Empire of Pain: The Secret History of the Sackler Dynasty

In 2010, Purdue Pharma released a new version of OxyContin that could not be crushed or in any way have the contents extracted. Though this had obvious benefits for preventing misuse, the company was also nervous that the new formula might somehow be a “concession” to its critics (305). Ultimately, however, it was decided that launching the new product would help profits, and the FDA even allowed Purdue to claim that the new formula was an “abuse deterrent” (307). The new formula resulted in a new patent, thus protecting the company’s most lucrative product from competition. This also blocked “any applications for a generic release of the drug” (308).

When the company developed a new pain patch, Butrans, Richard Sackler became obsessed with its sales data. The company CEO resented his interference, but ultimately was powerless. The family fired a sales executive who had attempted to suggest that the profits from the launch of OxyContin would be difficult to replicate in the current market.

The reformulation of OxyContin affected the trajectory of opioid sales and use. Sales of the new formula dropped sharply, which indicated that introducing it sooner might have saved lives and reduced public health challenges. However, many people addicted to OxyContin now began using heroin instead, desperate to avoid withdrawal. Subsequent studies found that in the US, increased heroin use and overdoses directly followed the introduction of tamperproof OxyContin.

Richard’s brother Jonathan Sackler was interested in social issues and education, ultimately focusing on charter schools. Jonathan was obsessed with the family’s media image, desperate to be known for philanthropy rather than OxyContin. Jonathan’s daughter Madeleine became a documentary filmmaker, making movies about working-class families and education, and then about prisons. She found it distasteful to discuss the source of her wealth and rarely did so. Radden Keefe notes an irony: While African Americans were under-prescribed opioids, they were caught up in the federal War on Drugs in other ways—but Madeleine’s film about an Indiana prison was glaringly silent about her family’s complicity in opioid use disorders and the growing prison population due to crackdowns on heroin sales. Madeleine’s collaborators came to feel that this omission was fundamentally dishonest and detracted from her work. She never reacted to these critiques.

As one social consequence of extreme wealth, Madeleine’s generation of the Sackler family, had “grown up thinking they were the smartest people in the room” (323). The only member of Madeleine’s generation to work actively at Purdue was Richard’s son David. David Sackler saw himself as a martyr to the family cause, devoted to the business and under-appreciated. Most of the other younger Sacklers only funded their lifestyles through the company, rather than work for it.

Mortimer Sackler and his wife Theresa were famous in the UK for their charitable donations. OxyContin profits were mostly held in Bermuda, so they “avoided paying hundreds of millions of dollars in taxes […] they just preferred that the gifts be on their own terms—to the arts and sciences, with naming rights, rather than be left to the discretion of the state” (327-28). Purdue’s Bermuda holdings were merely a small part of its international arm, Mundipharma, which increasingly concentrated on marketing opioids to middle class consumers in the developing world. China became a key new market, complete with a new group of salespeople and aggressive tactics:

The company claimed that OxyContin was the World Health Organization’s preferred treatment for cancer pain (it isn’t). According to an investigation by the Associated Press, Mundipharma reps in hospitals actually donned white coats and pretended to be doctors themselves. They consulted directly with patients about their health concerns and made copies of people’s confidential medical records (330).

In the United States, the philanthropic power of the Sackler name remained strong. Tufts Medical school even refrained from assigning a book about the opioid crisis, Dreamland, in 2013, for fear of offending the family. Inside Purdue, the public relations teams were satisfied that individual family members were well insulated from the damaged public image of OxyContin. But this public image success “was about to change” (331).