In April 1960, Life magazine ran a story about new methods being used to tame a lynx at San Diego’s zoo. In one picture in the magazine, the lynx looks as ferocious as a big cat should. In the other, it appeared to be transformed and was shown sweetly smelling a flower. The writer explained that the transformation in the animal’s mood occurred after a new tranquiliser called Librium had been administered. In Empire of Pain, Patrick Radden Keefe points out that “the article mentioned, in passing—as if this were not the whole point of the story—that Librium ‘may eventually have important human uses’.”

And so the public were prepared for Librium a drug which became a tranquiliser of huge popularity before another even more popular tranquiliser called Valium came along. These drugs were marketed by Arthur Sackler MD, the eldest of three Sackler brothers, who created a dynasty which is the subject of Radden Keefe’s engrossing new book.

For the Librium campaign, Sackler delegated a PR man to shadow the Life journalist – “The PR guy was with us every inch of the way, every lunch we had, every drink we drank,” the reporter recalled.

The pharmaceutical company behind Librium, Roche, spent $9 million in 1960 to market the drug, but the man behind the marketing was Arthur Sackler.

The consumer couldn’t be directly targeted but the doctor who was interacting with the consumer could and over fifty years, generations of the Sackler family relied, consciously or unconsciously, on the Arthur Sackler playbook.

Arthur Sackler was said to have “invented the wheel” when it came to the marketing of pharmaceutical drugs.

A generation later, the offspring of Sackler’s two younger brothers through the company Purdue Pharma  – Arthur Sackler had sold his shares before the drug was put on the market – aggressively marketed OxyContin. When they took that marketing campaign international, they recruited “pain ambassadors” who were all intent on delivering the message – pain relief was now at hand in a new drug which wasn’t addictive when used correctly.

This prescription painkiller’s roll in the American opioid crisis has led to the bankruptcy of the company. Purdue Pharma last year reached an $8 billion dollar settlement and agreed to plead guilty to criminal charges. The company was prepared to admit to supplying drugs without “legitimate medical purpose”. 

They did this with methods which would have been familiar to Arthur Sackler.

Sackler was a visionary with a prodigious appetite for work and for everything else. At one point, there were three Mrs Arthur Sacklers living in New York City.

“I think that you see in his life, the seeds for everything that comes later,” Radden Keefe tells me on a Zoom call from New York.

“Originally there were three Sackler brothers, their parents came over from Central and Eastern Europe at the turn of the century, they grew up in Brooklyn. So they’re this immigrant family, these three boys, they’re Jewish. They go to a big public high school in Flatbush in Brooklyn, and they grew up wanting to be doctors. And so they all become physicians, the two younger brothers actually have to leave and they go to medical school in Scotland, because this is a time when there are anti semitic quotas on Jews in American Medical Schools. But they come back.

“And there’s this period of time when as young men, all three of them are working at this quite barbaric, insane asylum in Queens, New York in the 40s. And at the time, there’s about 6000 beds in this facility. And they didn’t really know what to do with mental illness. And so what was happening was, they were using electroshock therapy, which was kind of in vogue at the time. So the brothers have to administer this procedure thousands of times, and they find it very demoralising. And they have this – I think – very idealistic notion at the time where they think there’s got to be a better way. And they think this is these are problems of brain chemistry. And if the problem is a chemistry problem, then maybe there’s a chemical solution. And so they have this notion that someday we’ll live in a kind of utopian future when there’ll be a pill for everything, for everything that ails you.”

There would be a new contract with patients and it would be agreed with doctors, but if those who ended up in asylums were at the extreme end of medicine, the Sackler capitalised first on the age of anxiety and then, on the age of pain management, the second with devastating consequences. Nearly half a million people have died in the opioid epidemic in America since the 1990s.

Central to this new contract was the idea of doctors as a “kind of priesthood”, as Radden Keefe puts it. Drugs couldn’t be marketed directly to consumers – they could read about their effect on a lynx instead – but Arthur Sackler knew that if doctors recommended them, patients would listen, so they went that route as – a generation later – did the OxyContin Sacklers.

These drugs – Valium, Oxycontin and prior to that MS Contin – couldn’t be addictive, many felt, because they were being prescribed by doctors. “The first hit comes from a guy in a white coat with a stethoscope around his neck and a diploma on the wall.”

There were free samples too, just as betting companies might provide free bets and the doctors who prescribed the most were known, in language imported from Vegas casinos to refer to big gamblers, as “whales”.

The official line was that only people who were prone to dependency and would have become dependent on something anyway became addicted. If MS Contin and OxyContin were were used for pain management, they weren’t addictive. A useful doctor contributed that this was “because addiction ‘is a psychological malady’ and only occurred when morphine was misused by ‘those who do not need it’”.

Anyone who read Radden Keefe’s excellent ‘Say Nothing’ will be familiar with his style. This story is as gripping, it is a story of a family, but a story of abuse and addiction and how the world became medicalised.

Who were the Sacklers? The Sackler name might be familiar from their philanthrophy in the arts world – there was a Sackler wing at the Louvre, the British Museum, the Tate and the Met in New York – but they weren’t as forthcoming in terms of their pharmaceutical ventures.

“I grew up in Boston and I live in New York,” Radden Keefe says. “In both places, the Sackler name is very, very prominently featured and I think there’s a tendency to kind of think of it as if it’s the Carnegies or the Rockefellers, a sort of 19th century fortune. Now we see the name on all these university buildings and museum wings and so forth. And when I made this discovery, initially, that the vast bulk of the wealth had been made quite recently and made on the sale of this addictive drug Oxycontin, with this quite devastating legacy. That was a shock to me. I was working on a piece for The New Yorker magazine, where I initially wrote a piece about the Sacklers in 2017. And I went to the website of their company, Purdue Pharma, and I scoured the whole website looking for some mention of the family name, you couldn’t find it. So it’s this bizarre contrast where the name is everywhere in the philanthropic realm – they have a kind of a mania for putting it up there – and yet nowhere on the family business.”

Arthur Sackler had compartmentalised as well so this was nothing new and it is a striking feature of the book how methods he practiced were again rolled out by another generation after his death and when his side of the family no longer had any association with the company.

Sackler had set his brothers up with a company in the 1950s called Purdue Frederick and while the Sacklers made a fortune in many ways, MS Contin was the drug which brought huge revenues for Purdue Frederick which had subsequently become known as Purdue Pharma.

MS Contin had revolutionised how cancer patients managed their pain but, as with Valium, they wanted to find a way of taking the drug to those who were suffering with more general pain. This was the mass market.

The patent was due to expire on MS Contin and with it the company’s revenue and as they stood on the edge of this “patent cliff”.

Oxycodone was a drug that had been around for a long time. It was stronger than morphine, something Purdue would discover doctors didn’t realise and Radden Keefe produces a company email where it is stated that this misconception shouldn’t be corrected. Purdue added the Contin coating from MS Contin which served many purposes.

Radden Keefe explains in Empire of Pain:

“As with any strong opioid, there would be the matter of possible addictive potential to contend with. You might suppose that Purdue would conduct tests of the addictive properties of its new drug. But the company didn’t. Instead, Purdue argued that the patented Contin coating on a dose of OxyContin would obviate the risk of addiction. The whole principle of addiction to opioids was premised on the idea of peaks and troughs—of dose and withdrawal, euphoric high followed by the onset of craving. But because the controlled release coating caused the drug to filter slowly into the bloodstream, over the course of twelve hours, the patient would not experience the immediate rush of an instant-release drug and, as a result, would not be whipsawed between high and withdrawal.In fact, Purdue argued, it wasn’t just that OxyContin carried little risk of addiction. The drug’s unique qualities made it safer than other opioids on the market.”

In our conversation, Radden Keefe explained further. “And there are two really critical things that happened at this stage. The first is that they make a decision internally that MS Contin was mainly for people with very severe cancer pain. But this goes back to what we’re talking about Valium – cancer pain, that’s a limited market. What they were interested in was what about people with moderate pain? And so the first huge decision is to take this drug and position it not just for very severe pain, but also for moderate pain, not as a kind of nuclear solution that you graduate to, but actually it’s the first course of treatment they had. In their marketing phrase they said Oxycontin will be the one to start with and the one to stay with.”

A former wrestler who had written a book on pain management had been recruited at an earlier stage to sell this idea of the management of pain and now it became another frontier – pain was not a symptom of something else, but something to be treated and defeated.

Oxycontin succeeded in every way including as a new addictive drug which was addictive and ripe for abuse. How the company became aware of this was a matter of dispute.

“Within four years they’re generating about a billion dollars a year. So four years go by, and then what they’ve always said is that they learned about the problem by reading newspaper articles. And I should say, as a reporter, that always seemed a little a little off to me, I’ve written about a lot of companies and problems at companies. And it’s generally not the case that the reporters know first and the company figures it out after they read the article in the newspaper. More often than not the company’s known for a while by the time you’re reading about it in the press. And what I was able to substantiate in my research is that this is a total lie that they didn’t know anything for four years. In fact, almost immediately, word starts coming back to the company and their discussions at quite high levels, about people abusing the drug, crushing it, snorting it, shooting it up, people becoming addicted, people overdosing, people dying.”

The story and the tragedy is detailed at the level you’d expect from Radden Keefe. He took the same approach in ‘Say Nothing’, a book that catalogued the disappearance and murder of Jean McConville and, if there is a common theme, Radden Keefe thinks it might be denial. “Both are stories about the stories that people tell themselves about the decisions that they’ve made, and the consequences of those decisions.”

The reaction Radden Keefe has received from Ireland to Say Nothing has been overwhelming positive, helped by the fact that as an outsider, it was harder to attribute motives to him. He has also experienced the phenomenon. – noted by others too – that a younger generation read the book without any real awareness of the Troubles. “What’s really striking to me is that a lot of young people have read it. who say I didn’t know this history, but to me this felt like a foreign country, a foreign time and place.”

For the Sacklers, there has been a long attempt to minimise the consequences and Radden Keefe was the latest journalist to encounter difficulties in trying to tell the story.

“Justice has not caught up with them,” he says, “but the truth I think finally has. So up until just a few years ago, there was this disconnect, where this was a very kind of elite family really celebrated in in high society in New York and London. There was no sense that they were tainted by the legacy of the family business and that has completely changed at this point. Nobody will take their money. museums and universities are taking down the family name. They become quite toxic. Some of the some of the New York Sacklers have had to flee to Switzerland and other places where they can keep a low profile, or Florida. When you consider the decades long project and family branding associated with putting the name up on buildings and so forth, all of that I think has been undone. But I would say that’s about as far as the accountability has gone.”

“When we leave,” Arthur Sackler once told his children, “we have to leave the world a better place than when we arrived.” While his children had no part in the OxyContin story, the world would probably question where the Sackler family left it.

Empire of Pain – The Secret History of the Sackler Dynasty is available now, published by Picador