Empire of Pain is a fascinating look at the company and family behind the creation of Oxycontin.  Patrick Radden Keefe has done an incredible job researching the history of the Sackler family.  The first part of the book reads like a rags to riches story.  Three brothers, sons of Jewish immigrants, overcome economic and social hurdles to complete medical school and establish lucrative careers.  Arthur, the oldest of the brothers, has a talent for marketing and soon builds a small empire with an advertising agency that caters to the pharmaceutical industry.  Towards the end of his life he purchases a small pharmaceutical company for his two younger brothers, the Purdue Frederick Company.

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Richard Sackler, the son of one of the younger brothers, Raymond Sackler, joins Purdue and becomes the mastermind behind the development and marketing of Oxycontin.  On some level its seems they started out with the best of intentions.  If you know anyone who suffers from chronic pain you understand how it can cripple a person's life.  When the drug was first launched Purdue did receive feedback from chronic pain sufferers thanking Purdue for giving them their life back.  But Purdue also knew there was problems with Oxy.  It was marketed to provide 12 hours of relief, but it didn't, resulting in pain sufferers taking more medication then they were prescribed and thus beginning the cycle of addiction.  Purdue also claimed the time release coating would prevent a big hit of the opioid at once but this too was false because the coating could easily be removed thus allowing addicts to get the full hit of the drug.

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Purdue's marketing strategies were also dubious.  Through bonus programs they encouraged their sales force to aggressively encourage doctors to write prescriptions for higher than necessary dosages.  They chose to ignore information from their own internal data systems that easily identified doctors and geographical areas where prescription rates were abnormally high.  Richard Sackler and the Sackler family refused to accept that Oxycontin was in any way responsible for the opioid crisis sweeping across America.  Their refusal to acknowledge their drug's role in the crisis is one of the unanswered questions of this book.  It is hard to pinpoint why this is.  Are they so wealthy and far removed from normal society they lack the experience of substance abuse?  Do they simply pass the blame to the many criminal doctors writing unnecessary prescriptions and driving the crisis.  But yet all those unnecessary prescriptions left them phenomenally wealthy.

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I enjoyed this book and I like the author's writing style.  My only small complaint is a hint of bias towards the end of the book.  The opioid crisis has spanned three presidential administrations but the author only calls out one by name in the last chapters.  I will leave you to guess which president that is.  Also, although I personally feel the Sackler family did play a role in the crisis it is hard to get a feel for just how much of a role.  There is not much information on the role greedy and/or incompetent doctors played in this crisis.  Federal agencies, like the FDA, do not come out of this looking very good either which is particularly scary in light of the pandemic we are living through.