Olivia: In the 25 years after one specific pill was introduced, nearly half a million Americans died from opioid overdoses. Today, we're talking about the family that sold the pill, built an empire of pain, and put their name on museums to make us forget. Jackson: Half a million people. That number is just impossible to wrap your head around. It’s the population of a major city. And to think it traces back to a single family, a single product… it’s staggering. Olivia: That pill, of course, was OxyContin. And the family is the Sacklers. We're diving into Patrick Radden Keefe's monumental book, Empire of Pain: The Secret History of the Sackler Dynasty. Jackson: And Keefe is no ordinary writer. He's a staff writer for The New Yorker, and this book won the prestigious Baillie Gifford Prize. What's incredible is that he wrote this entire, exhaustive history without a single comment from the Sackler family themselves. They refused to cooperate. Olivia: Exactly. Which makes the depth of his investigation even more astounding. He essentially had to piece together this secret history from documents, depositions, and sources willing to talk. And the story he uncovers starts long before OxyContin ever existed, with the family patriarch, a man named Arthur Sackler.

Jackson: Right, Arthur is the ghost in this machine. He died before OxyContin was even launched, but Keefe argues he’s the one who drew the blueprint for the whole disaster. How so? Olivia: Arthur was a brilliant, restless, and deeply ambitious man. The son of Jewish immigrants in Brooklyn, he was driven by a powerful need to succeed and, most importantly, to establish what his father always told him was the most valuable thing you could have: a "good name." Jackson: A good name. The irony is just dripping from that phrase, given what happened. Olivia: It’s the central paradox of his life. He became a doctor, but his real genius was in advertising. In the 1950s, pharmaceutical ads were incredibly dull and technical. Arthur had a revolutionary idea: you don't sell a drug to the patient, you sell it to the doctor. And you sell it like you’d sell a car or a soda. Jackson: Wait, so he basically invented the modern, aggressive drug ad? The ones we see everywhere today, promising a new life in a pill? Olivia: He wrote the playbook. He started an ad agency, McAdams, that specialized in pharmaceuticals. His big break came with drugs from the company Roche, particularly the tranquilizers Librium and Valium. His agency’s campaigns were groundbreaking. Jackson: What did they do that was so different? Olivia: They medicalized everyday life. They created ads that targeted women, suggesting that the anxieties of being a housewife, a single woman, or a career woman weren't just life—they were symptoms of a treatable condition. One ad for Valium showed a woman surrounded by shadowy hands, with the tagline "You can't set her free. But you can help her feel less anxious." Jackson: Wow. That is… incredibly cynical. They were essentially marketing anxiety to sell a pill. Olivia: Precisely. And they created a distinction where there was little. Librium was for "anxiety," Valium for "psychic tension." They were chemically similar, but the marketing created two separate, massive markets. They would fund "scientific" studies to back up their claims, send armies of sales reps—or "detail men"—into doctors' offices, and place splashy, colorful ads in medical journals. It was a complete revolution in how medicine was sold. Jackson: And this made him rich. Olivia: Fabulously rich. But he was also obsessed with his legacy. He started collecting art on a massive scale, particularly Chinese artifacts. And he began his other great project: philanthropy. He donated enormous sums to museums and universities—the Met, Harvard, the Louvre. He wanted the Sackler name to be synonymous with art, science, and culture. Jackson: So he was laundering his reputation. Using the money he made from marketing tranquilizers to women to buy a "good name" in the halls of high culture. Olivia: That's the argument Keefe makes. Arthur created this perfect, self-reinforcing loop: the profits from his ethically questionable marketing funded the philanthropy that burnished his name, making him seem unimpeachable. He created the blueprint: sell hard, deny the downsides, and use philanthropy as a shield. He just never applied it to a drug as dangerous as the one his family would later unleash.

Jackson: Okay, so Arthur builds this marketing and reputation-laundering machine. How does it get turned into an engine of mass destruction with OxyContin? Olivia: After Arthur’s death, his younger brothers, Mortimer and Raymond, bought out his share of a small pharmaceutical company they owned called Purdue Frederick. For years, it was a modest company, selling things like laxatives and earwax remover. Their big success was a morphine pill called MS Contin, used mostly for cancer patients in severe pain. Jackson: Morphine. So they were already in the opioid business. Olivia: Yes, but in a limited way. The real turning point came in the 1990s. Purdue was facing what’s known in the industry as a "patent cliff." The patent on MS Contin was about to expire, meaning cheap generics would flood the market and their profits would evaporate. They needed a successor, a new blockbuster drug. Jackson: And that’s where OxyContin comes in. What was it? Olivia: It was oxycodone, another opioid, put into the same "Contin" controlled-release system. The idea, allegedly, came from Kathe Sackler, Mortimer's daughter. But the person who really drove the project was Richard Sackler, Raymond’s son. Richard was determined to make OxyContin a billion-dollar drug. Jackson: How was it different from MS Contin? Why did they think this would be a blockbuster? Olivia: Because they decided to market it for everything. Not just severe, end-of-life cancer pain, but for common ailments like back pain, arthritis, sports injuries. To do that, they had to overcome what they called "opiophobia"—the widespread, and correct, belief among doctors that opioids were highly addictive and should be used sparingly. Jackson: So they had to convince doctors that their new, powerful opioid was somehow not addictive. How on earth did they manage that? Olivia: With a series of brilliant and devastatingly effective lies. First, they got the FDA to approve a unique line in the package insert. It said, "Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of the drug." This was a golden ticket. Their sales reps could now tell doctors the FDA itself had said OxyContin was safer. Jackson: Was it true? Olivia: No. There was no study to support it. In fact, the FDA examiner who approved that label, a Dr. Curtis Wright, left the agency shortly after and, within two years, took a high-paying job at Purdue. Jackson: You're kidding me. The revolving door. Olivia: It gets worse. The second big lie was their core marketing message: that the risk of addiction was "less than one percent." Jackson: Less than one percent? For a drug that's chemically similar to heroin? Where did they get that number? Olivia: From a five-sentence letter to the editor published in the New England Journal of Medicine in 1980. It wasn't a study. It was an anecdotal observation about hospitalized patients who were given small doses of opioids under strict supervision. Purdue took this flimsy piece of evidence and trumpeted it as scientific proof that OxyContin was safe. They trained their massive sales force to repeat it like a mantra. Jackson: That is just breathtakingly dishonest. Olivia: And it worked. In 1996, Richard Sackler launched the drug at a sales conference, telling his team to expect a "blizzard of prescriptions." And they got it. Sales went from $44 million in the first year to over $1 billion just a few years later. They incentivized sales reps with huge bonuses based on the dosage they sold, so reps pushed doctors to "titrate up" patients to higher and higher strengths. Jackson: And there was another lie, wasn't there? About how long the pill lasted. Olivia: Yes, and this was perhaps the most insidious. Purdue marketed OxyContin as providing 12 hours of steady pain relief. But they knew, from their own clinical trials, that for many patients it wore off much sooner, sometimes after just eight hours. Jackson: So what happens in those last few hours before the next dose? Olivia: Excruciating withdrawal. The patient experiences intense pain and craving. So what do they do? They start watching the clock, desperate for their next pill. Their doctor, believing the 12-hour claim, might think they're just "drug-seeking." The reality is, the drug itself was failing them, creating a cycle of withdrawal and reinforcement that is the very definition of addiction. Purdue's own marketing was creating addicts.

Jackson: It's just a cascade of deception. At what point does the dam break? When does the world start to connect the Sackler name on the museum wing with the bodies piling up in places like Appalachia and Maine? Olivia: It was a slow and painful process. For years, Purdue’s response to the growing crisis was denial and deflection. Richard Sackler wrote in an internal email that the addicts were the problem, calling them "the victimizers" and "scum of the earth." The company’s official line was that the problem wasn't the drug, but the criminals who abused it. Jackson: They blamed the victims. Of course they did. Olivia: They hired an army of high-priced lawyers, led by former New York mayor Rudy Giuliani, to fight every lawsuit. They settled cases on the condition that all the evidence, including damning depositions, be sealed from the public. They were masters of controlling the narrative. In 2007, the company and three executives pleaded guilty to criminal charges of "misbranding" the drug, but no Sackler family member was ever charged. They paid a $600 million fine, which sounds like a lot, but as one executive was overheard saying, "That's been in the bank for years. That's nothing to us." Jackson: It was just the cost of doing business. So the legal system was slow, and largely ineffective at holding the family itself accountable. What finally started to change things? Olivia: The cultural pressure. It started with journalists like Keefe himself, and Barry Meier at The New York Times, who refused to let the story go. But the real turning point came from an unlikely source: the art world. Jackson: Nan Goldin, the photographer. Olivia: Exactly. Nan Goldin is a world-renowned artist, and in 2014, she was prescribed OxyContin for a wrist injury. She became severely addicted and nearly died. After she got sober, she learned that the family behind the drug that almost killed her was the same family whose name was plastered all over the museums where her own work hung. Jackson: And she was furious. Olivia: She was incandescent with rage. She founded an activist group called PAIN—Prescription Addiction Intervention Now. They began staging these incredible protests. They went to the Met, into the Temple of Dendur which is housed in the Sackler Wing, and staged a "die-in," lying on the floor as if dead. They threw thousands of empty orange pill bottles, designed to look like OxyContin prescriptions, into the reflecting pool, chanting "Sacklers Lie, Thousands Die!" Jackson: That's incredibly powerful. Using the very spaces they bought to sanitize their name as a stage to expose them. Olivia: It was a brilliant strategy. Goldin threatened to pull out of a major retrospective of her work if the gallery accepted Sackler money. The pressure mounted. First, the National Portrait Gallery in London turned down a million-pound donation. Then the Tate museums. Then the Guggenheim. And finally, in 2019, the Louvre in Paris scrubbed the Sackler name from its walls entirely. Jackson: So the legal system couldn't touch them, but cultural shaming—attacking their "good name"—is what finally started to crack their armor. Olivia: It's the ultimate irony. The one thing Arthur Sackler craved above all else—a good name, immortalized in stone on the world's most prestigious buildings—became the very thing his family's actions destroyed. His legacy is not one of art and science, but of pain.

Jackson: This book is just a gut punch. It’s a story about greed, but it’s also about denial on a scale that’s hard to comprehend. Olivia: It's a chilling arc. Arthur built the weapon of influence, a way to sell medicine by shaping belief. His heirs, particularly Richard, took that weapon, aimed it at the heart of American medicine, and fired, creating that "blizzard of prescriptions." And now, the fallout is a generation of activists and victims trying to claw back the "good name" the family bought with the profits from all that pain. Jackson: And it raises that huge, uncomfortable question about philanthropy. Keefe’s book makes you look at every big donation to a museum or university differently. It forces you to ask: where did this money really come from? What is being washed clean here? Olivia: That's the lasting impact of this story. It's not just about one family or one drug. It's about the systems that allowed this to happen: a captured FDA, a medical establishment seduced by marketing, and a cultural elite willing to look the other way in exchange for a generous check. Jackson: Keefe's book is a masterpiece of investigative journalism, but it leaves you with a haunting question: In a system where profit is king and accountability is for sale, what does justice for an 'Empire of Pain' even look like? Olivia: It's a question with no easy answers. We'd love to hear your thoughts on this. Find us on our socials and let us know what you think. The story is so much bigger than just this one book. Jackson: This is Aibrary, signing off.