The Origins of the Opioid Epidemic with “Empire of Pain” Author, Patrick Radden Keefe

    Bestselling author and investigative journalist Patrick Radden Keefe discusses his latest book, Empire of Pain: The Secret History of the Sackler Dynasty on our podcast Heart of the Matter with Elizabeth Vargas.

    In his book, Patrick tells the story of the family responsible for setting into motion the opioid epidemic. Following his recent testimony before the House Committee on Oversight and Reform about the Sackler family, Patrick joins Elizabeth to discuss the “Don Draper of medical advertising,” how one family created a massive addiction crisis, and what is in store for the Sacklers, who now face numerous lawsuits.

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    If you’re unable to listen, check out the full transcript of Patrick’s conversation with host Elizabeth Vargas below.

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    Episode transcript

    Elizabeth Vargas

    Hello, everybody. Welcome to “Heart of the Matter.” I am your host, Elizabeth Vargas, and we are nearing on the very end of June. And we’re smack in the middle of an epic battle going on right now on Capitol Hill. There have been some hearings in Congress recently in the last few weeks about the Sackler family and Purdue Pharma. You might have missed it if you’re not reading the tiny stories in newspapers, but this has been an epic battle. Every state in the country is suing Purdue Pharma and the Sacklers, some of them personally, because of the opioid crisis, trying to get money from this company and this family that has made billions and billions of dollars selling OxyContin in its various forms since the late 1990s. Many people feel like this drug and this company and this family are the tip of the spear of the opioid crisis. The United States has the highest rate of opioid overdoses in the world, and it’s only gotten worse in the last year.

    And nobody knows this better than my guest on today’s podcast, Patrick Radden Keefe, who has written an extraordinary new book called “Empire of Pain.” It’s coming out of a cover story in The New Yorker magazine that I read several years ago. It really intrigued me at the time because it was all about the Sacklers themselves, how they were the first pioneers in all those annoying ads we see on TV these days, peddling all these drugs, and the hysterical long list of side effects you might want to watch out for, which include all these horrible, horrible things, and you’ve forgotten by the end of all the side effects what it is I’m supposed to be treating. Anyway, the Sacklers were among the first family in medicine to pioneer this. They made their fortune peddling Valium, got very rich selling Valium, bought Purdue Pharma, and in late 1996, introduced OxyContin to the world.

    Right now, Congress is debating something called the SACKLER Act, something that would actually help let these states go forward with all these lawsuits that the Sacklers are trying to stop. And my guest today, Patrick Radden Keefe, recently testified before Congress, based on all of his years of exhaustive and investigative research into the Sacklers and how they operated. And I’m really, really happy to have on the podcast today Patrick Radden Keefe to talk about the Sackler family, Purdue Pharma, and the opioid crisis that continues to ravage this country.

    Patrick, welcome to Heart of the Matter. It is great to have you here. You have spent years investigating Purdue Pharma and the Sackler family. You wrote an incredible cover story for The New Yorker on the first family of pain, as you called them, and now have written this extraordinary book, “Empire of Pain,” that is now out on shelves and bookstores everywhere, and on Amazon. And it’s a deep dive. There have been other books that have tackled the opioid crisis and the role Purdue Pharma played in it, but you really focus on the Sackler family, which I have been incredibly interested in since I started reading about this story and covering this story. And you write about the fact that the Sacklers, from very early on, the patriarch of the family said, “Protect the family name. That is what you must do at all costs, is protect the family name.” And yet, we’re at a time when the Sacklers have been called predators, heavy-handed and thuggish, the cartel of the opioid crisis, and the most evil family in America. Is that hyperbolic?

    Patrick Radden Keefe

    Well, I mean, I think that there’s been this sort of interesting thing with the Sacklers, which is that they did protect the name and they managed to outrun the truth for so long. As you said, I mean, I wasn’t the first person to write about this. 20 years ago, The New York Times was saying, “There’s this product, OxyContin, it’s killing people. It’s manufactured and marketed by this company in Connecticut, Purdue Pharma. And Purdue Pharma is owned by this family: the Sackler family.” But when I started working on what started out as this piece in The New Yorker in 2017, they had a great reputation. It somehow didn’t seem, over the course of 16 years, to have caught up with them.

    Elizabeth Vargas

    Why not?

    Patrick Radden Keefe

    I think there are a bunch of answers to that. Some of it I do think is that I was able to trace, when I got into doing my book, this history, going right back to the 1950s, of sort of burnishing the family name, as you said, protecting the family name, kind of a family branding exercise, putting the name up on museums and universities, and always distancing the family from the source of the family’s wealth. So long prior to OxyContin, the first great Sackler fortune was made, actually, with another addictive drug, Valium, in the 1960s. And Arthur Sackler, who designed the marketing campaign for Valium, he started giving all this money away, and people in New York knew there was this new guy in town and he’s buying art and he was giving money and he had a close relationship with The Met and with Columbia University, and nobody quite knew where the money came from. And everybody knew what Valium was and knew it was the biggest blockbuster of its day, but nobody knew that Arthur Sackler was sort of the guy behind it.

    Elizabeth Vargas

    You called him the Don Draper of medical advertising. What did he do? How did he make this money off of Valium?

    Patrick Radden Keefe

    He’s a fascinating guy. I mean, he grew up in Brooklyn, the son of immigrants, during the Great Depression, the oldest of three brothers. All three brothers went on to become doctors. But Arthur had this just classic American insatiable ambition. You know there’s that Steve Jobs line about how there are some people that put a dent in the universe? This was a guy who put a dent in the universe. And he didn’t just want to be a physician. He wanted to be in business. And he, at a certain point, started working at and then bought out and took over his own medical advertising firm. So this was in the 1950s.

    And what he did, really, was he took … When you think about Mad Men, all the kind of exciting stuff that was happening in advertising in that era, of consumer advertising, for Campbell’s Soup or a sports car or a bathing suit or cigarettes, Arthur Sackler took a lot of that stuff and imported it into the world of selling drugs. And he had this uncanny grasp for figuring out not just how to sell drugs to consumers, but in some ways, more importantly, how do you sell them to doctors? How do you persuade the doctor to write the prescription? And because he was a doctor, he had, I think, this very compelling, seductive way of going about that.

    Elizabeth Vargas

    The brothers eventually buy Purdue Pharma, which is then just a little-known company known for selling laxatives and earwax remover.

    Patrick Radden Keefe

    Right, right.

    Elizabeth Vargas

    But in 1995, they go to the FDA with a new drug called OxyContin. And within an extraordinarily fast period of time, just 11 months, they win FDA approval with the help of a man named Curtis Wright, who worked for the FDA. First of all, how did they get approval so quickly, and were they fully honest about the properties of the drug when they got that approval?

    Patrick Radden Keefe

    So they really got approval in record time. The drug just raced through the system. And that’s a little strange, when you look back at it, because this was a new kind of drug. Oxycodone, which is the main ingredient in OxyContin, the one active ingredient, is an old drug. It’s been around for a long time. It’s a strong opioid. And so that wasn’t new. The context in which people had used oxycodone up to that point was in medicines like PERCODAN and PERCOCET, which listeners are probably familiar with, where it’s a painkiller, but one in which the dose of oxycodone was pretty limited because it would be cut with acetaminophen or aspirin, and you can’t take too much of those without having toxic effects on your body.

    So, OxyContin was novel because it was these huge doses of oxycodone, much more than had been ever prescribed in pill form up to that point, with a coating system that would slowly release the drug into your system, in theory, over the course of 12 hours. And what Purdue argued, I think dishonestly, was that doctors had been reluctant to prescribe these types of strong opioids up to that point, in part out of a fear that they could be quite addictive. And they said, “Well, because we have this Contin system, where you’re not constantly dosing, you’re not going to have the highs and the lows, it’ll just slowly filter into your system over the course of 12 hours, you really don’t need to worry about addiction. In fact, people won’t become addicted to this drug. It’s safer than other drugs on the market.”

    And they then proceeded to have this huge marketing push to get not just people with really severe pain like cancer pain, end of life type pain or really acute pain, but also people with non-malignant pain, to take the drug. And they were remarkably successful. And so, I think that it was this thing that happened with the FDA where they were trying to sell the FDA not just on the idea that, “Oh, we should be allowed to sell this drug to American consumers, but also, we should be able to market it in this really broad-based way that no strong opioid ever has been before.” And for reasons that we can talk about, I think there are grounds to be skeptical about the kind of review they got at the FDA, but the FDA signed off on it.

    Elizabeth Vargas

    The FDA signed off on it, and Curtis Wright, the FDA employee who shepherded this approval through the FDA in record time, left the FDA a year later to go work for Purdue Pharma-
    Patrick Radden Keefe:
    Exactly.

    Elizabeth Vargas

    … at triple the salary, which raises a lot of questions about what was he promised in exchange for this record fast approval, with claims that this drug is completely not addictive. Also, we know that this drug was three times as strong as morphine, and doctors didn’t know this. And you disclose that internal emails showed that the Sacklers and Purdue Pharma were saying, “Yeah, let the doctors believe that. We know it’s actually three times as strong as morphine, but don’t anybody tell the doctors that because this works to our advantage.”

    Patrick Radden Keefe

    Yeah, I mean, in the whole book, there were a lot of shocking things that I discovered along the way, but this, to me, was one of the most shocking, was that it’s about twice as strong as morphine, not three times. But even so, they had done these focus groups with doctors, and they found that doctors had this misapprehension, doctors didn’t understand the product. They thought that it was weaker than morphine. They couldn’t quite figure out why that was. They thought one possibility is because of the whole PERCODAN and PERCOSET thing, that doctors were used to prescribing oxycodone and PERCODAN and PERCOSET, and so they just sort of assumed, “Oh, this is like those drugs, and would be weaker than morphine.” But of course, that’s wrong.

    And there are these incredible emails, including the most senior people at the company and Richard Sackler, one of the members of the family who was running the company, in which they talk about this. And they say, “Boy, we better not do anything to tip those doctors off that they completely misunderstand the potency of this product that we’re selling.” And that, to me, was just so shocking, the idea that … I mean, I understand that there’s a profit motive if you run a pharma company, but the idea that you would, right there in black and white in emails, say, “Doctors don’t understand this thing that we’re selling. Let’s hope that they don’t figure it out.”

    Elizabeth Vargas

    How soon did the Sacklers and Purdue Pharma begin to get word that in fact OxyContin was addictive, and in fact people were dying because they were taking too much of it?

    Patrick Radden Keefe

    So, this has been a really interesting aspect of this story because there is an official line that the Sacklers and Purdue have always had, which is that … OxyContin goes on sale in early 1996. What they’ve always claimed is that it was four years before they realized there was any sort of problem, and that in early 2000, they stated to figure it out, and that the way they figured it out was by reading reports in the press that said people are abusing this drug, they’re getting addicted in large numbers, they’re overdosing. And that has always seemed, just intuitively as a reporter, to me, that sort of makes my spidey sense tingle, and I think that that sounds like it maybe couldn’t be true.

    And the main reason for that is I’ve written about a lot of companies over the years, and no matter how good a reporter you are, it’s generally not the case that you know before a company knows that there’s something wrong with one of their products or that there are problems out there, so the idea…

    Elizabeth Vargas

    Right, if it’s on the front page of the newspaper, the company shouldn’t be reading about that issue.

    Patrick Radden Keefe

    Yeah, that’s not where they should be learning about it, so that always just seemed a little iffy to me. And even so, Richard Sackler, a member of the Sackler family, testified under oath at a deposition that, “We didn’t really think there was much of a problem at all until early 2000.” A couple of the senior-most executives in the company gave sworn testimony to Congress in which they said that. And what I found in my research was it was a total lie, a total lie and a coverup, that they knew really early on, as early as 1997, so that’s just a year after the drug was released, that there were real problems, there were concerns about addiction, concerns about abuse.

    And you have to remember, a pharma company, this would be true of any pharma company, but Purdue in particular, they have this army of sales reps. And these are like the eyes and ears of the company, they’re out there in the communities all across the country talking to doctors, talking to nurses, talking to pharmacists. And they write these notes about each of their interactions, and the notes go back to the company. So when you actually look at these notes they were sending, the whole thing is about, “Oh, people are talking about the street value of the drug, and it can be crushed and snorted, and some people are shooting it up in a spoon.” And these notes are going back into the company, so it is this-

    Elizabeth Vargas

    And you saw these notes?

    Patrick Radden Keefe

    Yeah. Yeah, yeah, yeah, because what happened is that there were eventually investigations, and the investigators pulled together thousands and thousands and thousands of these notes from the sales reps. But I’ve also interviewed sales reps who worked at the company. There’s a story I tell in the book about a guy who was a rep who was in Virginia, and there was this one doctor who he loved to call on because she wrote so many OxyContin prescriptions. They would call doctors like that whales. And for him, that was great, because it meant more prescriptions, which meant a bigger bonus. And one day, he goes in, I think this is in about ’99, he goes into her office, and she was just looking ashen and upset, and he asked why. And she said that she had just had a young relative die from an overdose of OxyContin.

    Elizabeth Vargas

    By the way, whales are also what casinos call the gamblers who come in to lay quarter-million dollar bets.

    Patrick Radden Keefe

    Exactly, yeah. It’s so shocking.

    Elizabeth Vargas

    You testified before Congress about the SACKLER Act, which we’ll get to in a second, but in your opening remarks to Congress, you said, “The Sackler family was intimately involved in the rollout for OxyContin. Richard Sackler said in an email that he, ‘Dedicated his life to it.’ Cathy Sackler claimed in a deposition that she came up with the idea for the drug. When people started to die from OxyContin, the Sacklers knew. Another company or another family might have changed course after learning that a product they sold was killing people; not the Sacklers. They continued to push for more aggressive marketing, they continued to support false promotional claims about how the drug wasn’t addictive. They blamed and demonized the very victims who were getting hooked on their product. Richard Sackler once described these people as, ‘The scum of the Earth.'” That is shocking.

    Patrick Radden Keefe

    Isn’t it?

    Elizabeth Vargas

    Yeah.

    Patrick Radden Keefe

    Yeah, it’s a weird thing. I do think when you look at how the opioid crisis unfolded, it’s this slow-moving disaster. That’s the thing that’s so strange, right? So, half a million people have died, but it’s taken 25 years. And for me going back and telling this story, when you look at the whole thing, what’s so strange is it’s not like there weren’t warnings. I mean, there were warnings all along the way, but people didn’t wake up. And I think that that passage you just read is pretty indicative of why. Because there was a strategy that the Sacklers had and that their company had. When we talk about addiction, it was kind of brilliant in an evil way, because it played into a series of themes and myths that we have in this country about individual responsibility and pull yourself up by your bootstraps.

    And so what happened was, when it was evident that there were real problems with the drug and people were dying, and they couldn’t deny it anymore … You had that four-year period where they could kind of stick their heads in the sand and pretend they didn’t know, but then eventually it becomes such a problem by 2000 that they sort of have to address it. They made this pivot where they said, “The drug isn’t the problem. It’s the abusers.” And they basically said, “We told the world the drug isn’t addictive, and we still stand by that. If you use it appropriately, it’s not addictive. But if you’re one of these people who’s just an addict, and you’re a reckless criminal,” to use another word that Richard Sackler used to describe these people, “If you weren’t abusing OxyContin, you might be abusing something else.”

    So they did this thing where they … I mean, it’s brilliant, when you think about it, right? They said, “Okay, there is abuse happening, but it’s not our fault. We have no responsibility for that.” And I think that tapped into a lot of ideas that we happen to have in this country about addiction in particular, in a way that ended up being really effective at sort of buying time for the family and the company to keep selling the drug.

    Elizabeth Vargas

    How long did it take for the Sacklers and Purdue Pharma to finally admit, yes, it’s addictive?

    Patrick Radden Keefe

    Oh, they still don’t.

    Elizabeth Vargas

    They still don’t?

    Patrick Radden Keefe

    They still don’t. Yeah, they still don’t. They still maintain … It’s amazing, because in the ’90s, the sales force would go out, and what they would say again and again and again is, “If you’re a pain patient and you take it because a doctor prescribed it, and you take it the way you’re supposed to take it, it’s addictive less than 1% of the time.” And that was just a totally made-up number, based on not any kind of rigorous science, that they repeated again and again and again.

    Elizabeth Vargas

    Right, and nobody can figure out even where that figure came from, right?

    Patrick Radden Keefe

    Well, I mean, it’s crazy, but there was this letter to the New England Journal of Medicine, this very short letter describing a study that it was kind of a small study, and very specific circumstances, and it got repeated again and again and again. But one of the authors of this letter has come out and said, “It’s crazy that the pharma industry weaponized that letter as a kind of marketing strategy to say, ‘Don’t worry, everybody can take it. It’s going to be completely fine. You won’t get addicted.'” So what’s interesting though is that almost everyone at this point, even doctors and people who were big advocates fore more opioids back in the ’90s, and certainly all the sales reps who I’ve interviewed, everybody says now, “Oh, that was crazy. That was just a fantasy, the idea that it’s addictive only 1% of the time.”

    The Sacklers continue to maintain that. This is in some ways a story about just the epic delusion of this family and how when you’re a billionaire and you’re surrounded by people whose job it is to tell you that you’re right all the time, it becomes possible to, I think, just sort of take leave of reality in this way. So they continue to maintain even now that it’s … They say it’s not an addiction problem, it’s really a drug abuse problem.

    Elizabeth Vargas

    But that gets to the heart of the Sacklers themselves. And I’ve heard you say, “What is the story they tell themselves?” How did this family, born into such wealth and advantage, get to this place where they are, in 2021, continuing to deny that this drug that everybody on both sides of the political aisle, every state, that everybody agrees helped launch … It’s not solely responsible for the opioid crisis-

    Patrick Radden Keefe

    Of course.

    Elizabeth Vargas

    … but as you called it, it’s the tip of the spear of the opioid crisis. Many people start on this drug and switch to heroin and fentanyl when they can no longer get it, after they’ve developed an addiction to opioids. What does this family tell themselves? And I know that none of them would cooperate with you, none of them would give you an interview. In fact, they repeatedly threatened to sue you and tailed you and did all sorts of intimidation. But you’ve talked to a lot of people who know them very well, have worked for them. You’ve examined all of their emails and internal correspondence. What do they tell themselves, Patrick?

    Patrick Radden Keefe

    Well, it’s amazing. I mean, I should say, this is part of what I wanted to understand. Even though they wouldn’t talk to me, I was interested in … I didn’t want to tell a story with these kind of caricaturish, mustache-twirling villains, right? I don’t think they set out to create the opioid crisis. So then the question becomes, how do they see it? There’s an old adage in Hollywood among screenwriters that I always think about, which is that the villain in the movie generally doesn’t think that he’s the villain in the movie. He thinks he’s the hero of the movie, right? And so, you’re trying to get inside the head of someone, even somebody who’s done terrible things.

    I think there’s a lot of denial there. It’s interesting, I think this is a family that became very emblematic of greed, and I think greed is a big part of this story. But I also think there was some idealism at the beginning, and an idea that they thought, “We’re going to bring relief to all these patients in pain, and we’ll make billions of dollars at the same time. Yes, of course, for thousands of years, people have had to reconcile the upsides and the downsides of opioids, but we’re so smart, we cracked it. We came up with this amazing way to just hack the problem and help everybody and make a ton of money and not worry about addiction.” And then almost from the start, when it turned out that, “You were wrong about that,” there was a kind of hubris and an anger where they felt like, “We’re the victims here.”

    Elizabeth Vargas

    Wait, “We’re the victims here”?

    Patrick Radden Keefe

    Yeah, yeah. “We gave this gift to the world.”

    Elizabeth Vargas

    In what delusional universe did they think that they’re the victims here, when half a million people have died?

    Patrick Radden Keefe

    I know. No, believe me, but when you read their emails, you see how out of touch they are. I mean, there’s an amazing moment where Jackie Sackler, who is the wife of one of the second-generation Sacklers, Mortimer, he was on the board, very intimately involved in the company, this is just quite recently … Her husband, Mortimer, in his private emails, which I’ve gotten because people leaked them to me, he still talks about the “‘so-called’ opioid crisis.” And she had this amazing thing where she was talking about how hard it’s been for her family because people have started to think that the Sackler name is no longer a blue chip name, and to vilify them. And she was talking about how her kids, who are going to be applying to private school in New York City, “How are my children going to get into the private school of their choice in the fall?” And she said in this email, “Children’s lives are being destroyed.”

    Elizabeth Vargas

    Yeah, they are.

    Patrick Radden Keefe

    And I cannot tell you, I’ve talked to so many people who’ve lost a loved one and seen what that can do to a family. And you’ve got to be pretty out of touch to talk that way about your kids’ private school prospects.

    Elizabeth Vargas

    In 2007, three executives from Purdue pleaded guilty to three misdemeanors. The company paid a fine. It was called, basically, a traffic ticket, because in the overall scheme of the money that Purdue was making off of OxyContin, it was nothing. First of all, why was it three misdemeanors and not three felonies, as the state of West Virginia had hoped?

    Patrick Radden Keefe

    So, that’s a great question. Yeah, there were these federal prosecutors in Virginia who had been really going after Purdue hard. And there were these three very senior executives, and they wanted to bring felonies against the executives. And I have interviewed people who were at the Department of Justice at the time, who were involved in these discussions. And one of the things that I reveal in the book is that they go after these three executives, but the people they really wanted to go after were the Sacklers, the people above them. And this is the way it normally works in white collar criminal investigations. You don’t go for the CEO or the board chairman. You go for the people just beneath him. And then usually what you’re hoping to do is charge that person with felonies, which means they could get jail time. And if this is some white collar, wealthy, pampered executive, at the thought of spending a night in jail, they flip, and then they turn on the people above them. And that’s the classic way that they do it.

    So this was the plan that they had. They wanted to go after the Sacklers. They were going to get these guys to flip. And at the last minute, Purdue and the Sacklers had their lawyers intervene in the political leadership at the justice department, so basically go over the heads at the justice department, of these prosecutors. And they took the felonies off the table, which meant that it would just be misdemeanors, no jail time. So the three executives took the misdemeanors. And there was a lawyer for the Sacklers who said, “They had to take the fall to protect the family. That’s what they had to do. The objective was to protect the family at all costs.” And as for the fine, it was a $600 million fine, and that’s, to one way of looking at things, a large amount of money, but they were making over a billion dollars a year selling OxyContin at this point. So the CFO at the time said internally, I interviewed somebody who witnessed this, said, “That’s nothing to us. We’ve had that money in the bank for years.”

    Elizabeth Vargas

    After those guilty pleas in 2007, did the Sacklers and Purdue Pharma change their ways? Did they do anything to change the drug? We know they reformulated it to make it less easy to abuse. It has a special coating, which of course people promptly got around. But was there any letup on the marketing, the incredibly aggressive push to doctors and to sales reps to-

    Patrick Radden Keefe

    Nope.

    Elizabeth Vargas

    Okay, nothing.

    Patrick Radden Keefe

    They doubled down on it.

    Elizabeth Vargas

    They doubled down.

    Patrick Radden Keefe

    Yeah, they expanded the marketing push. Yeah, absolutely. I should say, they kind of paid lip service to the idea that they had cleaned up their act and they had a new corporate integrity agreement and they hired new compliance people. But the reality was that inside the company, they absolutely doubled down. They were still pushing very hard. Sales of the drug went up after that. They expanded the sales force to go out and keep marketing the drug. A lot of the dodgy stuff they had done before and gotten in trouble with, they kept going with. And in fact, we know now that … It’s funny, because in 2017 when I started working on this, the company said to me, “Oh, all our problems were pre-2007. We’ve totally been on the straight and narrow since then.” And just this last November, they pled guilty to a new set of felony charges for the company, and those cover behavior going back 10 years. So even as early as 2010, and certainly in 2017 when they were telling me that they weren’t breaking the law anymore, they were breaking the law.

    Elizabeth Vargas

    They were breaking the law. And your emails that you were able to examine, the internal emails from the company, show they knew that. Again, it isn’t like, “Oh, we had no idea.” They knew.

    Patrick Radden Keefe

    Yeah. I mean, you’ve got a … Look, some of this stuff, it’s funny. There are all these instances in which, in the emails, they’re not saying, “Let’s go out and commit a crime.” There are emails where … I’ll give you an example. There’s a pain clinic in L.A. which is run by this pretty unscrupulous woman. And there’s a whole strategy where homeless people are picked up on Skid Row in vans, they’re brought to the pain clinic. The pain doctor writes them prescriptions. They go to a pharmacy and fill those prescriptions. All of that OxyContin is bundled and then sold on the black market.

    A Purdue sales rep goes in to the doctor’s office and looks around and writes a memo saying, “This looks like … There’s gang members around. It looks really sketchy. Shouldn’t we inform the DEA?” And the compliance guy back at headquarters, who’s a former DEA agent, writes back and says, “We won’t do anything about that right now.” They don’t end up reporting the place. They sell over a million pills that are prescribed through this particular place. And eventually, the doctor’s office is shut down, but it’s shut down by the authorities because they got reports from outside. So this happens again and again and again and again and again. And in the emails, you see even sometimes their own sales reps saying … There’s a case in Massachusetts about a doctor where the sales rep writes and say, “I went to the doctor’s office, or pain clinic. There’s a line of people so long that people have brought beach-type deck chairs to sit on while they wait to come in and get their prescription.”

    Elizabeth Vargas

    Oh, my God.

    Patrick Radden Keefe

    And then continued to call on that doctor. So that happens all across the country, where any person who has eyes in their head would know this is a bad outfit, but the company continued to call on them. And the reason there, it’s funny, they would talk about the black market, but of course, the pills themselves are sold by the company, do you know what I mean? Like if the pills end up on the black market, the company still makes the money. So you mentioned the reformulation that happens in 2010. They reformulate the drug to make it harder to tamper with. And sales of the biggest pill, the Oxy 80, drop by 25% nationwide. So what does that tell you about-

    Elizabeth Vargas

    That they were abusing them.

    Patrick Radden Keefe

    Absolutely. And that 25% of the market for their biggest dose, up to 2010, was people who were crushing these pills.

    Elizabeth Vargas

    And for people who may think, “Well, yes, but that doesn’t mean the Sacklers knew that this was going on. The Sacklers might not have known about the line outside, with people with deck chairs waiting for their chance to go in and buy a bunch of Oxy.” The internal emails show, in fact, the Sacklers were intimately involved. We even have complaints from some sales reps saying, “Please don’t let Richard Sackler come on my sales call with me, and can you please keep him away from” … They were so intimately involved in the running of Purdue Pharma that people were complaining about it.

    Patrick Radden Keefe

    Yeah, totally. I mean, this has been one of the things that’s so fascinating about their defenses. So they say now, “Oh, we never really had much to do with that company. Yes, we owned it, and of course we dominated the board, but really, it was a pretty arms-length thing. And we would get board resolutions and we would vote, but that’s pretty much it.” And the thing is, that’s so hard to square with the paper trail, where you see all of this just crazy intervention by the family, by the board.

    There’s emails from two different CEOs of the company saying, “I’m trying to do my job here and be the CEO, and the Sacklers aren’t letting me because they keep intervening.” There’s a third CEO of the company who described the board of the company, which is dominated by the Sacklers, as the de facto CEO. So there’s a CEO who literally is acknowledging, “I’m the figurehead here, maybe, but I’m not really, practically speaking, the CEO.” So this was a family that was calling the shots at the company.

    Elizabeth Vargas

    And yet, we are now at a point where we have every state in the country suing Purdue Pharma, and often the Sacklers. They have now pled guilty, as you just pointed out, a second time to three felonies in 2020. They reached a deal with the Trump Department of Justice in the waning days of the Trump administration. And there’s now … Let me just read from your Congressional testimony about the current state of things: “The Sacklers ultimately took more than $10 billion out of Purdue. They did this because they knew a day of reckoning was coming, and they wanted to be ready when it came. So in 2019, when the family had effectively looted its own company, the Sacklers said, ‘Too bad about all those lawsuits. The company’s got no money left. We’re kicking it into bankruptcy.’ When Purdue filed for Chapter 11, all that litigation was put on hold, so the businesses could be restructured and hundreds of thousands of creditors could fight over the scraps. What they’re hoping is that this federal bankruptcy judge in New York will give them a sweeping grant of immunity from any and all civil lawsuits related to the opioid crisis, and the Sacklers are ready to sacrifice the company to do it, protect the family name at all costs. If this happens, it will represent a colossal miscarriage of justice.”

    That’s what you said before Congress. So basically, they’ve taken $10 billion out of Purdue, slowly over the past several years. They’re now saying, “We need bankruptcy protection for Purdue, because there’s no more money left,” because they’ve taken it all out. “And in exchange for bankruptcy protection and this fine, we want to be immune and protected from any and all lawsuits and litigation going forward related to this opioid crisis.” They have made and looted, basically, $10 billion from Purdue Pharma over the past several years. And this opioid crisis has cost the United States $2 trillion. These states and counties and jurisdictions and families are all suing Purdue and the Sacklers for money for treatment to help fix the problem their drug helped create.

    Patrick Radden Keefe

    Right.

    Elizabeth Vargas

    And it looks like, as you said in your Congressional testimony, the Sacklers will walk away again.

    Patrick Radden Keefe

    I think it does look that way, yeah. And it’s pretty breathtaking when you think about it, because they’ve used this bankruptcy process to get … what they’re aiming to do is get this release from any future liability, even though they haven’t declared bankruptcy. So they’re going to walk away with that money. And you’re right, I mean, if you think about the cost of the crisis, not just the human cost, which is really incalculable, but just the financial cost, which is born by taxpayers, right, you have this insane situation in which you have $2 trillion that regular taxpayers will have to bear across this country, and then this family which … You’ve got to remember, they take that $10 billion out, but you’ve also got that guilty plea covering behavior going back 10 years. So the company was a criminal enterprise at the time when they were taking all that money out, but they’re going to be allowed to keep it. And I think it’s a pretty sad way for the story to end.

    Elizabeth Vargas

    There’s something called the SACKLER Act, a bill that is before the House Judiciary Committee, that would prevent the Sacklers from doing this deal, from getting bankruptcy protection for Purdue Pharma and immunizing them against any future litigation or investigation. What are the chances this bill’s going to pass, and why are they all arguing about it? I mean, it’s bipartisan. The scorn and derision for this family came from Republicans and Democrats. So, why are we debating this?

    Patrick Radden Keefe

    Yeah, it’s strange. I don’t know. This was a pretty narrow piece of legislation that was addressed to do something that I think most people would find to be a good idea in this case or any other case, which basically says if you have a federal bankruptcy judge, the judge can release a company … If a company goes into bankruptcy, a person goes into bankruptcy, they can be released from liability if they declare bankruptcy. But that if you have some third party who doesn’t declare bankruptcy, the judge shouldn’t be able to say, “Hey, I’m going to freeze any future … any state lawsuits, and prevent states from being able to pursue these suits.” You have to remember, this is a very powerful family, and they are very politically influential. I tell the story in the book of how there were power lawyers from both sides of the aisle … I mean, Rudy Giuliani on the one hand, and Eric Holder on the other, who went to…

    Elizabeth Vargas

    Mary Jo White.

    Patrick Radden Keefe

    … Mary Jo White, who went to work for Purdue and for the Sacklers. They have been lobbying pretty hard to have this outcome that they want. This bankruptcy judge that is poised to give them this release, because of a weird aspect of the bankruptcy law, they got to choose, handpick their own bankruptcy judge. They decided where to declare bankruptcy. So they picked this one guy in White Plains who I think they had good reason to believe would be sympathetic. And I’m afraid that for the billionaire class, this is kind of the way it works. And so, I think the chances are pretty slim that the SACKLER Act is going to pass in time to actually prevent the judge from giving them this release, which he has said he wanted to. You’ll chuckle at this. The judge said at one point in one of these bankruptcy hearings that he wanted to give this release to the Sacklers because that would give them what he called true peace.

    Elizabeth Vargas

    Oh. Oh, okay, because the Sacklers need true peace.

    Patrick Radden Keefe

    Yeah, heaven forbid they be looking over their shoulder.

    Elizabeth Vargas

    Yeah. I was just really struck in that hearing by the attorney general for the state of Massachusetts, Maura Healey, and also the Republican attorney general from the state of Idaho, I believe it was-

    Patrick Radden Keefe

    Mm-hmm (affirmative).

    Elizabeth Vargas

    … saying, “All we want is the chance to take them to court. We’re not asking for anybody to find them guilty. We just want the chance for justice, the wheels of justice to turn. And if this bankruptcy judge comes in and approves this deal in August as expected, sadly, the wheels of justice will stop.”

    Patrick Radden Keefe

    Yeah. And I mean, think about it, if you’re the attorney general of Idaho, your state attorney general, part of what he was saying is, “How is this federal bankruptcy judge in White Plains, New York, going to prevent me and the state of Idaho which I represent from trying this matter in Idaho state court? That guy should not have the choice as to whether or not this case makes it to Idaho state court.”

    Elizabeth Vargas

    Richard Sackler is now reported to hold a patent for a drug that can wean people off OxyContin. Is that true?

    Patrick Radden Keefe

    Yeah, I mean, I would have to look back at the sort of specifics on the patent, but yes, there is a … He has his name on a bunch of patents over the years, and one of the things that he I guess looked into with others is ways to remedy addiction, which is kind of [crosstalk], right?

    Elizabeth Vargas

    Oh, my God.

    Patrick Radden Keefe

    Yeah, the cynicism of it. But they get you coming and they get you going. I think that’s the way it works with this family.

    Elizabeth Vargas

    Are you still in contact with many of your sources? I’m just curious as to … And in the years you’ve been reporting on this story, is there dissension within the Sackler family? Are there members of that family who are saying, “Oh, my God. This is terrible. We have to stop”?

    Patrick Radden Keefe

    It’s so interesting you should ask this. I, for a long time, had a theory that there must be some third-generation Sackler who was just uncomfortable with all this. And I will say, there are a lot of the third-generation Sacklers who they’ve grown up with great wealth. They have these trust funds and they’re worth hundreds of millions of dollars, but they’re not involved in the family business. And I think for some of them, there’s a sense in which they sort of say, “I didn’t serve on the board of the company, so it has nothing to do with me.”

    There was actually an interview in The Hollywood Reporter with one of the third-generation Sacklers. He’s a film financier. He has his own film fund. This is a guy who’s probably in his 30s. And the money is clearly OxyContin money, right? It’s not that he went out and made money independently. But he was interviewed and he said, “Oh, that whole OxyContin, Purdue, all that, that has nothing to do with me, because, you see, I didn’t work for the company.” So I was really shocked. I kept thinking there’d be some apostate, some member of the family who was troubled by it. But there doesn’t seem to be.

    Elizabeth Vargas

    Wow.

    Patrick Radden Keefe

    And one of the things I got ahold of in my reporting was a WhatsApp log of a family WhatsApp, like many people have with their relatives, from the Mortimer Sackler side of the family. And it covered more than a year of back and forth, and people planning dinners and wishing each other well on the holidays, and talking about the company and its troubles and the PR response. And what was amazing to me is that nowhere in this whole log is there a single moment where anyone in the family says, “Jeez, maybe we have done something wrong here.”

    Elizabeth Vargas

    Wow. How much are the Sacklers worth?

    Patrick Radden Keefe

    We don’t know exactly. I mean, at least $11 billion, and quite possibly a good bit more than that.

    Elizabeth Vargas

    One of the wealthiest families in America.

    Patrick Radden Keefe

    Yes.

    Elizabeth Vargas

    Without a doubt.

    Patrick Radden Keefe

    Mm-hmm (affirmative).

    Elizabeth Vargas

    Museums are now refusing to take any more donations from the Sacklers, if that is punishment of some kind. There are a handful of buildings around the world that have begun to remove the Sackler name. There have been members of the Sackler family who felt like they had to move to Florida to get away from the disapproval everywhere in New York City. But that seems to be it. That’s the penalty for this, right?

    Patrick Radden Keefe

    I think that’s right, yeah. I mean, I think when you talk about accountability, if you mean it in a legal sense or in terms of any sense of penance, or even just an acknowledgement of wrongdoing, I think you’ll be pretty disappointed in this case. I think this is a story with a sad ending. I do think that one thing the family was able to do for a long time was suppress the truth, and that is no longer possible. So, that’s the one sense in which I think there will be something. It’s not quite justice, but it’s not nothing, which is that I do think the truth has caught up with them. I think they’re going to have to run further away than Florida to escape it. And I think that that family name that they spent so much of the last century promoting and polishing and putting up on buildings is now synonymous with death and destruction on a really epic scale. And I don’t know that that association is going to go away any time soon.

    Elizabeth Vargas

    Patrick Radden Keefe, the book is “Empire of Pain.” It’s an extraordinary work of investigative journalism, the culmination of several years of work. And if any of our listeners have been outraged listening to Patrick today talk about the Sacklers and Purdue Pharma, please call your congressmen and talk to them about the SACKLER Act. I’d probably venture to say that Isaac Sackler, the patriarch of this family, never dreamed there would be something called the SACKLER Act that was aimed at finding some way to let the wheels of justice bring members of the Sackler family to some sort of reckoning. At any rate, thank you so much for being with us today on “Heart of the Matter.”

    Patrick Radden Keefe

    Well, thank you for having me.

    Elizabeth Vargas

    We really appreciate it.

    Patrick Radden Keefe

    Thank you so much.

    Elizabeth Vargas

    Thank you so much for listening today to “Heart of the Matter.” You can find this podcast on Apple Podcasts, Spotify, and on our website at drugfree.org/podcast. And as a reminder, if you need help with a loved one who is struggling with substance use, you can text 55753 or visit drugfree.org. We’ll talk to you soon.

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    Heart of the Matter with Elizabeth Vargas, gives guests the opportunity to share their personal, candid stories about addiction. Find all episodes and learn more.

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    Published

    June 2021