Empire of Pain: The Secret History of the Sackler Dynasty

Barry Meier, an investigative reporter at The New York Times, started his career as a journalist covering the chemical industry, writing exposes about unethical or dangerous business practices. During his career at the Times, Meier reported on suits against the tobacco industry and its efforts to conceal the link between cigarettes and lung cancer. In early 2001, an editor alerted Meier to a new public health trend: OxyContin addiction and overdoses. It was now used as a popular recreational drug because when “chewed or crushed” the time release mechanism was destroyed and a “mammoth hit” resulted (222). Meier published his first story on the subject in February 2001.

At Purdue, after OxyContin became a massive revenue source, Richard became so blasé about his new wealth that he wrote “‘yawn’” when informed the drug was now making “$20 million a week” (223).

Howard Udell, the family’s faithful lawyer, took over much of the political and legal work around the growing concerns about OxyContin’s safety. One of Radden Keefe’s anonymous sources is a former legal secretary, pseudonymized as Martha West. Martha West joined internet forums to learn how the drug was abused and its growing popularity as a recreational drug, calling herself “Ann Hedonia, a pun based on the word ‘anhedonia’ which means the inability to feel pleasure” (224). However, in memos that circulated at many levels of the company, Udell deliberately encouraged minimal documentation of any issues with OxyContin misuse or overprescription. He was so certain the drug was fine that he encouraged Martha West to take it after an injury.

The first hints that OxyContin was not harmless emerged in the same places that sales representatives had targeted—regions with chronically ill and disabled populations, and higher extent of workplace injury. Udell became especially concerned when a federal prosecutor in Maine launched an investigation, noting high levels of overdoses and the large number of prescriptions in the state.

Though Udell and the Sacklers would claim that this was the first time they became aware of any risks, their own sales force reports from 1997 to 1999 prove that problems were apparent early on. While earlier letters to the company from patients had touted the drug’s benefits, soon those who had lost loved ones to OxyContin overdose also began to write and tell their stories to the company. To counter any claims that the company was responsible for overdoses and the increase in opioid use disorder, Richard blamed irresponsible users who were already addicts. Radden Keefe notes that in reality, many of those who developed issues were prescribed the drug for “legitimate pain conditions” (230).

Part of the problem may have been marketing literature promising longer pain relief than was actually possible. Sales representatives encouraged more frequent prescriptions in response. By 2001, Martha West, Howard Udell’s secretary, was struggling with her own OxyContin addiction, snorting the pills just as she had read about online.

Barry Meier stayed on the opioids story. When he could not gain access to the Sacklers for interviews, he was referred to Dr. David Haddox. Haddox, a “true believer,” insisted that “‘pseudo addiction’” was the real cause of most withdrawal issues (233-34), and merely indicated the patient needed more frequent or higher doses of OxyContin. Meier also received a tip that the company’s top salespeople were all in regions known for increasing struggles with OxyContin use, including deaths and overdoses. Meier learned about “pill mills” doctors whose main business was OxyContin prescription—their “sales figures were so high because of the abuse” (235). Meier decided to continue investigating, fascinated by the Sackler family’s history of charitable giving.

Richard Sackler, in private correspondence, lamented that he could not simply blame the company’s new struggles on addiction, because this would make martyrs out of those he despised. Eventually, he and Purdue management confronted Martha West about her opioid use disorder, and she was fired. In 2004, she made public a record of her history of documenting OxyContin’s addictive properties for Howard Udell. In response, Purdue used her addiction history to discredit her. West was embarrassed to recall this time in her life, including her private rants about the company while she was in treatment.

Richard Sackler’s marketing director Michael Friedman made efforts to shield the company from liability for opioid use disorder and overdose deaths. Friedman continued to work closely with Howard Udell, and the company’s chief medical officer, Howard Goldenheim, on a coordinated message: Opioids were vital for pain patients and stigmatizing their use would be harmful. They further insisted that law enforcement had greater responsibility than Purdue did. They denied that the company’s marketing contributed to overuse, or that the company had any knowledge of the drug’s adverse effects for some users before 2000.

At a 2001 hearing, congressional representatives were not particularly adversarial toward Purdue, trusting most of the statements presented. One Congressman did ask if the company flagged doctors who overprescribed, as one in his district had, and why they had not alerted the public sooner. Radden Keefe reflects that at this moment, it might have been possible for the Sacklers to acknowledge the harms of OxyContin in some way, or stop pursuing its sales as avidly.

However, Richard Sackler went in the opposite direction. One of his public relations associates threatened Richard Blumenthal, the attorney general of Connecticut, with loss of campaign contributions if he continued to investigate Purdue. Udell cultivated political contacts in the service of the company’s agenda, hiring former federal prosecutors like Eric Holder and Mary Jo White, who would represent Kathe Sackler at one of her depositions about OxyContin and Purdue. Purdue’s defenders also crafted a political message, insisting that they were speaking for pain patients who needed OxyContin and did not deserve punishment for the wrongs of irresponsible users or those who committed crimes. They also funded pain management advocacy groups and lobbyists.

Howard Udell’s team was particularly brutal with possible witnesses, as when they used Martha West’s medical records to delegitimize the reliability of her testimony. To counter a lawsuit filed by a former salesperson, Karen White, who had refused to market as aggressively as she was told to, attorneys proceeded to “smear her as unstable, unreliable, a drug abuser” (254).

Purdue’s public relations arm also assiduously tracked any negative press reports about opioid overdoses and deaths, especially those conducted by investigative journalists. The company became increasingly concerned when Barry Meier of the New York Times transformed his investigative journalism into a book manuscript.

An investigative journalism scandal at the Times ultimately blunted the impact of Barry Meier’s investigations. In 2003, the Times discovered that one of its investigative reporters, Jayson Blair, had “fabricated” much of his work (258). The newspaper created a new office to ensure that investigative journalists followed ethical standards—the public editor. Howard Udell saw this new office as an “opportunity” to remove Meier so that things “might get a lot more comfortable for the company” (259). Udell convinced public editor Daniel Okrent that Meier’s forthcoming book was not objective about opioids or Purdue. Okrent pulled the book. He later regretted his decision, but it was an important temporary victory for the Sacklers.

John Brownlee, US Attorney for the Western District of Virginia, focused on the widespread presence of opioids in his district and on Purdue as its origin point. Two prosecutors in his office, Randy Ramseyer and Rick Mountcastle, were already investigating the company. The ambitious team saw Purdue as “big game” both for the ethical imperative of justice and their possible political careers (263). They requested records from Purdue; the company sent more than they could easily process, a common delaying tactic. Mountcastle was well aware that Purdue had hired top law firms, and that many of these firms had a “revolving door” hiring policy—some of their attorneys had served in the Justice Department (265). These close relationships meant political pressure tried to kill his investigation early. However, James Comey, then deputy attorney general, gave Mountcastle his blessing, despite these pressure efforts.

Mountcastle’s legal team began to construct a narrative about Purdue’s conduct. They found records proving fears of abuse dated back to 2000, along with studies proving the drug could be injected and wore off faster than advertised. They also discovered the close relationship between Purdue and the FDA, and the agency’s apparent willingness to allow the company to make sweeping claims about OxyContin’s harmlessness—claims the company’s sales teams used in their interactions with prescribers. They discovered that the patients featured in Purdue’s promotional videos had struggled with addiction, some of them eventually dying.

By 2003, Richard Sackler left his formal role at Purdue, appointing Michael Friedman, his loyal marketing director, in his place. The family remained closely involved with day-to-day operations. Kathe Sackler was eager to take credit for her role in the creation of OxyContin. The family’s confidence was bolstered by its superstar team of advocates, which now included former New York City Mayor Rudolph Giuliani.

Undaunted, Brownlee decided to focus his federal case on Howard Udell, Michael Friedman, and chief medical officer Paul Goldenheim. A 2006 memo that outlined the key role played by all three men “told the story of a years-long extraordinarily profitable criminal conspiracy” (273). The prosecution hoped that by targeting management figures close to the Sacklers, they might persuade them to testify against the family in exchange for lighter sentences (274).

In 2006, the Western District prosecution team was summoned to Washington, DC, to discuss the case with the Justice Department, which confirmed their fears that Purdue’s political allies wanted to squash their efforts. They were told the case only supported a single misdemeanor charge. Later efforts to determine which Justice Department leaders had pushed the decision found no one willing to claim credit for the “orphan directive, a backroom deal for which none of these former civil servants would take responsibility” (276).

Brownlee, outraged but undaunted, insisted that Purdue admit liability or face criminal charges, which resulted in more pressure to drop the case. When Brownlee refused, Friedman, Udell, and Goldenheim pled guilty—none of them turned on the Sackler family. Soon after, Brownlee was fired—a politically motivated “scandal” involving multiple appointees (278). Brownlee believed his case against Purdue was the reason.

Barry Meier, back on his original story for the Times, went to Virginia for the sentencing of Purdue executives. The families of the three convicted men wrote impassioned pleas on their behalf attesting to their morality and decency. The families of those who had died after taking OxyContin were outraged by the comparatively light sentences. The nature of the proceedings allowed the men to insist they were “entirely innocent” (282), as they were only acting on behalf of the company, not as private citizens. There was a strong subtext that white men with professional backgrounds were naturally morally upright.

The lawsuit ultimately did little to harm Purdue, in part because of the company’s complex corporate structure. Liability for Purdue Pharma would have had disastrous consequences for the company’s ability to use federal healthcare programs like Medicare for its products. Instead, Purdue Frederick, the original company that sold over the counter products like laxatives and Betadine, assumed the liability, freeing the rest of the company to continue to make and profit from OxyContin. The Sacklers later financially compensated the executives “designated to ‘take the fall’”—a dynamic Radden Keefe likens to a “Mafia film” (284). Richard Sackler eventually admitted he had never even read the charges against the company.