According to estimates provided by the National Institute on Drug Abuse, close to 50,000 people in the United States of America, died in the year 2019 alone on account of opioid related overdoses. A majority of those deaths were triggered by overconsumption of prescription pain relievers, heroin as well as synthetic opioids such as fentanyl. However the Darth Vader of all opioids was Oxycodone. Sold under the brand names, Roxicodone, and OxyContin, this opioid was the purported panacea for treatment of every kind of pain. The drug was also, incorrigibly addictive, a fact that was conveniently brushed under the carpet by its manufacturers, the powerful and influential Sackler family. Blending a strategic mix of threat and finagling, the Sackler family could co-opt an eclectic mix of bedfellows. From manipulating the key decision makers at the US Food and Drug Administration (FDA) with the allure of “revolving door” opportunities to inculcating a remarkable cultural cachet by lending their names to a plethora of philanthropic causes, the Sacklers were an exercise in dissonance.
Purdue Pharma was a non-descript, muted component of a Byzantine maze of cross holdings. This was also the OxyContin factory. A factory that churned out greed by the minute, doled out false promises of manufactured relief by the hour, yet all along weaving an intricate web of deception and delinquency. Patrick Radden Keefe, an American writer and investigative journalist, pries open the veritable Pandora’s Box that the Sacklers tried to safekeep – and with unimaginable success – and treats his readers to an incendiary revelation of gluttony, insensitivity and downright calumny.
The rise and fall of the Sacklers, as chronicled by Keefe has to be the book of the year 2021 for me. No other book comes near in capturing the catharsis of a nation that is left teetering on the brink. The rustic and the refined, the infirm and the junkie were all consumed by the rapacious influence of OxyContin. They were victims not just of a drug, but more significantly, of a deliberately crafted and perniciously encouraged multi-million dollar strategy that exhorted all doctors to abandon their medical ethics and prescribe the highest doses of OxyContin to all and sundry. Purdue Corporation even had a “Toppers” scheme for their sales representatives under which every sales representative had to convince scores of doctors to prescribe OxyContin. This was the painkiller “to start with and to stay with”. Backing the medical representatives were glossy studies – suspicious and sketchy – vouching the alleviating properties of OxyContin. These studies were commissioned by Purdue, financed by Purdue and conducted by doctors in institutions, functioning under the thrall of many a largesse bestowed by Purdue.
Consider this startling sequence of facts: A powerful officer at the US FDA, Curtis Wright showed immense enthusiasm and little alacrity in granting OxyContin all the relevant approvals. OxyContin was approved in a dizzyingly short time of just 11 months. After such an approval was given, Wright quit the FDA and after a mandatory ‘cooling off’ period of a years, took up a job with Purdue, earning a formidable pay of $400,000 a year. Another federal prosecutor, after getting Purdue Pharma to unabashedly and unashamedly admit that a 160mg tablet of OxyContin could kill a child, abdicated his governmental position for the more enticing prospect of a paid consultant for Purdue.
The first part of the absorbing book traces the meteoric rise of the Sackler dynasty. Arthur Sackler, the domineering family patriarch and a stickler for ‘family reputation’ was the eldest of three Jewish brothers. Mortimer and Raymond were always referred to by Arthur as his “kid brothers”. Arthur Sackler, juxtaposing ingenuity with implacable ambition set the stage for the family to take to OxyContin. Even though Arthur died before the first sale of OxyContin, the playbook for its promotion was his unmistakable legacy. The eldest Sacker racked up a fortune by marketing the tranquilizer Valium and transforming it into Big Pharma’s first ever blockbuster.
The relentless and restless brain driving both the sales of OxyContin to stratospheric heights, and overworked executives at Purdue to lamentable depths was Richard Sackler. The son of Raymond Sackler, Richard lived and breathed OxyContin. Rallying the likes of credentialed doctors such as Russell Portenoy, a former pain specialist at Memorial Sloan Kettering Cancer Center (also known as “King of Pain”, Portenoy towards the fag end of his medical career admitted that his entire outlook towards pain management was a flawed theory), towards his cause, Richard Sackler positioned OxyContin as the only medicine of choice that provided respite from pain, a symptom that was most neglected in the American medical fraternity and academia.
Purdue also boasted speakers’ bureau. The company paid thousands of clinicians to attend medical conferences and wax lyrical about the potency of OxyContin. As incentives, medical practitioners were offered all-expenses-paid trips to pain-management seminars in places like Boca Raton. Predictably records maintained by Purdue indicated that medical practitioners attending such seminars prescribed OxyContin more than twice as often as those who didn’t. A sales representative was recognised for his stirring efforts in persuading doctors to dole out OxyContin prescriptions, with a with a trip to Hawaii.
In a perverted show of condescending and patronizing philanthropy, the Sacklers were also carefully cultivating an image of refined sophistry by donating in the millions to various institutions. Lest this act be construed to be an atonement for their untrammeled voracity, every donation came with a horde of conditions attached. The Sacklers insisted that their names be permanently etched to and associated with their donations. Thus there was a phalanx of hallowed institutions paying tribute to a Sackler endowment. Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, or its Richard Sackler and Jonathan Sackler Professorship of Internal Medicine at Yale University, The Sackler Wing at the Metropolitan Museum of Arts; the Arthur M. Sackler Gallery and the Freer Gallery at the Smithsonian being a few examples. Manufactured munificence vainly trying to obfuscate mendacity. At the time of this review, most of these institutions have removed the Sackler name, courtesy untiring protests by activists such as Nan Golding.
Keefe himself was subject to intimidatory tactics during the course of writing this book. On at least two occasions a burly man was watching over Keefe’s house, standing next to his parked car. While there is no evidence to conclude that this was a Sackler-sponsored threat, the lawyers of the family, in no uncertain terms issued terse letters and warnings to Keefe, demanding that he not proceed with his venture.
This is the same brazen arrogance that also ensured that even after being found guilty of unscrupulousness, none of the Sacklers served prison sentence. Using a convoluted provisions of the bankruptcy law to their advantage, the Sacklers declared Purdue bankrupt just when the law was honing down on them to prosecute them for their inexcusable misdemeanours. The payouts extracted from them was a meagre $1 billion. The family had siphoned off loads of cash from Purdue and stashed them all away at convenient tax havens that were safely insulated from the reach of American jurisdiction and jurisprudence.
The Sacklers were cued into the dangerous fact that OxyContin was more potent than morphine. The Sacklers were under no illusion that the standard gap of twelve hours between two OxyContin tablets was not doing the trick and that some patients addicted to the drug were taking even twenty four tablets in a single day. The Sacklers received periodic reports on their proprietary IMS management system on disturbing cases involving fatal OxyContin addictions. The Sacklers had in their roster of physicians, absolute mad hatters who were willing to issue an unceasing flow of OxyContin prescriptions by writing with both hands even (an exaggeration). Yet the Sacklers preferred to turn a blind eye to the havoc that was being wreaked by their drug, While they raked in billions ($35 billion to be precise), mothers lost sons, sons lost fathers and fathers lost their wives.
While the Sacklers lead comfortably compensated and compromised lives, the death toll rages on, in a manner unabated.
“Empires of Pain” – an incredibly moving masterpiece.