Since I started this blog a year or so ago I have never reviewed a book in it but I have just finished one that the world needs to know about. It is “Empire of Pain” by Patrick Radden Keefe who is a regular contributor to the New Yorker.
Like most I suspect, I haven’t given much attention to the Opioid crisis that in Canada has been going on for five years. Of course I’ve seen the news reports that it is having a particularly devastating impact on my home province of British Columbia, causing the deaths of thousands of it’s citizens. I’ve also listened to Doctor Bonnie Henry’s comments on this crisis in the midst of the other health emergency, the COVID 19 pandemic. Still, I’ve assumed it was somebody else’s problem even as I witnessed some of its victims in my own neighbourhood. We are told it is a crisis that has reached all corners of the province, that it isn’t just confined to the war zone of Vancouver’s Downtown Eastside or to the most marginalized amongst us, and yet I still assumed it was. Implicit in that belief is a sense that drug addicts mostly have themselves to blame for their condition which, as a gay man who survived the Aids epidemic, is an astonishing blind spot.
And then I read “Empire of Pain”.
This is not a book that most of us would normally read and yet, in my view, it should be. It details how the drug industry aggressively marketed opioids beginning in the 1970’s through to the present day, opioids that they knew, or at least should have known, were addictive. Empire of Pain details this development through a focus on one company, Purdue Pharmaceuticals and it’s owners, the Sackler family. To the extent I had heard anything about the Sacklers, it was because of their philanthropy and the naming rights that came with it, whether the Sackler Wing and fountain at the Metropolitan Museum of Art in New York or similar such places in New York or London. They were major donors, almost always with the stipulation their name be prominently attached to whatever resulted from their donations. It certainly had nothing to do with the dark history behind their wealth from the sale of addictive pharmaceuticals.
In many ways the story is an American tragedy played out at several levels. First, you have the inspiring tale of immigrants from central Europe who settled in Brooklyn and had three sons, all of whom became doctors. The eldest, Arthur, epitomized so many things many of us admire about America and Americans. The endless ambition, the belief that hard work and risk taking should and will be rewarded financially, the commitment to family and to charity. And yet, even in the beginning, the seeds of their downfall were being planted.
Arthur Sackler, while epitomizing so much that is good in America, was also one of the early proponents of pharmaceutical advertising to the public that now fills the airwaves in America, complete with a spillover into Canada, and that, in the name of profit, can distort best medical practice. He was also a pioneer in the field of pain management and made his fortune marketing Valium and Librium through Purdue Pharmaceuticals. That both seem almost innocent in relation to what came next doesn’t lessen his role in creating a huge group of opioid addicts around the world. He died at a relatively young age and his branch of the family sold its interest in Purdue to his two surviving brothers, Jonathan and Mortimer.
The surviving brothers and their offspring were the driving force behind the development of Oxycontin which they marketed aggressively to the public, to pharmacists and to doctors. This, despite evidence it was highly addictive and, in its absence, was a gateway to other drugs like Heroin and Fentanyl. Millions were ensnared in this vicious trap while the family made billions from it.
Empire of Pain presents a meticulous record of the efforts by the Sackler family to push greater and greater amounts of Oxycontin into the market. It details a shocking lack of due diligence by the appropriate regulatory authorities in controlling them and, in startling detail, outlines how the vast fortunes assembled by the family were marshalled to corrupt governments and politicians. It acknowledges the Sacklers were not alone in pushing America and then much of the world into an opioid crisis by naming other pharmaceutical companies such as Johnson and Johnson, drug store chains, pharmacists and physicians who, perhaps blinded by the emoluments and money offered them, turned away from their ethical and professional obligations.
It is a story that spans the twentieth century, and now is twenty one years into the twenty first, and it implicates all types of individuals, some of whom are usually regarded with respect if not reverence in the telling of recent American history. It also gives important background for the breakdown of parts of the American working and middle class, leaving communities decimated, despairing and open to the blandishments of religious and political carnies. It provides important background about the fracturing of American society, as well as other, mostly western, societies.
And it makes a compelling argument that behind it all was the drive of one family for wealth and secular immortality. Their blindness to any culpability is astonishing for its arrogance, or perhaps, its ignorance. And the story is not yet over. State and federal attorneys generals have launched dozens of state and federal court actions against them but, through it all, the Sacklers have somehow used their great wealth and the influence that comes with it to avoid culpability. When and how it will end is hard to predict, noting that a recent settlement agreement has been rejected by too many states for it to be implemented. The most telling objection being that it leaves far too much wealth with the family and barely registers their guilt.
I should also note how readable the book is. It proceeds from the very first page as if it was a screenplay in many acts even though the reader likely already knows the outcome remains uncertain.
It is rare that I recommend a book but this is an exception.
Just sayin
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