Reviews with content warning for Medical content - Empire of Pain: The Secret History of the Sackler Dynasty

I’ve read another of Patrick Radden Keefe’s books, Say Nothing: A True Story of Murder and Memory in Northern Ireland, and if you liked that, I think you’ll also really love Empire of Pain.

I knew absolutely nothing about the Sackler family, Purdue or OxyContin when I started this book and it does a fantastic job of introducing you to this pharmaceutical dynasty, and their role in the opioid crisis in America.

I think what makes this book so unique in covering the addiction crises is that it goes back decades to the three brothers that founded Purdue Pharma and their experiences working in medicine and advertising which basically invented pharmaceutical marketing.

This book is a must read, it’s incredibly impactful and important, and covers so many essential areas of the story with such ease and grace. It’s an incredible achievement.

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brinnet's review against another edition

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challenging dark informative reflective medium-paced

5.0

Very interesting look into a wealthy American family and their role in modern drug addiction.

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kdsmoove's review against another edition

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dark informative sad slow-paced

5.0

“It is a peculiar hallmark of the American economy that you can produce a dangerous product and effectively off-load any legal liability for whatever destruction that product may cause by pointing to the individual responsibility of the consumer.”

*insert annie screaming gif”

the amount of times i screamed at the radio or texted someone “just when i thought these people couldn’t get any worse, they fucking do!” throughout reading this is not a low number. when i tell you i was HOOKED from the beginning and somehow not intimidated by the length.

i knew some about the opioid crisis, even enough to associate the sackler name with it but i had *no idea* just how deep the rot went. i didn’t realize that arthur sackler was the mastermind behind the way the entire pharmaceutical marketing schemes work now. that he basically invented sales and created his own fucking sources and oh my GOD. it was a solid five or six hours in before we even got to Reagan and i did the whole *leo pointing at the tv gif* thing to the stereo.

and of course today to tidy it up it HAD to be the fucking trump administration willing to let them off with a slap on the wrist. i am so mad, i will be staying mad. you should read this. but beware, there’s a lot of trigger warnings to check and it will make you very mad. One of the lines he used was “rip shit pissed” which sounds a lot funnier out loud than it does written down but i will be using it moving forward.

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_fallinglight_'s review against another edition

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challenging dark informative sad tense medium-paced

4.5

Surreal, insightful, albeit and clinical deep dive into the depraved and unhinged Sackler criminal billionaire family. This book is one of many definitive proofs that the billionaire is incompatible with humanity at this point and greed is an addiction as equally destructive and demoralizing as any substance addiction if not more or worse. The lengths the rotting rich go to to keep their corrosive money are so twisted but it's also morbidly impressive how they weave the web of connections and buy their way into getting the results they want. Particularly this family who honestly wouldn't have made it without ass kissers and enablers and unscrupulous people making their perversity possible bc most of them are so offensively insensitive and stupid.

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aegagrus's review against another edition

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3.25

Empire of Pain is a smart and thorough chronicle of three generations of the notorious Sackler family. Radden Keefe may write in the dramatized language commonly found in tales of “true crime”, but his credibility is bolstered by the years he’s put into this story and the vast quantity of source material he’s able to cite. His book does many things well. It provides a fascinating case study of the ways in which ill-gotten wealth can change a family over time, altering each generation’s proclivities and character. It effectively demystifies relatively arcane fields like pharmaceutical advertising and bankruptcy law. It doesn’t spare those peripherally implicated in the Sackler saga – well-known political figures from both major parties, doctors, lawyers, consultants, and museum administrators. Most importantly, it elucidates where we stand today, unflinchingly demonstrating the insufficiency of the ways in which the Sacklers have been “held to account”.

For all its thoroughness, Empire of Pain has a fairly narrow focus. Radden Keefe readily admits that his book is not intended to be a broad sociological account of the opioid crisis. At times, this tight focus on the Sacklers leaves the reader with questions. Radden Keefe does a pretty good job separating out the impact of Purdue Pharma from that of other opioid suppliers, citing empirical studies to show the close association between Purdue’s activities and the emergence of the crisis writ large. Purdue was an early and aggressive mover; in ascribing responsibility for the crisis, to start at Purdue is entirely justified. In other instances, though, the centrality of the Sacklers to this narrative may have led Radden Keefe to overstate their centrality – on the birth of medication-based psychiatry, for instance, or even on the ideological battles over how the medical field should approach chronic non-malignant pain (which is not to say that the Sackler’s astroturfing did not have a major impact in this regard).

It is also notable that a full third of the book is spent on the activity of Arthur Sackler, the family patriarch, who was already dead by the time OxyContin was created. The ways in which Arthur shaped the family’s trajectory are certainly relevant, getting the Sacklers started in the worlds of art and philanthropy, passing down an array of corporate structures, and inculcating deeply held ideologies in the succeeding generations. Arthur’s role in creating modern pharmaceutical advertising and his aggressive profiteering off of non-opioid tranquilizers (namely Valium) are also interesting. Nonetheless, too much time is probably spent mythologizing the dynasty’s origins, time which could perhaps have been better spent providing somewhat broader context for later material about the marketing of OxyContin and the ensuing litigation.

Empire of Pain is, all in all, well worth reading. If the reader is seeking to understand the opioid crisis itself, this book is probably not a perfect starting point. If the reader already has some background in the opioid crisis, however, or is primarily interested in a case study of the corrupt abuse of corporate, legal, and political power, Empire of Pain is an excellent choice.

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