Empire of Pain: The Secret History of the Sackler Dynasty

by Patrick Radden Keefe

In the twentieth century, power announced itself. In the twenty-first, the surest way to spot real power is by its understatement.

This is a familiar dynamic for a lot of prosecutors with a mortgage and tuitions to think about. You spend the first half of your career going after the bad guys and then the second half representing them.

In 1996, Purdue had introduced a groundbreaking drug, a powerful opioid painkiller called OxyContin, which was heralded as a revolutionary way to treat chronic pain. The drug became one of the biggest blockbusters in pharmaceutical history, generating some $35 billion in revenue.

According to the Centers for Disease Control and Prevention, in the quarter century following the introduction of OxyContin, some 450,000 Americans had died of opioid-related overdoses. Such overdoses were now the leading cause of accidental death in America, accounting for more deaths than car accidents—more deaths, even, than that most quintessentially American of metrics, gunshot wounds. In fact, more Americans had lost their lives from opioid overdoses than had died in all of the wars the country had fought since World War II.

Wow.

The school was named after the fifteenth-century Dutch scholar Desiderius Erasmus,

This is a baller name

But whereas the first half of the twentieth century marked a period of enormous progress in other areas of medicine, by the time Arthur arrived at Creedmoor, American physicians were still largely mystified by the function and dysfunction of the human mind. They could recognize a condition like schizophrenia, but they could only guess at what might cause it, much less how to treat it. As the novelist Virginia Woolf (who suffered from mental illness herself) once observed, there is “a poverty of the language” when it comes to certain infirmities. “The merest schoolgirl, when she falls in love, has Shakespeare, Donne, Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.”

"A poverty of the language" is a wonderful concept

This had become a mantra for Isaac. If you lose a fortune, you can always earn another, he pointed out. But if you lose your good name, you can never get it back.

Well, by that measure, I guess the Sackler's have indeed been held to account.

“The doctor is feted and courted by drug companies with the ardor of a spring love affair,” one commentator observed. “The industry covets his soul and his prescription pad because he is in a unique economic position; he tells the consumer what to buy.”

Word had spread in advertising circles that exciting things were happening under Sackler’s leadership, and, in the words of one former employee, the firm became a “magnet” for talent. Arthur had an eye for good people, and he started hiring copywriters and artists, luring them away from other agencies. He was an unusually open-minded employer by the standards of the day. If you had talent and drive, he didn’t much care about other prerequisites. He hired many Jews, at a time when they couldn’t find work at other agencies.

He was searching for other members of the same chemical family as Librium to see if there might be different compounds that would also make effective tranquilizers. By the end of 1959, before Librium had even been released, Sternbach had developed a different compound, which seemed as if it might potentially be more effective even than Librium, because it worked at smaller doses. Deciding what names to bestow upon new drugs was more of an art than a science, and, in any case, not Sternbach’s specialty. So it was someone else at Roche who came up with a name for the compound, a play on the Latin word valere, which means to be in good health. They called it Valium.

Librium and Valium were both minor tranquilizers. They both did pretty much the same thing. What Arthur’s team at McAdams had to do was convince the world—both doctors and patients—that actually the drugs were different. The way to do this was to pitch them for different ailments. If Librium was the cure for “anxiety,” Valium should be prescribed for “psychic tension.” If Librium could help alcoholics stay off the bottle, then Valium could prevent muscle spasms. Why not use it in sports medicine? Soon, doctors were prescribing Roche’s tranquilizers for such a comical range of conditions that one physician, writing about Valium in a medical journal, asked, “When do we not use this drug?” To Arthur and his colleagues, this was what made Valium such an easy product to sell. As Win Gerson remarked, “One of the great attributes of Valium is that it could be used by almost every specialty.”

In 1964, some twenty-two million prescriptions were written for Valium. By 1975, that figure reached sixty million. Valium was the first $100 million drug in history, and Roche became not just the leading drug company in the world but one of the most profitable companies of any kind.

Librium and Valium made Arthur Sackler very rich. But even as they were doing so, troubling signs were starting to emerge that the miracle drugs devised by Leo Sternbach at Roche might not be quite so miraculously free from side effects as the advertising campaigns had suggested. Roche had informed doctors and regulators that the drugs could be prescribed without fears of abuse, because unlike barbiturates these tranquilizers were not addictive. As it turned out, this assurance was based more on wishful thinking than on science. In fact, when the company was doing all those clinical trials in order to establish the myriad different medical conditions for which Librium and Valium might provide the solution, they never conducted a single study into the question of potential abuse.

In 1965, the federal government started to investigate Librium and Valium. An advisory committee of the Food and Drug Administration recommended that the tranquilizers be treated as controlled substances—a move that would make it much harder for consumers to get them. Both Roche and Arthur Sackler perceived this prospect as a major threat. As a general rule, Arthur was skeptical of government regulation when it came to medicine, and he recognized that new controls on the minor tranquilizers could be devastating for his bottom line. For nearly a decade, the company resisted efforts by the FDA to control Librium and Valium, a period in which Roche sold hundreds of millions of dollars of the drugs. It was only in 1973 that Roche agreed to “voluntarily” submit to the controls. But one FDA adviser would speculate that the timing of this reversal was no accident: at the point when Roche conceded defeat, its patents on the drugs were set to expire, meaning that Roche would no longer enjoy the exclusive right to manufacture them and would be forced to lower its prices in the face of generic competition.

To be sure, Arthur had many business interests: he started companies left and right and invested widely in a range of industries. But the original House of Sackler was built on Valium, and it seems significant, and revealing, that for the rest of his life Arthur would downplay his association with the drug, emphasizing his achievements in other areas and deliberately obscuring (or leaving out altogether) the fact that his first fortune was made in medical advertising.

J. P. Morgan, who died the year that Arthur was born, had a second career as a collector. He ended up spending half his fortune on art.

Kefauver’s preferred mode of interrogation was to use his own politeness to lull a witness into a false feeling of security and let him talk until he’d talked himself into a corner.

Félix Martí-Ibáñez, who was never one to allow such an occasion to pass unmarked, had written Bobby a letter. “You are entering life with the greatest assets any young man may have: loving and devoted parents,” Martí-Ibáñez wrote.

“Corporate attorneys can do one of two things,” Bart Cobert said. “They can go to management and tell them, ‘You can’t do that.’ Or they can go to management and say, ‘Tell me what you want, and I’ll figure out a way to do it.’

But Napp had recently developed a special coating system for pills that allowed the diffusion of a drug into the bloodstream of a patient to be carefully regulated over time. They called the system Continus, and they had already used it for an asthma drug. But what if you applied it to morphine? It would mean that a patient could swallow a pill and the morphine would slowly release into the body, in the same manner that it would on a drip. The new drug, which would become known as MS Contin, was released in the U.K. in 1980, and it was a breakthrough.

Even when a drug is tremendously lucrative—in fact, especially when a drug is tremendously lucrative—the drugmaker is always selling on borrowed time, conscious that at some fixed point in the future the patent will expire and the generics will come rushing in to decimate profits. There’s a phrase used in the pharmaceutical business to describe this inevitable but terrifying stage in the process. They call it “the patent cliff,” because that’s what a graph of revenue resembles at the moment when the patent expires: a drop so steep it’s like plummeting off a cliff.

analgesic medicine (as pain medicine is known)

it was another opioid, a chemical cousin of morphine—and also of heroin. But oxycodone was much more potent than morphine. The drug was already widely available as a painkiller, in mild treatments like Percodan and Percocet. But there was only a small amount of oxycodone in those pills, because in Percodan it was mixed with aspirin and in Percocet it was mixed with acetaminophen, both of which can be toxic if a person takes too much of them. If you deployed pure oxycodone using the Contin system, however, it might be possible to administer a larger dose that would filter slowly into the bloodstream, allowing the patient to take a more formidable quantity.

Not everyone found Richard’s style of micromanagement so congenial. He was an early adopter of email, and at meetings he could be a discomfiting presence, focusing on his huge laptop computer, as if he weren’t listening to what anyone in the room was saying, only to look up, suddenly, and ask a pointed question. Periodically, he would stand, walk over to the wall where there was a phone jack, and plug his laptop in. Then everyone would be forced to listen to the rings and dings of Richard’s noisy dial-up connection so that he could send an email. Richard’s work ethic could be taxing for those who worked under him. If you emailed him at midnight after a long evening of work, he would email you back, immediately, with questions. If you didn’t get him what he wanted, he would call you at home. He knew that many of his employees thought he was a pain in the ass, but there was a compulsion in this behavior, a single-minded devotion to making the new oxycodone product a worthy successor to MS Contin.

In a characteristically idiosyncratic recruiting move, Richard had hired Friedman after sitting next to him on an airplane.

I do love avant guarde hiring...

a team of chemists in Germany had recently managed to refine morphine into a new drug, heroin, which the German pharmaceutical company Bayer began to mass market as a wonder drug—a safer alternative to morphine. Heroin was created by the same research team that invented aspirin.

Doctors are human, and the notion that donning a white coat might somehow shield them from temptation is a fantasy. A 2016 study found that purchasing even a single meal with a value of $20 for a physician can be enough to change the way that he prescribes. And for all their lip service to the contrary, the Sacklers didn’t need studies to tell them this. Some years, Purdue would allocate as much as $9 million just to buy food for doctors. Richard Sackler was enough of a stickler for detail that he would never countenance such an outlay of funds unless he was assured a good return on investment. In a 1996 email to Michael Friedman, he pointed out that according to Purdue’s own data, “physicians who attended the dinner programs or the weekend meetings wrote more than double the number of new Rxs for OxyContin compared to the control group.” (“Rx” is an abbreviation for prescription.) He noted that “weekend meetings had the greatest impact.”

was occasionally said, at Purdue, that OxyContin was so good it would “sell itself.” This was just a turn of phrase, rather than a formal marketing strategy, but the Sacklers took the notion seriously enough that Purdue initiated a costly program to issue free samples of OxyContin to pain patients. This was an old technique in the pharma business. When Bayer marketed heroin at the turn of the twentieth century, it offered free samples of the drug to potential customers. When Roche was seeking a foothold for Valium in Canada during the 1970s, the company gave away eighty-two million Valium pills as free samples in a single year. If you are selling a product that makes people feel good (and may also be highly addictive), that first free hit will generally pay for itself many times over.

Shortly after Rudolph Giuliani stepped down from his position as mayor of New York City, he went into business as a consultant, and one of his first clients was Purdue. When he entered the private sector, Giuliani was looking to make a lot of money quickly. In 2001, he had a net worth of $1 million; five years later, he would report $17 million in income and some $50 million in assets. For Purdue, which was working hard to frame OxyContin abuse as a law enforcement problem, rather than an issue that might implicate the drug itself or the way it was marketed, the former prosecutor who had led New York City after the 9/11 attacks would make an ideal fixer. In Michael Friedman’s view, Giuliani was “uniquely qualified” to help the company.

The next day, Richard followed up, saying, “I’d like to try an argument on you. I believe the media has nefariously cast the drug abuser as a victim instead of a victimizer.” For people who knew Richard, this refrain had probably grown a bit tiresome by now. But Wettlaufer had put himself forward as a sympathetic ear. “These are criminals,” Richard continued. “Why should they be entitled to our sympathies?” “I do not believe most drug abusers are nefarious criminals,” Wettlaufer replied, “and I’m sure when you aren’t so pissed, you don’t either.” Such people have lives that “are far more difficult to cope with than ours,” Wettlaufer pointed out. “They deserve pity.” Just the same, he assured Richard, “You are doing NOTHING WRONG. That’s what counts…Deep breaths Richard. You will get through this with your humanity intact. In the final hour, it’s all you have anyway.” Never one to shrink from an argument, least of all this one, Richard wanted to go another round. “I understand what you are saying. But we don’t agree,” he wrote. “The abusers are misbehaving in a way that they know is a serious crime. They are doing it in complete disregard of their duties to society, their family and themselves.” At this point, Wettlaufer was starting to lose patience with his friend. “Poor people in the inner city and in the backwoods of Kentucky almost never have the luxury of thinking about their ‘duty to society.’ They are surviving day to day,” he wrote. Their “criminal intent” is “driv...

During the months he spent working on Pain Killer, Barry Meier had not been publishing articles about OxyContin in the newspaper. But after the radio host Rush Limbaugh confessed, in the fall of 2003, that he had developed an addiction to OxyContin and other painkillers that had been prescribed to him for back pain, Meier wrote an article about the episode. With the book done and out, it appeared that he was back on the beat.

Friedman, Goldenheim, and Udell “took responsibility on themselves and pleaded guilty,” Kathe Sackler would later say. In doing so, they were ensuring that the family would not be implicated. “Those three guys basically took the hit for the family, because the family was going to take care of them,” Gary Ritchie, who spent eleven years at Purdue as a chemist, recalled. “ ‘Keep yourself out of prison; we’ll take care of you off the books.’ That’s just how they did business,” he said. Not long after the guilty plea, the Sacklers voted to pay Michael Friedman $3 million. Howard Udell got $5 million. The dynamics in play resembled nothing so much as a Mafia film. As one friend of Goldenheim’s put it, the three men had been designated to “take the fall.”

In a subsequent congressional hearing at which John Brownlee testified about the case, Arlen Specter, the Republican senator from Pennsylvania, remarked that when the government fines corporations, rather than sending executives to jail, it amounts to “expensive licenses for criminal misconduct.”

Mortimer attended Dalton, the ritzy private school on the Upper East Side. He was a delicate child, with big eyes and a mop of dark curls, and some of his classmates made fun of him, because even by the standards of the 1980s the name Mortimer had a cartoonishly old-rich-guy ring to it. In the recollection of one student who overlapped with him at Dalton, “He just seemed innocent and mocked and friendless and rich.” And Dalton was a school for rich kids, “so to be ostracized on that basis, you had to be pretty fucking rich.”

Amanyara was dedicated to the idea that for the wealthy client customer service should be a concept without any practical limitation. In keeping with the Asian theme at the resort, the staff was, for the most part, not drawn from the local population, or from surrounding islands, for that matter. Instead, nearly half of the employees were Filipino. If the sand on the beach got too hot in the noonday sun, staffers would spray it with water so that guests could stroll where they wanted without fear of burning their feet.

The death of the actor Heath Ledger that January, from an overdose involving a long list of painkillers, including oxycodone, brought a new level of national attention to the problem.

And at each meeting, the Sacklers would vote to pay themselves. A hundred million here, a hundred million there. If the younger Mortimer felt that he was not being paid promptly and in the amount that he had anticipated, he would complain. “Why are you BOTH reducing the amount of the distribution and delaying it and splitting it in two?” he fumed in 2010, upon learning that the company would need to reduce the family’s quarterly disbursement from $320 million to $260 million and pay the money out in two tranches.

Purdue’s leadership was so single-minded in extending the life of OxyContin, in fact, that it sometimes seemed to this executive as if the company wasn’t a pharmaceutical business at all but “an intellectual property law firm that happened to have some R&D and a marketing arm.”

Richard now scrutinized every particular of the rollout of Butrans. He demanded “intelligence” on the drug’s performance from the Purdue executive Russell Gasdia. He wanted to know whether the sales team was “encountering the resistance that we expected and how well are we overcoming it, and are the responses similar to, better, or worse than when we marketed OxyContin® tablets?” (Even in emails, Richard took the trouble of appending the registered trademark symbol to OxyContin, an indication, perhaps, of his high esteem for the law of intellectual property.)

Even so, if the reformulation was driving any number of people away from snorting or injecting OxyContin, that would appear to be a step in the right direction. And Purdue didn’t really need to conduct complex research studies to develop a sense of the impact of the new pills. The company could just look at its bottom line. According to a research abstract by a team of scientists at Purdue, after the reformulation, sales of 80-milligram OxyContin pills dropped 25 percent nationwide.

On the other hand, that drop in sales offered a stark indication that for years Purdue had been deriving a quarter of its revenue on the highest dose of OxyContin from the black market. The company studied the phenomenon; Richard complained about the “sudden decline” and wanted to know what “corrective actions” could be taken. According to court documents, Purdue concluded, internally, that the lost profit could be attributed in significant measure to a “reduction in medically unnecessary prescriptions.”

Now, on top of these other challenges, the pills stubbornly refused to deliver the full rush of oxycodone right away. As a consequence, many people simply gave up on OxyContin. In an ideal world, they would have just quit cold turkey, braving the torture of withdrawal, or sought treatment and carefully tapered their use of the drug. But the reality was that a lot of these people were already addicted. Many had been for years. They had passed a point of no return. And as it happened, there was an inexpensive substitute for OxyContin that was cheaper and stronger and widely available: heroin.

When it first became popular as a recreational high in Appalachia, OxyContin acquired the nickname hillbilly heroin.

The Sacklers had come to think of themselves as “the smart billionaires who knew better.” More than one person who worked at Purdue during this era likened the experience to the acidly humorous HBO show Succession, in which a trio of overindulged adult children vie, haplessly, to seize control of a conglomerate built by their hard-driving father.

“Richard is an odd duck,” one former Purdue employee said, describing a man who seemed, increasingly, to inhabit an alternate reality of his own fussy design. “His life’s falling apart and he’s recommending a book you should read.”

Richard said that he hadn’t. But OxyContin was a highly effective painkiller, he insisted. “But whether it’s effective or not also depends on other factors, such as abuse,” Thompson pointed out. “I mean, you can kill somebody and take away their pain. But that wouldn’t be effective, would it?”

At this point, more than 165,000 Americans had lost their lives to prescription opioid abuse since 1999. Overdoses had now surpassed car accidents to become the leading cause of preventable death in America. In a midyear update to the Sacklers in June 2016, staffers told the family that, according to surveys, nearly half of all Americans knew someone who had been addicted to prescription opioids.

One unadvertised hazard in the life of a plutocrat is that the people around you can be prone to yes-man sycophancy. In theory, you should be able to avail yourself of state-of-the-art counsel. But instead, you often get lousy advice, because your courtiers are careful to tell you only what they think you want to hear. The danger, whether you are a billionaire executive or the president of the United States, is that you end up compounding this problem yourself, by marginalizing any dissenting voices and creating a bubble in which loyalty is rewarded above all else.

It was a bit rich, she thought, for the Valium Sacklers to be getting morally huffy about their OxyContin cousins.

the island of tasmania lies 150 miles off the south coast of mainland Australia, in one of the more remote locations on earth. In a place called Westbury, on the northern part of the island, fields of long-stemmed opium poppies quiver in the breeze around the Tasmanian Alkaloids facility. The flowers are mostly pink, with occasional flashes of mauve or white. But these aren’t normal poppies. They’re a special variety of super poppy that’s been genetically engineered to produce a higher proportion of thebaine, an alkaloid that is the key chemical precursor for oxycodone. At the Westbury facility, the poppies are harvested, then processed into a concentrated extract that is flown to the United States, where the raw narcotic material can be processed into oxycodone and other opioids. This is the breadbasket of the opioid boom. Though it is only about the size of West Virginia, Tasmania grows 85 percent of all the thebaine in the world.