Patrick Radden Keefe’s Empire of Pain is a richly detailed work of narrative nonfiction that traces the rise of the Sackler family from modest beginnings to one of the most influential — and controversial — dynasties in American history.
Meticulous in its research and elegant in its construction, the book offers a fascinating lens through which to examine the intersection of wealth, power, and pharmaceutical ambition. It is the kind of work that reminds readers of what long-form investigative journalism, at its very best, is capable of achieving.
Keefe handles his subjects with considerable nuance. Rather than painting the Sacklers in broad strokes, he takes the time to understand them — tracing how each generation inherited and transformed the family’s legacy in ways both remarkable and deeply troubling. Arthur Sackler, the patriarch, emerges as a genuinely compelling figure: a man of real vision and accomplishment whose methods cast a long shadow over what came after. It was Arthur who pioneered many of the aggressive pharmaceutical marketing techniques that would later be deployed to devastating effect by his brothers and their heirs. That tension between achievement and consequence is what gives the book much of its depth, and Keefe navigates it with a steady and assured hand.
The book’s later sections turn to Purdue Pharma and the development and promotion of OxyContin — and it is here that Empire of Pain becomes particularly difficult to put down. Keefe presents a meticulous account of how the drug was marketed, how its risks were downplayed, and how an entire public health catastrophe unfolded, in part, as a consequence of decisions made in boardrooms by members of one extraordinarily wealthy family. The narrative surrounding the opioid crisis is handled with care and thoroughness, balancing corporate history with the very real human stories that sit at its center. Keefe never loses sight of the broader social implications, though he presents them with restraint rather than polemic — a choice that, ultimately, makes the account all the more powerful.
What lingers long after the final page, however, is a question the book does not shy away from raising: that of accountability. The three founding brothers — Arthur, Mortimer, and Raymond — are all deceased, but many of their heirs, including Richard Sackler, former president of Purdue Pharma, and other family members such as Kathe, Mortimer Jr., Ilene, David, and Theresa Sackler, remain very much alive. The family’s combined net worth was estimated at $10.8 billion in late 2024, a figure that speaks for itself when set against the scale of the crisis their company helped to create. Nearly 100,000 people die from opioids every year in the United States, and yet the Sacklers, throughout years of legal proceedings, have consistently denied wrongdoing.
A settlement was eventually reached in January 2025, requiring the family to pay $6.5 billion over 15 years and relinquishing ownership of Purdue Pharma. While this represents a significant legal development, many observers have noted that the family will not be left in anything approaching financial hardship. Much of their wealth is held in offshore accounts and may be impossible to access through lawsuits, meaning that the settlement, for all its scale, may represent only a fraction of what the family extracted during OxyContin’s most profitable years. No criminal charges have been brought against any member of the family. The Sackler name, once emblazoned on the wings of museums and the facades of university buildings around the world, is gradually being removed — but the family’s fortune, by and large, endures. Reading Empire of Pain with this context in mind adds a layer of weight to an already substantial book. Keefe has produced a work that is not merely a history of one family, but a broader meditation on how wealth insulates, how reputation is constructed and dismantled, and how the legal and regulatory systems that are meant to provide accountability can, at times, fall short of doing so. For readers with an interest in American business history, public health, or the ethics of corporate power, this is a work well worth your time and attention.
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