Review: Empire of Pain

 Empire of Pain is the history of the Sackler family. This is the family responsible for the opioid epidemic in the USA, killing lots of Americans and contributing to the recent decline in life expectancy in the country. 

What I didn't realize was that the Sacklers were also responsible for Valium, which was also marketed widely. (Arthur Slacker, the patriarch of the family was one of the first people to market medicines directly to doctors, and pioneered the use of drug company representatives who visit physician offices one at a time over time in order to get the doctors to write more prescriptions for the drug)

This made the family rich, and they used that wealth to start collecting art and getting their names into museums. The family also owned a variety of other firms, one notably called IMS, that tracked where prescriptions were being filled, granting valuable information about which regions of the country are buying which drugs. They also owned a notable medical journal, which also served as placement venues for their ads budget.

This complex web of businesses was a design, and the three Sackler brothers (and their spouses) were in on it. In order to avoid the appearance of improprietary, ownership of the various companies were split, occasionally given to various close friends of the family so that Arthur Sackler wouldn't been seen as serving himself.

When the family bought Purdue Pharmaceuticals, they started with making MS Contin, a slow release morphine pill that could be swallowed. This was as opposed to injected morphine, allowing those in hospice care to go home and self medicate. Of course, morphine has a negative reputation, and doctors would think twice before prescribing it. They would then come up with Oxycontin, which is a similar slow release form of Oxycodone, which apparently is an even more powerful opiate but which doctors didn't associate with addiction because its previous formulations was in very low dose and weak forms.

The book is exhaustive in its documentation about the tenuousness of the entire FDA approval process. Apparently, the FDA official in charge was bribed with a future consulting job at Purdue Pharmaceuticals, and he allowed all sorts of wild claims that were not substantiated in the literature accompanying the drug. At the same time, the company promoted up other non-evidence-based claims that the slow release nature of the pill would mean that the drug was not addictive.

The most frustrating bit about the book, of course, is that there's no happy ending. The Sacklers get away (by hiring very good lawyers) with their wealth intact, while leaving tax payers holding the bag for all the drug rehab centers and loss of lives. The book implies but doesn't provide evidence that the judge handling the bankruptcy case was on the take from the Sacklers --- he retired after he finished handling the case.

The only bright spot in the ending is that one of the activists managed to get the Sackler name removed from many of the donated buildings and wings of various famous places (including the New York Met, Tufts' medical school), and the Sacklers are no longer held in high esteem amongst the society they like to hang out with. There's pretty slim consolation for any who lost loved ones to the opioid epidemic though.

It's a depressing book, but everyone should read it.