PDF Summary:Empire of Pain, by Patrick Radden Keefe

Empire of Pain by Patrick Radden Keefe provides an incisive account of the Sackler family's role in the opioid epidemic that has ravaged countless lives in the United States. The book chronicles the family's origins and their transition from medical marketing pioneers to the creators and purveyors of the potent painkiller OxyContin.

Keefe's meticulous examination shines a light on Purdue Pharma's aggressive promotion of OxyContin and the deceptive marketing tactics employed to downplay its addictiveness. The narrative exposes the Sacklers' relentless pursuit of wealth, their efforts to evade accountability, and the devastating consequences that ensued—propelling an epidemic that swept across America.

(continued)...

The FDA's involvement in validating Purdue's marketing claims.

Keefe's examination uncovers a disturbing trend of cooperation between Purdue and the FDA. The agency responsible for monitoring the pharmaceutical sector and protecting public health regularly approved Purdue's exaggerated claims about OxyContin's safety and efficacy. Purdue's recruitment of Curtis Wright, the principal FDA examiner for OxyContin, offers profound insight into the possible corrupt practices in the drug industry.

Whistleblowers, media representatives, and legal prosecutors have brought to light the reality concerning OxyContin.

The growing group of skeptics began to question Purdue's marketing tactics for OxyContin, which highlighted its allegedly lower risk. Courageous individuals, like former Purdue staffer Karen White, came forward to reveal unethical marketing strategies. Investigative journalists, including Barry Meier of The New York Times, uncovered Purdue's intentional concealment of the dangers linked to OxyContin. The company conceded to criminal wrongdoing for misleading the public about the risks of its top-selling drug, following a substantial legal initiative led by John Brownlee, a federal prosecutor from Virginia.

Practical Tips

• You can educate yourself on the ethical practices of pharmaceutical companies by researching their history of drug approvals and marketing tactics. Look for patterns of behavior in different companies and compare them to the known case of Purdue Pharma. This will help you make informed decisions about which companies' medications you might trust or advocate for in the future.
• Develop a habit of critically evaluating drug advertisements and labels by checking the cited studies and their funding sources. When you come across an ad for a new medication, take the time to look up the research behind it. If the study was funded by the pharmaceutical company itself, consider seeking out independent research for a more balanced view.
• Encourage open conversations with your healthcare provider about medication options by preparing a list of questions regarding the efficacy, side effects, and potential for addiction of prescribed drugs. Before your appointment, write down these questions and make sure to discuss each one, ensuring you have a clear understanding of the treatment you're receiving.

The Sacklers' response to the intensifying crisis of dependency on opioids and the ensuing challenges they faced in the legal arena and in the court of public opinion.

The text scrutinizes how Purdue Pharma and the Sackler family responded to the growing criticism for their part in triggering a major public health crisis in the United States. The story delves into their strategies for quieting detractors, shifting culpability, and above all, safeguarding the family's wealth.

Denying and Deflecting: Purdue’s Strategy to Minimize Accountability

Amid increasing examination by regulatory bodies, journalists, and family members of those afflicted by pain and whose lives were devastated, Purdue Pharma, in collaboration with the Sackler family, crafted a narrative that emphasized their commitment to ethical business practices and their substantial philanthropic donations.

The narrative reframed the situation, depicting OxyContin as a victim of illegal activities and shifting the blame onto individuals who misused the medication.

Richard Sackler maintained a firm stance on the safety and efficacy of OxyContin. The company asserted that the misuse of the substance and the resulting fatal overdoses should be attributed to the addictive propensities of some individuals coupled with their reckless behavior.

The company downplayed its accountability by emphasizing its modest market share and the fact that its products had received approval from the Food and Drug Administration.

The Sacklers frequently highlighted Purdue's status as a company that was not particularly large. The company argued that its presence in the market was small compared to the giants of the industry. Despite growing recognition of OxyContin's potential for addiction, the FDA approved its application, thus shielding the producers from legal accountability.

The family of Sacklers placed a high value on maintaining their privacy, cultivating an air of mystery and safeguarding their family's good name.

The Sackler family has long valued their privacy, consistently avoiding public attention. The company's standing among healthcare providers and pharmacists across the country was enhanced under their guidance. Despite wielding significant influence, the Sackler family remained largely out of the public spotlight.

The family meticulously avoided any association of their name with discussions about Purdue Pharma or its product, OxyContin. Family members shied away from publicity. During the congressional investigation into the opioid crisis, the firm assigned its top executives and public relations experts to handle representation.

Prioritizing Revenue Protection through Legal Defense and Reputation Enhancement Strategies

The Sackler family adopted a strong legal approach, guided by their experienced legal advisor Howard Udell, to avoid responsibility and deflect blame. They utilized substantial assets to overpower detractors, mute opposition, and postpone judicial consequences.

Howard Udell continued to be a dedicated advocate and legal advisor to the Sacklers.

Howard Udell, who previously provided legal services to Purdue Frederick, eventually ascended to the role of Purdue Pharma's chief legal officer and was portrayed by Patrick Radden Keefe as an individual serving the interests of the Sackler family. He held an unwavering belief in their enterprise and demonstrated relentless dedication. Udell regarded any legal challenges directed at Purdue as personal attacks on the family and consistently upheld a firm position in their defense.

The Sacklers gathered a powerful group of legal defenders, among whom were distinguished individuals such as Mary Jo White and Rudy Giuliani.

The Sackler family often secured the expertise of prominent lawyers to defend their business concerns and maintain their reputation. They secured the services of individuals like Rudy Giuliani along with Mary Jo White, leveraging their past roles as prosecutors to gain the clout needed to sway current legal officials, which in turn aided in fostering a reputation of dedication to public welfare and uprightness.

Silencing Critics and Stifling Dissent: Lawsuits, Retractions, and Intimidation Tactics

Purdue's legal representatives employed a variety of strategies to respond to the criticisms directed at the company's conduct. They commenced unfounded lawsuits against former employees. They demanded that news outlets retract their claims. They employed private investigators to collect data that might serve to undermine their adversaries. They were also prepared to wield their influence over the judicial structure of the state.

Gaining control over regulatory bodies and developing political clout.

Purdue, Keefe reveals, actively participated in contributing to political campaigns. They were adept at establishing relationships with members of Congress, generously funding political campaigns, and lobbying vigorously to obstruct legislative initiatives aimed at regulating the circulation and marketing of painkillers. They recruited former FDA personnel and established strong relationships with the officials responsible for overseeing their activities.

The strategy of declaring bankruptcy was employed by the family in question to protect their wealth and ensure the security of their assets.

Despite acknowledging their role in 2007, Purdue along with the Sackler family continued to manufacture and market opioid medications. As lawsuits from regional legal authorities and representatives of the affected parties intensified, they devised a strategy to shield the family from accountability by seeking bankruptcy protection and adroitly maneuvering through the judicial process with a selected mediator to supervise the case.

Depleting the financial reserves of Purdue: The pursuit of heightened monetary gains by the family.

The family's three lineages had funneled Purdue's profits, which totaled in the billions, through a sophisticated global network of trusts. Facing potential financial difficulties from numerous state lawsuits, the Sackler family stepped up their efforts to reduce their company's worth. Purdue was still generating billions in revenue from its various opioid sales, but year after year the family withdrew more and more money.

Judge Drain instituted protective measures: Offering protection from legal repercussions and guaranteeing no accountability.

Purdue deliberately changed its corporate registration to New York and began the process of bankruptcy in a court presided over by Judge Robert Drain, evidently choosing a judicial setting they considered advantageous. Drain's background in corporate law allowed him to show understanding towards the Sackler family's circumstances while displaying hostility towards the legal actors seeking equitable resolution. The family received protection against possible civil lawsuits, thereby shielding them from legal accountability.

The company sought a comprehensive settlement to conclusively resolve all opioid-related claims.

The plan to financially reorganize Purdue hinged on changing the company's ownership and earmarking a specific amount of money to combat the opioid crisis, as well as ensuring safeguards against prospective lawsuits. Even though Purdue professed to be facing economic hardships, the Sackler family's wealth remained in the billions. They pledged a considerable amount of $4.3 billion, yet this figure is insufficient when considering the full costs of the epidemic. The plan was to distribute the funds over a period of nine years, primarily relying on consistent returns from investments instead of their own personal fortune. They neither admitted to any wrongdoing nor did they fail to secure their legal and communications advisors against any responsibility. Judge Drain's endorsement of the agreement granted them peace under the jurisdiction of legal boundaries.

Other Perspectives

• The narrative crafted by Purdue Pharma and the Sackler family could be seen as a legitimate defense strategy in response to complex legal and public relations challenges.
• Emphasizing FDA approval is a standard practice for pharmaceutical companies to underscore the legitimacy and regulatory compliance of their products.
• The Sackler family's desire for privacy could be interpreted as a reasonable preference that many individuals and families share, especially those in positions of wealth and influence.
• Hiring legal advisors and prominent lawyers is a common practice for individuals and corporations seeking to navigate legal complexities and protect their interests.
• The use of legal defense strategies, such as lawsuits and demands for retractions, can be part of a company's efforts to correct misinformation and protect its reputation.
• Engaging with regulatory bodies and political figures is a standard part of corporate operations, often necessary for advocating for business interests within the framework of the law.
• Declaring bankruptcy can be a legitimate financial strategy for a company facing overwhelming legal challenges and is a legal option provided within the U.S. bankruptcy code.
• The establishment of trusts and the management of profits are legal financial practices that can be used for estate planning and asset protection.
• The role of a judge is to interpret and apply the law impartially, and protective measures may be seen as a judge's adherence to the legal protections afforded under bankruptcy law.
• Seeking a comprehensive settlement is a common resolution in large-scale litigation, aiming to provide a structured and manageable way to address numerous claims and facilitate the distribution of funds to affected parties.

Efforts to hold the Sacklers accountable for the opioid crisis and its extensive impact on public health and society.

This final section explores the devastating impact of OxyContin across the United States, examines the efforts of the legal and government systems to hold the Sackler family accountable, and chronicles the rise of a new movement that challenges the family's reputation and their philanthropic donations.

The Devastating Role of Oxycontin in the Opioid Epidemic.

The book by Patrick Radden Keefe argues that the Sackler family and their company, Purdue Pharma, played a significant role in the emergence of the opioid crisis, which has become a substantial disaster in America.

Numerous lives have been claimed by lethal overdoses, a tragic consequence of addiction.

The author provides a comprehensive analysis of the extensive information related to the opioid addiction crisis. Patrick Radden Keefe characterized the data as startling, emphasizing that a multitude of people in the United States became dependent on opioid pain relievers, which resulted in innumerable deaths due to overdoses.

The transition to heroin and fentanyl: Unanticipated Consequences of Substance Modification.

In 2010, the nation grappled with a significant emergency stemming from the misuse and dependency on prescribed opioids. Purdue created an updated formulation of OxyContin featuring a unique coating intended to substantially diminish the drug's ability to be pulverized. This step had been touted by the company as evidence of a genuine commitment to public health. However, Keefe demonstrates that the alteration had disastrous unintended consequences.

With the increasing difficulty in acquiring OxyContin, individuals grappling with opioid addiction sought out less expensive substitutes like heroin and eventually fentanyl. By 2016, the main factors contributing to deaths were those opioids acquired through illegal means. The Sackler family asserted that their business practices were within the bounds of the law and denied any responsibility for the unauthorized use of prescription drugs. The actions of Purdue and the Sackler family are considered by experts in economics and public health to have played a role in the significant increase in opioid dependency among Americans, leading to a series of outcomes that escalated into a relentless and deadly public health emergency.

The Sacklers’ Profits Built on a Foundation of Death and Despair

The opioid crisis, according to Patrick Radden Keefe, stemmed from deceptive promises and a relentless quest for success. The emergence of the crisis can be attributed to a blend of factors, including aggressive marketing tactics from OxyContin's developers, the FDA's participation, and deceptive claims about the medication's potential for risk. Patrick Radden Keefe argues that the Sackler family's fortune was amassed at a grave human toll, with countless lives and communities across America enduring irreversible changes due to these catastrophic occurrences.

Seeking Justice: Prosecutors, Plaintiffs, and the Quest for Responsibility

This section explores the intense and meticulous work of public health officials, plaintiff's attorneys, and prosecutors in their pursuit to hold Purdue Pharma and the Sackler family accountable, obtain some measure of restitution, and guarantee that information about OxyContin is disclosed to the public.

The person being referred to was Mike Moore. The shift into a period characterized by the rampant abuse of opioid medications.

Among the numerous lawyers engaged in opioid crisis-related lawsuits, Mike Moore is notably prominent. Moore, an attorney known for challenging large corporations and instrumental in the landmark settlement with Big Tobacco, recognized similarities between that case and the growing legal battles associated with the opioid OxyContin.

The quest to unearth the truths embedded in the collective legal proceedings.

Numerous lawsuits against Purdue Pharma and additional opioid producers were consolidated into a single multidistrict litigation, which Judge Dan Aaron Polster presided over in a federal court in Ohio. Moore and his team tenaciously sought to uncover the truth, obtaining a vast array of private documents from the company and the Sacklers, and engaged in extended discussions to reach a settlement that ultimately proved to be deeply disappointing.

Maura Healey played a pivotal role in highlighting the Sackler family's involvement by releasing Purdue's confidential documents to the public.

Massachusetts Attorney General Maura Healey was crucial in securing a landmark victory that ensured the Sackler family faced responsibility for their actions. The 2019 legal action brought forth by Healey was significant because it held eight Sacklers accountable, asserting that their association with the company did not shield them from responsibility.

Healey's brave choice to make her amended complaint public undoubtedly changed the trajectory of opioid-related legal proceedings. This dossier, containing startling details from Purdue's confidential records including intimate communications, unveiled the depth of the Sackler family's direct engagement in the marketing tactics and distribution of the painkiller OxyContin. Keefe points to this incident as a critical turning point that exposed the clandestine operations of the Sackler family.

Public Response and Advocacy: Transforming the Discourse and Challenging the Dominance Held by the Sacklers

Advocates and legal representatives for the impacted individuals sought restitution through the courts, as another form of responsibility started to emerge outside the confines of judicial contention. Nan Goldin, an artist and activist who had personally struggled with OxyContin addiction, initiated a movement that challenged the carefully constructed social image and status of the Sackler family.

Photographer Nan Goldin, in conjunction with her group PAIN

Patrick Radden Keefe chronicles the formation of the group PAIN by Goldin, which brought together a varied coalition of activists, artists, and people in recovery from opioid dependence. The demonstrations by PAIN activists at prominent cultural venues, including the Sackler Wing of the Metropolitan Museum of Art and the Guggenheim museum, which had received donations from the family, brought about increased media scrutiny and a reevaluation of the origins of the Sackler fortune.

Institutions and legislative bodies are increasingly advocating for responsibility and urging a distinction to be made from the history linked to the Sackler dynasty.

Goldin and her allies concentrated their demonstrations on the pharmaceutical firms and the organizations that had benefited from significant contributions, emphasizing the clear discrepancy between the Sackler family's celebrated philanthropic image and its lesser-known association with a catastrophic public health crisis. The campaigners demanded that the family's name be stripped from all esteemed affiliations, contending that their fortune was built on widespread anguish. They also urged institutions to use the contributions received from the Sacklers to establish initiatives focused on addiction treatment.

The enduring consequences of OxyContin and the continuous pursuit of justice.

Keefe ends on a note that is tentatively hopeful. The Sackler family has, up to this point, evaded any accusations of criminal liability. As part of Purdue’s bankruptcy and a separate settlement with the Justice Department, they have been granted immunity from most of the civil claims against them. The family's reputation has become irreparable. The company diligently worked to maintain the secrecy of its exclusive documents. The office of the Massachusetts Attorney General, in collaboration with other complainants, is preparing to release a substantial compilation of papers and private communications associated with Purdue Pharma and the Sackler family in an upcoming public archive.

The writer encourages us to consider the enduring legacy associated with the Sackler family. The family's relentless quest was a clear display of their appetite for wealth and status. Despite their efforts to create an enduring legacy by donating to numerous cultural and scientific institutions, their success was not to be. The Louvre no longer exhibits the family's name on its walls. The Metropolitan Museum of Art is taking steps to disassociate from the controversial contributions made by the family. Keefe suggests that the Sacklers may ultimately be plagued by the notoriety associated with OxyContin, acknowledging the contradiction that their vast wealth and power cannot guarantee the esteemed legacy they deeply cherish.

Other Perspectives

• The Sackler family and Purdue Pharma have consistently denied wrongdoing and have pointed to the FDA's approval of OxyContin as evidence that they operated within the regulatory framework.
• Purdue Pharma has argued that the blame for the opioid crisis is complex and cannot be placed on a single entity, given the involvement of various stakeholders, including other pharmaceutical companies, regulators, doctors, and patients.
• Some may argue that the reformulation of OxyContin to make it less prone to abuse was a responsible action by Purdue Pharma, despite the unintended consequences that followed.
• There is a perspective that the legal system should not be used to address public health crises and that the focus should be on improving healthcare policy and addiction treatment rather than litigation.
• The Sackler family has engaged in philanthropy across various sectors, and some argue that their contributions have had a positive impact on the arts, education, and science, which should be considered separately from the opioid crisis.
• It could be argued that the focus on the Sackler family and Purdue Pharma may overshadow the systemic issues in healthcare and pharmaceutical regulation that also contributed to the opioid crisis.
• Some legal experts may contend that the broad immunity granted to the Sacklers as part of Purdue Pharma's bankruptcy settlement was a necessary compromise to ensure a resolution and the availability of funds for claimants.
• There is an argument to be made that cultural institutions should not have to bear the burden of resolving moral dilemmas regarding donations, as their primary focus is to support the arts and education.
• The notion of stripping names from buildings and programs can be seen as a complex issue, with some arguing that it sets a challenging precedent for how institutions handle past and future donations.
• Regarding the enduring legacy of the Sackler family, some might argue that history should take a more balanced view that considers both the negative impacts of the opioid crisis and the family's contributions to society.