Empire of Pain: The Secret History of the Sackler Dynasty

Reading Empire of Pain, I couldn't help but feel sorry for the Sacklers. They played by "the rules", but now our attacked because their company brought opioids into the mainstream. Meanwhile, we still respect dynasties like the Kennedys that built a fortune out of bootlegging during prohibition. It seems there is a double standard. If a family is very public and outgoing, it doesn't matter where the money originally came from. If the family is private, then any negative connection taints the entire family.

The book traces the Sackler family from their life as poor Jewish immigrants to their modern fortune. The family is very private, thus most of the sources are second hand. They include records of friends and acquaintances as well as public records that were available. Due to the nature of sources, the parts that have the greatest details are not necessarily the parts that were most important.

Sacklers had started some businesses in New York after immigrating. There was a strong desire for education, with most descendants studying medicine. From this, there was a pivot to medical marketing. There was an acknowledgement that doctors were similar to other people. They could be persuaded by marketing. The marketing business did well. They were also willing to hire anyone capable, while other companies tended to be more restrictive in their biases.

Eventually, Purdue was acquired. This company primarily made over the counter medicines. Eventually, they created the contin drug release system. MS Contin pain relief medicine was created. This was followed by oxycontin. This medicine provided long term pain relief. It was thought to be much less capable of addiction. The company spend effort to help promote "pain relief" and encourage doctors to help customers relieve pain.

They did a little bit too good of a job promoting the pain relief. It worked and people liked to use it. Then the bad actors came in to play. Some doctors started prescribing too much. A black market arose. Users also discovered that they could crush the pills to get an immediate hit. There were records showing that Purdue knew about some of these issues, however, they did little about it. (Alas, in a big company, there is almost always somebody that knew something.) The private nature of the Sacklers and the company made things appear worse. It seemed like they were covering things up, whether they were or not.

Americans seem to always pick a scapegoat.  People are dying of opioid addiction. Lawyers are hunting for the deep pockets that have any association. Why are we not going after other epidemics? There is the epidemic of car crashes. How about going after all auto manufacturers, highway departments and oil companies? And what about all the alcohol related deaths? It seems somewhat arbitrary who is attacked. The Sacklers happened to be in the right place to be the scapegoat.