Empire of Pain: The Secret History of the Sackler Dynasty

Opium has been used as a pain reliever and sleep aid for millennia; its deadly qualities when taken in abundance have also always been known. Addiction to morphine first became a public health concern after the Civil War, when wounded soldiers relied on the drug for pain management, only to develop what we now know as opioid use disorder. Heroin, first synthesized in German laboratories, was initially thought to be less addictive, and was promoted as an alternative. However, it soon became clear that “physical dependence [on either heroin or morphine] can often lead to bouts of debilitating withdrawal” (187).

Richard Sackler devoted himself to OxyContin, promoting it as the superior alternative to MS Contin, which would soon lose its patent. He and Michael Friedman wanted to give the new product a “personality that was less threatening and more approachable” (188), so doctors would prescribe it readily without the anxieties they might have had about another opioid. The popular perception was that OxyContin was inherently less potent, which made it easier to market.

Medical doctors were becoming increasingly concerned with patients’ chronic pain. Dr. Russell Portnoy, known as the “‘King of Pain’” (189), was a passionate defender of opioids and blamed any stigma attached to them on “addictive personalities” (191).

In 1992, Purdue launched a public relations campaign in the Hartford Courant about its status as a drug pioneer, presenting Howard Udell as the company’s public face, instead of Richard or Kathe Sackler. The campaign coincided with Richard Sackler’s push to get FDA approval for OxyContin. Richard Sackler was eager to make the process as fast as possible, so he cultivated Curtis Wright, the chief of the FDA’s pain medication division.

Purdue asserted that the time-release coating on the new drug meant that it could not be abused or addicting, as morphine was, since a full dose was not accessible to the user right away. Purdue insisted that the “drug’s unique properties made it safer than other opioids on the market” (193). FDA-approved drugs carry written packaging describing their use and any risks, and Richard Sackler saw this packaging as part of the drug’s public face, taking a keen interest in any warning labels or safety descriptions.

Curtis Wright’s close relationship with Purdue as he oversaw the OxyContin approval process ran counter to the reforms of the 1960s prompted by the medical advertising industry and the Kefauver hearings that Arthur Sackler had participated in. Wright was in frequent contact with Richard Sackler, helping him compile data and advising on the official FDA packaging and labeling of the drug. This text, the “package insert,” included a sentence that OxyContin’s special formulation was “believed to reduce the abuse liability of the drug” (195). This would become particularly controversial in later decades, as liability for OxyContin’s overprescription became an issue, but neither Wright nor Richard Sackler ever took responsibility. Wright left government service for a job at Purdue, with Richard Sackler offering careful instructions as to the timing of the job offer to avoid any appearance of trading favors from the federal government.

Radden Keefe describes a 1995 explosion at a Napp chemical plant in Lodi, New Jersey, from the point of view of a chemical plant worker, Calixto River, who died in the explosion. Owned by Purdue, Napp was a London-based company that made chemicals for pharmaceutical products. The plant staff were poorly trained, and under increasing pressure to mix not only their own orders, but those for other companies. Failure to clean the mixer properly could lead to the inadvertent creation of toxic gases. In the aftermath of one such gas event, a huge fire and explosion broke out in the plant. Four workers died and 40 were injured. The plant was investigated and shut down; survivors lost their livelihoods. Raymond Sackler denied feeling any “responsibility” (204) for what happened.