slow. Mortimer Sackler, who did marketing and product development for the company, decided to aggressively market the pills without telling the Food and Drug Administration. Howard Udell, the company’s attorney, didn’t think that you needed FDA approval to sell drugs so the product was launched with a big party in 1984. The FDA basically agreed and just made Purdue file the basic application for a new drug without having to submit any evidence about side effects or addiction risk.
After Arthur’s death, settling his estate was a mess. He wasn’t good at putting things on paper, and he had borrowed a lot of money that had to be paid back. Most of his 100-million-dollar estate went to his second wife, Jillian, much to the chagrin of his kids. They sued and spent millions of dollars trying to upend the will. Another legal clash developed around what would happen to Arthur’s one-third ownership of the company. Back in the 1940s when they were starting out, the three brothers agreed that, when one died, his share would go to charity. Over the years they had informally rescinded that agreement but there was no paper trail so the issue was slugged out in court. Arthur’s heirs ended up selling his share of Purdue to the two remaining brothers for $22 million, a ridiculously paltry sum since MS Contin (and later OxyContin) was about to take off in world sales and greatly increase the value of the company. The author makes the point that the legal tussle gave many Sacklers the opportunity to demonstrate what cheats and liars they were. They did not disappoint.
In 1984, Richard organized a pain conference in Montreal to make the case to the medical profession that pain relief was the next big thing in medicine. Several experts were paid to explain to doctors how it was possible to provide effective pain management to patients by prescribing Purdue’s MS Contin. The morphine drug, which released doses in small amounts over time, made it less likely that the user would become addicted, at least that was the theory. All of the “experts” presenting the benefits of the drug were essentially on the company’s payroll.
The drug took off and the company made tens of millions of dollars each year. Despite this success, the company’s legal team pointed out that the patent would eventually run out so that generic drugs could be prescribed instead of the expensive MS Contin. This pushed Purdue to develop new, stronger painkillers that would have the full twenty years of patent protection.
Richard Sackler and his cousin, Kathe, took the lead in finding a new, more powerful drug that could use the same slow-delivery system as MS Contin. They came across oxycodone, a much more powerful drug than morphine. That fact was why it hadn’t been pitched as a viable treatment for pain. It was dangerous. OxyContin, the new slow-release pain drug, was developed in 1993 but it would take a few years to roll it out. While most pain drugs were reserved for patients with very serious issues – mainly cancer – Richard determined that the market could be greatly expanded by presenting Oxy as the wonder drug that would take care of any pain – back aches, arthritis, neck pain – with no negative effects. The potential market from making Oxy an everyday drug was huge.
Richard headed the sales effort that was premised on the fact that OxyContin was much less powerful that morphine and its derivatives. This of course was patently false. Oxy is much stronger and more dangerous, but Richard wasn’t going to let a few inconvenient facts get in the way of his marketing schemes.
Richard had to obscure the essential nature of Oxy so he hired doctors who would do his bidding and testify about how wonderful the drug was. He brought on a Cornell doc, Russell Portenoy, who believed that pain relief was being ignored by physicians. He saw opioids as the way forward in alleviating pain. Portenoy fervently believed that drugs weren’t addictive and that only flawed folks became addicts. Any bad outcomes were the patient’s fault, which became the company's main line of defense for the next twenty-five years.
Purdue needed FDA approval to sell the drug so it was pitched as pain relief for cancer patients. Curtis Wright was the FDA person in charge of the review and initially he was skeptical of the company’s claims that addiction was not an issue. Purdue had done no studies on this. Eventually Richard Sackler schmoozed Curtis who OK’ed the drug. Once approved, doctors could prescribe the Oxy to anyone, not just to late-stage cancer patients. Shockingly, shortly after approval, Curtis left public service and went to work for Richard Sackler at $400,000 a year, big bucks in the 1990s.
Early in 1995, a Napp Laboratories plant blew up and killed many workers. The investigation revealed that the facility was unsafe and that many safe-work regulations had not been enforced. The owners of Napp were the Sacklers. They paid a $127,000 fine and were on their way. A few months later, Raymond Sackler was given an honorary knighthood by Queen Elizabeth. It was a good time to be a Sackler.
OxyContin received its final approvals in January 1996. Richard Sackler was front and center at the kick-off. He had figured out that he needed the best and the brightest (and the most attractive) sales people to “push” the drug, and I use that term deliberately. As the author notes, pharmacological sales reps “are door-to-door missionaries.” The sales force received intensive training in how to close a sale with a doctor, not on the potential downsides of the drug. There was a rigid sales quota. If you were good, you would make a fortune. If you weren’t, you were out of a job.
The main selling point was the slow release of the drug, which would eliminate the possibility of addiction, unless you crushed it and took it all at once, which soon became routine for people needing a fix. Sales reps never mentioned that. Richard Sackler gave sales reps information from the prestigious New England Journal of Medicine which cited a study of 11,000 Oxy users that produced only four cases of addiction. There was no such study. Some Boston University doctors had checked records of thousands of patients receiving Oxy who had been in the hospital. Only four had problems but there was no follow-up on the thousands of the other patients to see where they were after leaving care.
Essentially the study showed that patients in for short stays who had been prescribed Oxy had not become addicts during their few days in the hospital. The doctors submitted a five-line summary of what they found. Despite the fact that this was not a study, for the next two decades, it was the basis for Purdue’s marketing of OxyContin as a safe drug.
Purdue paid for doctors to have lush vacations where they learned all about the benefits of Oxy. Purdue paid many doctors who led medical organizations as consultants and fed them bogus information about Oxy. Purdue put together a Speakers’ Bureau of doctors who, for a nice fee, extolled the virtues of the drug. Purdue gave patients lots of free samples which might trigger a need to keep using the drug. The company’s business plan was based on patients using higher doses of Oxy as time went on. That was a classic way to increase sales to people whose tolerance for the drug increased over time so that they needed higher doses. Sales went through the roof.
Barry Meier was an investigative reporter for the New York Times who had worked previously for Chemical Week magazine (one of my must-read journals) so he knew a lot about drugs. In 2000, he got a tip from a source in the Midwest that many people were addicted to this new drug, OxyContin, which was produced by Purdue Pharma. Meier had never heard of the drug or the company. He did some digging and found out that by crushing Oxy you could get high. You could also get addicted or dead. Law enforcement officials told Barry that Purdue’s sales reps used aggressive sales techniques and pitched the drug as “non-abusable.” People would get prescriptions and then sell them on the black market to addicts. In February of 2001, the story ran in the Times.
Meanwhile, sales of the drug exceeded the company’s wildest expectations. By now the younger Sacklers were in charge, with Richard running the company. Some employees checked into the possibility of abusing the drug and found evidence that it wasn’t completely safe. Sales reps reported in their visit notes that many doctors were becoming concerned that some patients were having bad experiences with Oxy. Howard Udell, chief counsel to Purdue, instructed reps to not put any bad things in writing. Nothing to see here, folks.
By the late 1990’s it was becoming clear that a lot of people in the regions that Purdue had targeted for marketing – often blue-collar and rural – were getting addicted. Maine was having serious drug issues, so the US Attorney, Jay McCloskey, went to meet with Purdue’s Howard Udell, who denied everything. Despite that, Purdue officials saw that there was a problem brewing. Their response was simple. OxyContin was not the problem. People who got addicted were weak, perhaps even criminals, which is why they got addicted. Purdue executives said that OxyContin was a miracle drug that helped millions of people relieve their pain. So what if a few got addicted and died?
Internal documents showed that the company knew that there was a black market for Oxy, a sure sign that it fed addiction. Executives also got barraged with letters stating that the drug had killed their loved one. Purdue came up with a phrase, “pseudo addictive” which meant that the drug really wasn’t addictive. Barry Meier dug in and found that the company’s top sales reps served areas that had the highest addiction and death rates in the country. These areas produced pill mills where doctors in “pain clinics” would prescribe hundreds of Oxys which no one person could consume. In Myrtle Beach, South Carolina cars, including many from out-of-state, would wait in line to get their pills. That meant that the tablets were being sold to a lot of people without prescriptions. Purdue knew about these fake clinics but did nothing about them since they accounted for millions of dollars in sales which beefed up profits, the only thing that counted. Richard doubled down on the company line that the users were the problem, not the drug. “If people die because they abuse the drug, then good riddance.”
In the early 2000s, US senators and representatives, hearing complaints from constituents, called the company to testify before Congress. Everybody lied, and some members of Congress congratulated Purdue on what a great company it was. Some elected officials could see through the lies but they were outnumbered. When state attorneys general began to investigate Purdue’s marketing techniques, Purdue would remind them that the company was a big contributor to Democratic and Republican elected officials. Wouldn’t it be a shame if that funding went away? Often that worked. When things got sticky and a lawsuit filed, the company would stonewall as long as possible and then reach a small settlement with the plaintiff. Purdue had to avoid going to court at all costs since that would mean discovery for the plaintiff’s attorney which would give them access to internal documents and emails that were damning to the company. Purdue also brought in big legal guns to defend them, including future US Attorney General Eric Holder and the not-yet-disgraced Rudy Giuliani. Purdue also organized and paid for many bogus “grass-roots” community organizations to defend Purdue against any and all charges.
A former sales rep, Karen White, was appalled at the misuse of Oxy that she saw on the job. She filed a lawsuit and named pill mill doctors who grossly over-prescribed the drug. She was trashed by her former employer, but eventually she prevailed and most of the doctors she named were punished.
John Brownlee was an ambitious US Attorney in the Western District of Virginia, which was awash in opioid addiction. Many of his assistant prosecutors had lost family members to opioids with OxyContin being the driving factor. In December of 2002 he subpoenaed Purdue Pharma for all records relating to OxyContin. Purdue had political friends who got to US Deputy Attorney General James Comey, later of Hillary Clinton fame. He called Brownlee in for a meeting which everyone assumed would result in quashing the investigation. Instead, Comey told him to proceed.
Purdue did what you do when asked for pertinent documents; it sent all documents, millions of pages that would be hard for a small US Attorney’s staff to go through. The lawyers did go through them and found damning evidence that early on Purdue Pharma was aware of the danger of Oxy. Because of its tight relationship with the FDA, especially with administrator Curtis Wright (who would later work for Purdue), the company never had to come clean. The attorneys also learned that the company’s sales rep training classes literally taught people how to lie about and cover up the downside of Oxy.
The drug was produced in huge doses. One size available was 80 milligrams, as much as in 16 Percocet tablets, which also could be addictive. Drugs that powerful had no use in legitimate pain therapy. The company also produced slick videos with patients praising Oxy for turning their lives around. Some of these people did benefit from the drug but more became addicted.
After almost six years of work, the Virginia US Attorney’s office produced an overwhelming body of evidence against the company and against individual Sacklers who would be indicted on multiple felony charges. The charges had to be cleared by the US Attorney General before being brought. While lower-level Justice Department officials were enthusiastic about going forward, the Sacklers used their influence and lobbyists to get rid of the felony charges against the Sacklers, the heart of the indictments. The only charges left were relatively minor ones for abusing drug distribution laws. Even that wasn’t acceptable to the Sacklers who saw themselves as victims in the governmental overreach. They refused to sign the plea agreement. US Attorney Brownlee put his foot down and Purdue reluctantly admitted guilt to these minor charges and made three of their top executives take the fall, essentially a fine, probation and community service.
President George W. Bush’s administration caved in here, which I find ironic since W. had a serious drug problem for much of his life. Brownlee and other US Attorneys around the country were summarily fired by Bush shortly after the Purdue incident. The Sacklers spent $10,000,000 on lobbyists and fixers to make the serious charges go away.
New York Times reporter Barry Meier published a book criticizing the drug industry and Purdue Pharma. The company's lawyers got someone in power at the Times and had Meier removed from doing any stories on Purdue because his book showed that he was biased against the company. Like the US Justice Department, the Times did Purdue’s bidding. Since the company was basically cleared of any serious wrongdoing when Brownlee’s investigation was squashed, the Times no doubt bought the Sacklers-as-innocent-victims argument. And don’t forget that the family had donated tens if not hundreds of millions of dollars to New York City institutions. When Mortimer Sackler died in 2009, the New York Times was fulsome in its praise, barely mentioning his association with Purdue Pharma and not saying anything negative about the company despite knowing how sketchy it was.
Purdue was assessed a $600 million fine for the Virginia case which was nothing compared to the billions of dollars Oxy brought in every year. The company considered this a small fee to pay for skating away from serious charges, and promptly hired another 100 sales reps to boost the sales of OxyContin. As part of the plea settlement, Purdue had agreed to stop aggressive marketing practices of Oxy, which they completely ignored with no consequences.
By 2008, Oxy was routinely being distributed as a street drug. Sleazy doctors would set up ”pain clinics” and over-prescribe Oxy tablets to a bunch of street people who would then give them to the local drug dealers for distribution. Purdue knew this and knew exactly where these fake clinics were, but they boosted sales which is all that counted.
As Purdue executives were starting to worry about the fact that the OxyContin patent would expire in 2013, thus ending the gravy train of exclusive drug distribution. They repackaged Oxy in a “tamper-proof” shell (it wasn’t) and petitioned the FDA to agree that this was a new drug so that there could be a new patent. It wasn’t a new drug – it was only a new wrapper – but when you own the FDA, that doesn’t matter.
By 2010, millions of Americans had become addicted to opioids with Oxy being the dominant super drug on the market. Many of these moved on to heroin and eventually fentanyl, which often killed them. Heroin sales shot up around this time. The American Society of Addiction Medicine did a study that showed that 4 out of 5 heroin addicts started on opioids, a market that OxyContin owned.
Richard still ran the company but the third generation of Sacklers were on deck. They were a motley crew, many of whom worked for the company, but they were all spoiled. They also thought that they were the smartest people in any room because they were filthy rich. They were not especially bright, but they were extremely lucky to have been born into limitless wealth.
In the twenty or so years since Oxy hit the market, Purdue Pharma made $35 billion. However, they wanted more so they went after the overseas market, specifically China and India, where they had some success.
By 2013, opioid overdose deaths in the US had tripled over a few years, but the Sacklers were royalty, being featured in puff-piece magazine articles and being touted for their philanthropy.
In August of 2015, Kentucky was suing Purdue for essentially being drug kingpins, with 29% of Pike County, KY, residents stating that they knew someone who had died from using Oxy. Richard Sackler, the company president, had to testify. He showed no remorse at all and even denied being the head of Purdue. The prosecutors accepted a $24 million settlement, small change for the company which accepted no responsibility for the opioid crisis in Kentucky. This was pretty typical. The Sacklers would stonewall and ultimately settle cases for relatively small amounts of money, given the billions of dollars they made every year. Public pressure was mounting as tens of thousands of people became addicted and died each year; but the Sacklers spent hundreds of millions of dollars on lobbyists, PR firms, and political contributions, expenditures which helped insulate the company and family from any serious attacks.
Nan Goldin was an artist in the East Village in New York City. She had an abusive boyfriend. A lot of gay male friends were dying of AIDS. She liked the art scene and she partied a lot. Along the way, she became a heavy drug user. In 2014 she hurt her wrist and was given a prescription for OxyContin. For the next three years she was consumed by her need to have her Oxy every day. Eventually she got clean, helped by the fact that her art had made her wealthy so she could afford good rehab, including the McLean program in Massachusetts.
By 2017, the press had realized that the Sacklers were indeed largely responsible for the opioid crisis. The New Yorker and Esquire did in-depth articles. Around the same time, Nan Goldin did a photographic exhibit of Oxy pills and portraits of junkies, including herself. She contrasted these images with pictures of institutions and universities that had taken Sackler money over the years. She also wrote essays about her experiences and the guilt of the Sackler family. The media noticed and she got great coverage which irritated Richard Sackler.
Goldin then organized street theater and protests at museums and other institutions that had taken Sackler money. She and her crew brought in thousands of orange pill bottles to the Metropolitan Museum of Art, which had received tens of millions of dollars from the Oxy empire. Each bottle had a label that read, “OxyContin. Prescribed to you by the Sacklers.” Nan’s people also did die-ins at the museum. Patrons must have loved those. She knew media personalities so all of her antics got great coverage.
Mike Moore was an attorney who had made a lot of money suing Big Tobacco. He turned his attention to the Sacklers and went to Ohio, where 20% of the state had been prescribed opioids and addiction and death were off the charts. While he was preparing lawsuits, the Sacklers got the Wall Street Journal to do a hit piece on the greedy lawyer, which he freely admitted he was. This attack didn't faze Mike because he sensed that the wind was shifting concerning the opioid crisis. He kept the pressure on.
Many galleries and museums that had taken money and regularly invited the Sacklers to events began to separate themselves from the family. Nan Goldin continued her street theater, directly confronting major institutions like the Guggenheim which had received lots of money from the Sacklers. Other museums and galleries started to turn down Sackler contributions. Nan started to confront members of the family when they went out to a public event and she had her friends in the media there to cover it.
Maura Healey became attorney general of Massachusetts in 2015. During her campaign, many people had come up to her and complained about the rampant over-prescribing of OxyContin. People in her office had lost loved ones to opioids. Her investigators found that 671 Massachusetts residents had died of Oxy abuse. Maura was irate. She announced that she was not just suing Purdue Pharma, but also suing the eight family members who had served on the company’s board. She filed for discovery and received 12 million documents related to Purdue. They told a sordid tale of greed and lying and dissembling throughout decades. The AG linked the family to a mafia family.
In January of 2019, Maura Healey announced the 274-page complaint. It was very detailed and showed that the Sacklers were involved directly in everything the company ever did. One of the Sacklers continual refrains was that the family had delegated operations to others. They hadn’t.
Emails surfaced that showed how the company pressured doctors to increase doses even when they were not needed. Richard’s casual dismissal of those who became addicted as lowlifes and criminals was there for all to see in his emails. The paper trail led to several Massachusetts doctors who prescribed tens of thousands of pills each year, usually to addicts and drug dealers. One doc prescribed twenty-four 80 milligram tablets (the really big doses that almost no one needed) each day for two years to a “patient.” Perhaps we should substitute “pusher” for “patient” here. The doctors were prosecuted separately. It is worth noting that the Sacklers kept pushing the pusher doctors all over the country even after they had signed many lawsuit consent decrees saying that they wouldn't do that as a condition of the deals.
Unlike many other places that the Sacklers could control, the Massachusetts judiciary let the complaint go forward. The size of the settlement that Massachusetts wanted was a lot larger than the pocket change that had been enough to get rid of other lawsuits, After AG Healey’s suit had withstood appellate scrutiny, two dozen other state attorneys general filed their own lawsuits.
Even late in this avalanche of lawsuits, the Sacklers maintained that OxyContin wasn’t a bad drug, but the people who abused it were bad. They even made the argument that some of the Oxy overdose deaths were of people who wanted to commit suicide so those deaths shouldn’t be held against the family. Calling the Sacklers psychopaths might be offensive to real psychopaths who weren’t nearly as bad as the Sacklers.
Despite mounting evidence to the contrary, the family also kept arguing that they didn't run Purdue so they were blameless for any bad outcomes. Another defense was that the FDA had approved everything that Purdue Pharma sold. That was true, but the FDA, even a corrupt one, isn’t equipped to do a ground-level investigation of how a drug company trains its reps to sell its drugs.
By late 2019, the walls seemed to be closing in on Purdue. The company had doled out hundreds of millions of dollars to settle various lawsuits. Ohio and Massachusetts were leading the way in negotiating a multi-billion-dollar settlement that would be used to treat opioid dependence and help families who had lost people to the drug.
After initially implying that the company would be willing to come up with a $10 to $12 billion settlement for all of the states that were suing, Purdue pulled back and said that it would just go bankrupt, wiping out any settlement. The company offered $3 billion with the stipulation that the individual Sacklers would skate, pay nothing themselves, and be protected against any future lawsuits forever.
In the fall of 2019, Purdue did file for bankruptcy. The Sacklers (who were Purdue) were still willing to pay $3 billion if they got to skate.
In November of 2019, a definitive peer-reviewed study came out that essentially established that Purdue Pharma’s aggressive marketing of OxyContin had sparked the opioid dependency crisis. The researchers had good empirical data that separated states with high utilization rates from other ones and found that the levels of addiction and death were much higher on Oxyland.
Nan Goldin was at it again. A fellow artist (a sculptor) had been on Oxy for years. He kept all of the 300 big bottles of his prescriptions and created a skeleton composed of his Oxy bottles which he proudly displayed with Nan at Purdue Pharma’s corporate headquarters in Stamford, Connecticut. Employees were not amused but Nan was.
Over the past few years, many museums and art galleries in the US and Europe disassociated themselves from the Sacklers, but Harvard and Yale didn’t. Tufts University had been getting money from the Sacklers for decades. Initially the school stonewalled efforts by students and alumni to drop the Sacklers, but in late 2019, the school stripped the Sackler name from a lot of places the family had paid for. Bravo. The Sacklers, still blameless in their myopic eyes, sued Tufts for breach of contract. They lost.
Robert Drain was the Sacklers bankruptcy judge. Apparently, the company going bankrupt gets to pick the judge to oversee the proceedings. He was a friend of the family and he had the power to keep the Sacklers insulated from any legal actions while in bankruptcy. He basically suspended activity on the bankruptcy proceedings. Drain also refused to figure out much the Sacklers had personally profited from pushing Oxy. One estimate was that they received about $800 million a year, but that was probably a low-ball figure since it was a privately-held company with off-shore accounts all over the place. The judge brought in attorney Ken Feinberg, who had developed a great reputation for his handling of disbursement of money to victims of the 2013 Boston Marathon bombing. It turns out that he had worked for Purdue and made $12 million so he was also friends of the family. No one’s perfect.
After the US Justice Department started to come down on Purdue Pharma in 2019, the Sacklers turned to President Trump for help, which he gave them by quashing the DOJ investigation. Donald J. Trump is not the type of person who would agree to have people who did really bad things be held responsible for their actions.
The book ends with the lawsuits unresolved. There was a tentative agreement to basically cave into the Sacklers offer – a few billion from the company would be paid out, but the family members would be off the hook forever. Many people, including Maura Healey, are pushing back against this. I would not be surprised if the settlement never happens. That would mean that individuals could sue Purdue and the Sacklers directly but the family is good at slithering out of tough situations so that might not be a good approach for the victims.
In late 2020, the Sacklers appeared before a congressional hearing. The House committee came down hard on David Sackler (third generation - Richard’s son) who apologized for the damage that opioids had done but took no responsibility for said harm. David was clueless and not very sharp. When confronted with all of the property he owned because of his profits from Oxy, he seemed to forget that he owned anything. One member of Congress said that it was pretty clear that the Sacklers had an addiction problem because they were addicted to money.
The family's reputation has taken a huge hit.
Richard Sackler, the president of Purdue Pharma, lives alone in a big mansion on Long Island now. He’s very rich and probably very miserable.
A lot of Sacklers have died.
Many of the institutions that took Sackler money over the decades have refuted the family and cut ties. They still have the buildings the family paid for, but the Sackler name has been removed.
The deal Since the book was published, an agreement had been struck. The Sacklers skated:. Members of the Sackler family who are at the center of the nation's deadly opioid crisis have won sweeping immunity from opioid lawsuits linked to their privately-owned company Purdue Pharma and its OxyContin medication. In return, they have agreed to pay roughly $4.3 billion, while also forfeiting ownership of Purdue Pharma. They would be absolved of any personal responsibility for any consequences of their aggressive marketing of OxyContin. "I've never seen any such abuse of justice," said Nan Goldin, an artist who emerged as a leading opioid activist after becoming addicted to OxyContin.Attorneys for Purdue Pharma and the Sacklers argued that without this deal there would be legal chaos as thousands of individual lawsuits move forward against the company and members of the family.
(This was on NPR on September 1, 2021. Here’s the article:https://www.npr.org/2021/09/01/1031053251/sackler-family-immunity-purdue-pharma-oxcyontin-opioid-epidemic)
There still is a lot of push-back on this settlement. AS of September 29, many states and Canadian provinces are appealing the decision. We shall see what happens down the road.
Bob’s Take
US regulatory agencies don’t regulate equally. Reading this book would justify a citizen’s having little faith in the government. The Sacklers proved that you can buy anything, including the US Food and Drug Administration.
Facebook. The Sackler’s consistent denial of any responsibility for pushing opioids is like Facebook’s recent responses to charges that the company allows fake and inaccurate and dangerous information to be posted with little oversight.
Facebook says it’s just a neutral platform and that the posters are bad. The company acknowledges no responsibility and offers no apologies. When you allow misinformation about life saving vaccines to stay posted, that's really bad. When bad postings and misinformation cause people to not get shots, many will die. That’s really, really bad.
Facebook says that inaccurate postings are not their problem. Mark Zuckerberg makes more money when controversial misinformation is posted than when you post pictures of your kids' birthday. The fake facts generate more hits which generate more ad revenue, so he will not change anything. Mark cares about one thing - making as much money as he can, regardless of who gets hurt, a characteristic he shares with the Sackler family.
As Frances Haugen, the Facebook whistleblower said Sunday night on 60 Minutes: “The thing I saw at Facebook over and over again was that there were conflicts of interest between what was good for the public and what was good for Facebook,” she told CBS interviewer Scott Pelley. “And Facebook over and over again chose to optimize for its own interests.” That sounds a lot like Purdue Pharma.
Theranos, Enron and Purdue Pharma - which one is the worst?
Theranos was the company started by Elizabeth Holmes that promised to develop a small, inexpensive machine that could do hundreds of blood tests quickly and inexpensively. It was a great idea which was scientifically impossible to implement. She was an attractive, charismatic leader who made a great presentation and charmed a lot of old white guys into giving her lots of money. She was a proficient liar who was too smart to not know what was really going on with her fraudulent test machines, but she probably wasn’t evil. She was vain and greedy. The people who invested in her were very wealthy so no big deal there. She did harm people who believed her bogus test results “– I have cancer” or “I’m pregnant” – but no one was done irreparable harm. No one died.
Enron was a decent company when it started before it became consumed by its self-created legend as the best and the brightest company ever. While some of their top people kept looking the other way, their key managers knew that the accounting was all smoke and mirrors that hid the essential weaknesses of their business model. Arthur Andersen, once the exemplar of a white-shoe accounting firm, sleazed out for big monthly payments that enabled the Enron charade to go on a lot longer than it should have. There was great damage done to the almost 30,000 employees who lost their jobs without having a clue about what sleazes they were working for. No one died.
The Sacklers were truly evil. Many people died and many are still dying. The family knew what was going on. In the opioid sales world, what was going on because of the Sacklers was killing people. They knew Oxy was highly addictive and caused deaths. They kept pushing the drug so they could increase profits. They had the statistics about opioid addiction and deaths and they didn’t care. Even as they were facing mounting pressure a few years ago, they were trying to figure out how to get kids – a new market! – hooked on Oxy. After Purdue signed a consent decree in 2007 to stop aggressively selling Oxy, they increased their sales force and boosted the bonuses paid out for being a Topper, which was a leading sales rep.
All the family cared about was profits, so they bought /lobbied/schmoozed everyone who could block their greed. They got to the W. Bush administration and they owned the FDA so they could make any potential problems go away. In terms of good press, they owned the New York Times, which for years ignored the horror that Oxy brought to millions of people across the land.
One congressman from Tennessee, a state ravaged by opioids, summed things up at the hearing. “Watching you testify makes my blood boil. I’m not sure that I’m aware of any family in America that’s more evil than yours.”
Maura Healey. I sort of liked Maura Healey when she was running for Massachusetts Attorney General in 2014, but once Donald Trump became president in 2017 it seemed that her main focus was suing his administration for this or that and then proudly announcing said suit at a press conference. Since The Donald disdained any rules he didn't agree with, finding things to sue his administration for was not much of a challenge, especially in the state that probably is the most anti-Trump in the land. Thus, I tuned out her litigation pronouncements and saw her as just another Massachusetts politician.
Reading this book gave me a new respect for her. She went after the Sacklers individually and personally. Her office did serious investigatory work - they went through 12 million pages of documents - and figured out what no one else had been able to prove: For three generations, the Sackler family had been intimately involved in every decision and action undertaken by Purdue Pharma. They called all of the shots all of the time.
She stood up against accepting the settlement that let the Sacklers walk although she was not alone in that. About half of the states involved in the class actions lawsuit were against the settlement that just happened.
Final thoughts This was a long, detailed book that made my blood boil. The Sacklers would have been right at home helping Adolf Hitler and the Nazis as long as they could make a buck or a billion bucks. Yuck.
