The High Price of Pain (2024)

According to the Centers for Disease Control and Prevention (CDC), from 1999 to 2019, nearly 247,000 people died from overdoses involving prescription opioids in the United States. According to the CDC, the problem can be broken into three waves. The first began with an increase in prescribing opioids, the second was an increase in heroin overdoses, and the third was an increase in illicitly manufactured synthetic opioids (particularly fentanyl). Oddly missing from the CDC’s assessment of the epidemic is the drug the media branded public enemy number one: oxycodone.

The multilayered saga of the rise and fall of the family that profited from the use of oxycodone is wonderfully rendered in a new book by Patrick Radden Keefe called Empire of Pain: The Secret History of the Sackler Dynasty.

Big Personality With Even Bigger Dreams

Empire of Pain is a big book that undulates with high drama and huge personalities, none bigger than, Arthur Sackler, who was born in Brooklyn in 1913. The author notes: “If Arthur would later seem to have lived more lives than anyone could possibly squeeze into one lifetime, it helped that he had an early start. He began working when he was still a young boy, assisting his father in the grocery store. From an early age, he evinced a set of qualities that would propel and shape his life—a singular vigor, a roving intelligence, an inexhaustible ambition.”

Title: Empire of Pain: The Secret History of the Sackler Dynasty

Author: Patrick Radden Keefe

Publisher: Doubleday

Publication Date: April 2021

Price: $32.50, hardcover, 560 pages

However, despite his role in the oxycodone scandal—laying the groundwork of the sell-drugs-at-any-cost ethos that is the underpinning of this book—Arthur Sackler, the son of immigrants and a child of the depression, imbued the very core values that helped America’s lower classes fight their way up the socioeconomic ladder. Along with his many contributions to the arts and charitable work for the underserved, he was also credited with helping to racially integrate New York City’s first blood banks.

The Road to Riches

After completing his medical degree at New York University, Arthur Sackler spent a few years interning at a busy hospital in the Bronx; he worked long shifts and did everything from delivering babies to racing to an accident scene in an ambulance. He had long nurtured a love for psychiatry, which flourished when he had the opportunity to work at Creedmoor Psychiatric Center. Yet he was repelled by what he considered barbaric psychiatric treatments coming into vogue, such as electroshock treatment and prefrontal lobotomy. Here, the readers are treated to a fascinating fly-by-the-seat-of-your-pants journey that Arthur took, with his younger brothers Raymond and Mortimer in tow, into the drug industry.

“Empire of Pain is a rich and fulfilling read. However, those looking for deeper answers into the opioid crisis will not find them here.”

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The story bogs down a bit in unnecessary detail, until Arthur Sackler’s desire to combine his interests in medicine, marketing, and pharmaceuticals became irresistible, and he bought a small ad firm. He would go on to devise the marketing plan for Valium and later purchase the drug company Purdue Frederick, which would be run by his brothers. From there, the Sackler dynasty takes root and blooms; the members, some notable and others not so, became stars of the luxury and international art set. Reading about their escapades, messy divorces and all, is entertaining, but the downfall of the Sackler family is what readers are most interested in and is rendered with painstaking clarity.

Complex Issue

The complexity of this story is highlighted by Purdue’s company lawyer, Howard Udell, who was considered in the words of one of his colleagues, “the heart and soul of the organization.” Mr. Udell was not only the protector of Purdue, but he was also the ethical stalwart who held things together during tough times. However, as profits from oxycodone soared, Mr. Udell caught wind that it was becoming a recreational drug and people were dying as a result. However, he shared the Sacklers abiding faith in the chemical wonder of oxycodone; in fact, he took the drug himself for back pain. Then, in 2000, the top federal prosecutor in Maine, Jay McCloskey, sent thousands of letters across the state warning doctors about the dangers of abuse and “diversion” of oxycodone. That is where the monumental legal battle begins, and it is a riveting story.

After a protracted legal battle, Purdue’s millions of sealed records were finally allowed to be opened; it came as a shock to Purdue. That, in effect, was the beginning of the end for the Sackler dynasty, at least in terms of its reach within the society that they had once been recognized as royalty.

One Part of the Story

Empire of Pain is a rich and fulfilling read. However, those looking for deeper answers into the opioid crisis will not find them here. Instead, they will find people to root for and against, as in every good drama. In the end, it is worth noting that oxycodone, which has been demonized, is simply an inanimate substance, a valuable one at that, for treating severe pain. The people who produced, sold, prescribed, and abused this drug all share a part in the opioid crisis story.

Empire of Pain is a well-researched, well-written book about a complex human condition—pain—one that is close to the oncology community. For that, this book is highly recommended for readers of The ASCO Post.

The High Price of Pain (2024)


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