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.