Empire of Pain by Patrick Radden Keefe Summary

Empire of Pain investigates the Sackler dynasty, the wealthy family behind Purdue Pharma, and their role in fueling the opioid crisis through aggressive marketing of OxyContin. Patrick Radden Keefe traces three generations of Sacklers, exposing their manipulation of medical regulations, exploitation of vulnerable communities, and use of philanthropy to whitewash their reputation. The book blends corporate history with a moral reckoning of greed and accountability.

This book is essential for readers interested in investigative journalism, corporate ethics, or public health crises. It appeals to fans of narrative nonfiction, true crime, and those seeking to understand systemic failures that enabled the opioid epidemic. Policymakers, healthcare professionals, and ethics scholars will find its insights into pharmaceutical marketing practices particularly relevant.

Yes. Hailed as a "masterpiece of narrative reporting" (The Washington Post), Empire of Pain won the 2021 Baillie Gifford Prize and was shortlisted for the National Book Critics Circle Award. Keefe’s rigorous research and gripping prose make it a definitive account of corporate impunity, though some critique its dense detail in early chapters.

Purdue Pharma, led by Sackler family members, falsely claimed OxyContin provided 12-hour pain relief despite internal studies showing efficacy waned at 8 hours. They incentivized doctors to prescribe higher doses, targeted regions with manual labor industries (e.g., West Virginia coal miners), and downplayed addiction risks. Sales reps used deceptive tactics, including funding research to exaggerate the drug’s safety.

The book condemns the Sacklers’ prioritization of profit over public health, their legal evasion tactics, and use of philanthropy to obscure their role in the opioid crisis. Keefe emphasizes how Purdue Pharma’s practices exploited regulatory loopholes and marginalized communities, leading to over 500,000 overdose deaths in the U.S. since 1999.

Keefe illustrates systemic failures: Purdue Pharma paid billions in settlements but avoided admitting wrongdoing, while the Sacklers shielded personal wealth via offshore accounts. The U.S. legal system, he argues, often protects wealthy corporations over individuals, enabling cycles of harm without meaningful consequences.

The Sacklers donated to museums, universities, and cultural institutions (e.g., the Met’s Sackler Wing), using philanthropy to launder their reputation. These contributions, funded by OxyContin profits, shifted public perception from “drug profiteers” to “benevolent patrons” until advocacy groups exposed the hypocrisy.

Some reviewers note excessive detail in early chapters about the Sacklers’ pre-OxyContin history, which slows pacing. Keefe also repeats key points (e.g., the 12-hour efficacy myth) for emphasis, which a few readers find redundant. Despite this, the book is widely praised for its depth and narrative force.

Unlike Beth Macy’s Dopesick (focused on victims) or Sam Quinones’ Dreamland (trafficking networks), Empire of Pain centers on the Sacklers’ systemic greed. Keefe’s approach mirrors Bad Blood’s corporate exposé style, blending meticulous research with dramatic family dynamics akin to HBO’s Succession.

A pivotal line from Bob Dylan appears in the book: "Steal a little and they put you in jail, steal a lot and they make you king." This encapsulates Keefe’s thesis about wealth shielding the Sacklers from accountability. Another standout quote: "The quicker you let go, the sooner you can move forward"—a twisted mantra of Purdue’s aggressive sales strategy.

The opioid crisis persists, with synthetic opioids like fentanyl causing record deaths. Keefe’s examination of regulatory failures, corporate lobbying, and wealth inequality remains urgent. The book serves as a cautionary tale for ongoing battles over pharmaceutical ethics and corporate accountability in healthcare.

A staff writer at The New Yorker, Keefe specializes in investigative narratives (Say Nothing, The Snakehead). His expertise in unraveling complex histories and legal battles shines here, combining forensic detail with gripping storytelling to humanize systemic corruption.