Exhaustively reported and meticulously written, EMPIRE OF PAIN is a compelling and necessary addition to the existing literature about America’s opioid epidemic and the family that started it.

Whether the epidemic has reached your town, neighborhood or family, or if you’ve only seen news pieces about its insidious reach or read books like DREAMLAND or PAIN KILLER, reporter Patrick Radden Keefe’s latest chronicle is a spellbinding and masterly must-read. The broad strokes of the opioid crisis are not new information, and Keefe has no story to break here. But in choosing to focus on the Sackler family rather than the many victims, he throws the spotlight on a dazzling American dynasty of greed, obfuscation and denial.

Like the Rockefellers and Vanderbilts, the Sacklers have long been recognized as one of the richest families in the world, and their incredible dedication to philanthropy has been celebrated by elite institutions, international royalty, and several United States politicians and monuments. Unlike their contemporaries, they are not “old money,” but rather an entirely self-made family with humble beginnings. In the first third of EMPIRE OF PAIN, Keefe details their start in America, beginning with Isaac, a Jewish immigrant; his wife, Sophie; and their three sons: Arthur, Mortimer and Raymond. Isaac was an ambitious man who instilled in his children both a dedication to good, hard work and a deep-seated pride in the Sackler name. As the big brother, Arthur took his father’s lessons to heart, aspiring to become the family’s first doctor, despite the anti-Semitism he faced in working-class Brooklyn.

"...a compelling and necessary addition to the existing literature about America’s opioid epidemic... Keefe’s portrait of the Sackler family is unparalleled. His focus on every member of the dynasty and each of their cronies, supporters and cleaners is laser-sharp..."

Arthur was a Renaissance man through and through, an ironic distinction that seemed to foreshadow his family’s future generous contributions to the arts. Quickly molding himself into a cunning workaholic, he could find and get a job almost anywhere. More importantly, though, he was often able to tie jobs together to earn a greater cut. It was not long before Arthur was able to help support his family financially, and part of it came in securing jobs and businesses for his brothers --- all while he studied to be a doctor at New York University.

As a doctor with an advertising background, Arthur found himself uniquely positioned not only to treat patients (it’s important to note that he made groundbreaking advances in the medical world, particularly in the treatment of mental illnesses), but to help brand and develop drug-promotion strategies. In fact, Arthur was responsible for the pharmaceutical industry’s first $100 million brand: Valium, mother’s little helper. While Arthur prided himself on his Hippocratic virtue, he had the curious trait of wanting a piece of every medical firm --- doctor’s offices, medical journals, pharmaceutical companies and more --- while working furiously to blur any connection to his name when it came to these businesses, choosing instead to kickstart a nearly manic secondary career as an art collector. It was in this arena where Arthur demanded that the Sackler name be attached to every donation, wing, scholarship and foundation. Enter the Sackler dynasty.

In the book’s second part, Keefe, having laid the groundwork for the family’s outrageous --- but almost hidden --- wealth, focuses on the next generation of Sacklers, most notably Arthur’s nephew, Richard. As is all too common in families with humble beginnings and fabulously wealthy upswings, Richard and his siblings and cousins, while raised with every privilege available, are simply not as good as their predecessors. Richard in particular is very intelligent (also a doctor, despite never having practiced) but is often shortsighted in his visions for the Sackler brand, now known as Purdue Pharma. As Keefe describes him, Richard “had to be the smartest guy in the room” and pushed more innovative --- and dangerous --- drug developments, first MS Contin (morphine pills) and then the drug that bought the Sackler family their notoriety: Oxycontin.

At the time of its invention, Oxycontin was heralded for its -contin suffix, a term that denotes continuous release, preventing the otherwise highly addictive drug Oxycodone from causing the same peaks and troughs most often created by street drugs. It was an innovative, groundbreaking development: an opioid product with no addictive qualities, one that could treat chronic and localized pain alike, saving an entire nation from unnecessary suffering. Or so Purdue Pharma --- and the sales reps, doctors and medical journals paid by Purdue --- said.

It’s no secret what happened next. Even though his own reporting is meticulous, Keefe is careful to pay tribute to those who came before him, particularly Barry Meier, the man who not only identified the opioid crisis on a national scale but connected the Sackler family to it once and for all.

In the book’s final third, Keefe chronicles the family's downfall --- the crisis that created zombie towns and eradicated mill town workers, athletes and high school valedictorians in one resounding swoop. But as I said previously, Keefe doesn’t dwell on the epidemic’s victims, focusing instead on the family’s jaw-dropping, gut-wrenching total lack of moral culpability. Despite their inspiring beginnings as Jewish immigrants and their admirable backgrounds as doctors, the Sacklers, as Keefe shows us, have morphed into a conglomerate, a dynasty, an American oligarchy that has directly caused the deaths of hundreds of thousands of people, many of whom had never abused --- or even touched --- drugs before. And still they deny it, pay off their accusers and continue Arthur’s legacy of obfuscation.

Keefe’s portrait of the Sackler family is unparalleled. His focus on every member of the dynasty and each of their cronies, supporters and cleaners is laser-sharp, and he is able to track with gorgeous, heartrending lucidity the broad strokes and deep-cut connections between the modest beginnings of Arthur’s parents and the supreme greed and selfishness of his descendants. As he shows us, the Sacklers have long been obsessed with privacy and obscuring their connections not only to Oxycontin, but to Big Pharma as a whole, while still stamping, engraving and painting their name on every philanthropic opportunity available to them.

However, despite countless lawsuits and eye-opening reports, the Sackler family has, on the whole, remained untouched: none of them are wasting away in prison, and their wealth has stayed mostly in their pockets. There is no justice here, but in Keefe’s careful storytelling, exhaustive reporting and never-ending curiosity, we have a certain poetic justice: the Sackler family name, once the most important thing in Arthur’s life, will never again carry the same reputation.