Empire of Pain Quotes

“I think Upton Sinclair once wrote that a man has difficulty understanding something if his salary depends on his not understanding.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“It is a peculiar hallmark of the American economy that you can produce a dangerous product and effectively off-load any legal liability for whatever destruction that product may cause by pointing to the individual responsibility of the consumer.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“The opioid crisis is, among other things, a parable about the awesome capability of private industry to subvert public institutions.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“I would submit, sir, that you and your family are addicted to money.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“The truth was, Librium and Valium were marketed using such a variety of gendered mid-century tropes—the neurotic singleton, the frazzled housewife, the joyless career woman, the menopausal shrew—that what Roche’s tranquilizers really seemed to offer was a quick fix for the problem of “being female.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“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.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“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.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“The Sackler empire is a completely integrated operation,” Blair wrote. They could develop a drug, have it clinically tested, secure favorable reports from the doctors and hospitals with which they had connections, devise an advertising campaign in their agency, publish the clinical articles and the advertisements in their own medical journals, and use their public relations muscle to place articles in newspapers and magazines.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“In 1994, Friedman wrote a memo marked “Very Confidential” to Raymond, Mortimer, and Richard Sackler. The market for cancer pain was significant, Friedman pointed out: four million prescriptions a year. In fact, there were three-quarters of a million prescriptions just for MS Contin. “We believe that the FDA will restrict our initial launch of OxyContin to the Cancer pain market,” Friedman wrote. But what if, over time, the drug extended beyond that? There was a much greater market for other types of pain: back pain, neck pain, arthritis, fibromyalgia. According to the wrestler turned pain doctor John Bonica, one in three Americans was suffering from untreated chronic pain. If that was even somewhat true, it represented an enormous untapped market. What if you could figure out a way to market this new drug, OxyContin, to all those patients? The plan would have to remain secret for the time being, but in his memo to the Sacklers, Friedman confirmed that the intention was “to expand the use of OxyContin beyond Cancer patients to chronic non-malignant pain.” This was a hugely audacious scheme. In the 1940s, Arthur Sackler had watched the introduction of Thorazine. It was a “major” tranquilizer that worked wonders on patients who were psychotic. But the way the Sackler family made its first great fortune was with Arthur’s involvement in marketing the “minor” tranquilizers Librium and Valium. Thorazine was perceived as a heavy-duty solution for a heavy-duty problem, but the market for the drug was naturally limited to people suffering from severe enough conditions to warrant a major tranquilizer. The beauty of the minor tranquilizers was that they were for everyone. The reason those drugs were such a success was that they were pills that you could pop to relieve an extraordinary range of common psychological and emotional ailments. Now Arthur’s brothers and his nephew Richard would make the same pivot with a painkiller: they had enjoyed great success with MS Contin, but it was perceived as a heavy-duty drug for cancer. And cancer was a limited market. If you could figure out a way to market OxyContin not just for cancer but for any sort of pain, the profits would be astronomical. It was “imperative,” Friedman told the Sacklers, “that we establish a literature” to support this kind of positioning. They would suggest OxyContin for “the broadest range of use.” Still, they faced one significant hurdle. Oxycodone is roughly twice as potent as morphine, and as a consequence OxyContin would be a much stronger drug than MS Contin. American doctors still tended to take great care in administering strong opioids because of long-established concerns about the addictiveness of these drugs. For years, proponents of MS Contin had argued that in an end-of-life situation, when someone is in a mortal fight with cancer, it was a bit silly to worry about the patient’s getting hooked on morphine. But if Purdue wanted to market a powerful opioid like OxyContin for less acute, more persistent types of pain, one challenge would be the perception, among physicians, that opioids could be very addictive. If OxyContin was going to achieve its full commercial potential, the Sacklers and Purdue would have to undo that perception.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“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.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“She complained that because of Purdue’s message about the drug being “good for whatever ails you,” OxyContin was “creeping into a whole population of people where it doesn’t belong.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“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.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“This same aversion to intravenous drug use—to shooting up—had also served as a natural cap on the size of the market for heroin in the United States. But when somebody who is already addicted to opioids starts to feel the first pangs of withdrawal, a lifetime’s worth of inhibitions can be swiftly cast aside. This is the logic of addiction. Maybe needles make you queasy. But if your body is acting as if you might die if you don’t get a hit, you’ll start doing all sorts of things you might have sworn, in the past, that you would never do.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“African Americans had been spared the full brunt of the opioid epidemic: doctors were less likely to prescribe opioid painkillers to Black patients, either because they did not trust them to take the drugs responsibly or because they were less likely to feel empathy for these patients and want to treat their pain aggressively. As a result, levels of addiction and death were statistically low among African Americans. It appeared to be a rare instance in which systemic racism could be said to have protected the community.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“According to a study by the Associated Press and the Center for Public Integrity, Purdue and other drug companies that manufacture opioid painkillers spent over $700 million between 2006 and 2015 on lobbying in Washington and in all fifty states. The combined spending of these groups amounted to roughly eight times what the gun lobby spent. (By comparison, during the same period, the small handful of groups pushing for limits on opioid prescribing spent $4 million”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“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.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“it was when Arthur Sackler said it. Doctors are human, and the notion that donning a white coat might somehow shield them from temptation is a fantasy.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“Heroin was created by the same research team that invented aspirin.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“Often, companies will wait until the original patent has nearly run its course and then introduce some minor tweak to the product, thereby obtaining a new patent and effectively restarting the clock.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“That message was repeated many times throughout the event—that when morphine was used to treat pain, it was not actually addictive.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“2019, a team of economists from Notre Dame, Boston University, and the National Bureau of Economic Research published a dense research paper on the timing of the “rapid rise in the heroin death rate” in the years since 2010. The title of the paper was “How the Reformulation of OxyContin Ignited the Heroin Epidemic.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“We have often sneered at the superstition and cowardice of the mediaeval barons who thought that giving lands to the Church would wipe out the memory of their raids or robberies; but modern capitalists seem to have exactly the same notion; with this not unimportant addition, that in the case of the capitalists the memory of the robberies is really wiped out. —G. K. Chesterton (1909)”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“David had talked about his desire to “humanize” his family, but one problem for the Sacklers was that, unlike a lot of human beings, they didn’t seem to learn from what they saw transpiring in the world around them.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“Richard couldn’t even feign compassion. It seemed to Thompson that the general impression Richard was trying to convey, not just with his answers but with the tone of his voice and his body language, was that he was above all this.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“Roche offered a different interpretation: while it might be true that some patients appeared to be abusing Librium and Valium, these were people who were using the drug in a nontherapeutic manner. Some individuals just have addictive personalities and are prone to abuse any substance you make available to them. This attitude was typical in the pharmaceutical industry: it’s not the drugs that are bad; it’s the people who abuse them.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“OxyContin was, in his view, entirely beyond reproach—a magnificent gift that the Sacklers had bestowed upon humanity that was now being sullied by a nihilistic breed of hillbilly pill poppers.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty

“Some participants had said that “the only difference between heroin and OxyContin is that you can get OxyContin from a doctor.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“In some cases, these communities also happened to have long-standing problems with prescription drug abuse. In some parts of Appalachia, people would pair an OxyContin with a Valium—one of Richard Sackler’s pills and one of his uncle Arthur’s. They called this “the Cadillac high.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“But people had figured out that if you crushed the pills—even if you just chewed them with your teeth—you could override the controlled-release mechanism and unleash a mammoth hit of pure oxycodone. It did not take much trial and error to make this discovery. In fact, each bottle came with a warning that, in retrospect, doubled as an inadvertent how-to:”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction

“In Arthur’s view, it was laughable—even insulting—to insinuate that a colorful ad or a steak dinner might be enough to sway the clinical judgment of an MD. Doctors, he argued, simply can’t be bought.”
― Patrick Radden Keefe, Empire of Pain: The Secret History of the Sackler Dynasty, winner of the Baillie Gifford Prize for Non-Fiction