Patrick Radden Keefe’s Empire of Pain is another dizzying, provocative investigation: Review

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Patrick Radden Keefe's body of work doesn't seem, at first glance, the most accessible. An investigative journalist by trade, he reports on many manners of corruption, and his last book, 2019's Say Nothing, had an elevator pitch that sounded anything but mainstream. It dove into The Troubles in Ireland, using the decades-past disappearance of a 38-year-old mother of 10 to detail the human effect of that very specific time in I.R.A. history. It also became a New York Times bestseller — and was one of EW's best books of the year. Keefe has a way of making the inaccessible incredibly digestible, of morphing complex stories into page-turning thrillers, and he's done it again with Empire of Pain: The Secret History of the Sackler Dynasty.

The behemoth (450 pages, plus 80 more of notes and indices) is a scathing — but meticulously reported — takedown of the extended family behind OxyContin, widely believed to be at the root cause of our nation's opioid crisis. It's equal parts juicy society gossip (the Sackler name has been plastered across museums and foundations in New York and London, they attend society events with the likes of Michael Bloomberg) and historical record of how they built their dynasty and eventually pushed Oxy onto the market. It's not likely to flip-flop anyone's opinion over who is to blame for the addiction epidemic: If you've made it this far with your belief of the Sacklers' innocence intact, there's likely nothing that can be said to sway you. But for the rest of the reading public, it lives out every promise inherent in the word exposé.

Empire is divided into three parts: Patriarch, which chronicles the life and career of Arthur Sackler, who built the family's wealth and launched their foray into pharmaceuticals in the first place; Dynasty, which deals mostly in the invention of OxyContin (which grew out of the pain remedy MS Contin); and Legacy, which details not only the start of the family's downfall but drives home Keefe's portrait of just how careless, money-hungry, and conniving the Sacklers were in their push to dominate the painkiller market.

Keefe, as a journalist, is measured in his delivery. He never shies away from including his deeply disturbing evidence of ways that Purdue lied about OxyContin's addictive properties, say, or ways that the Sacklers ignored how their product was killing people en masse. But he doesn't editorialize. As a reader, there are moments in which we want more from him; it would occasionally be a more satisfying read if he couched the reporting in his personal stories or reactions. It's clear why he, as a reporter, didn't do that; it's clear to the book critics and readers that these people are monsters.

What he does do is weave in stories of people that he met through his reporting that have had their own brushes with this disastrous drug. The photographer Nan Goldin is one: after decades in and out of addiction (Oxy and heroin) she became an anti-Purdue and anti-Sackler activist, staging protests at museums like the Met, where the family donated the wing that houses the Temple of Dendur. Martha West served as the secretary to Purdue general counsel Howard Udell — she was encouraged by Udell to seek out an Oxy prescription after he saw her limping in the office and quickly found herself taking more than the recommended dose, crushing and snorting pills before work.

Say Nothing, Keefe's previous book, was news-breaking: He essentially solved the crime of his subject's disappearance in his reporting. His current subject matter doesn't offer the same opportunities to wrap up the story in a tidy bow, so there's a chance that fans of his may feel less closure than they hoped for after reading Empire. But what he has done is provide a record of this disaster and a terrific starting ground for other journalists and authors who'd like to pick up the torch (he also does break plenty of news, releasing WhatsApp conversations and emails between Sacklers that show the family members portraying themselves as victims of an anti-OxyContin news cycle, among other items). The tome also serves as yet another reminder of the humanity behind the addiction crisis: Every time he reports on the ways that the Sacklers vilify addicts as "criminals" or bad people is a reminder that it's really quite the opposite. If you're lucky enough not to have been personally touched by this epidemic, it feels like required empathy reading; if you're less fortunate, it could be a rallying cry.

The author closes with several afterwords, where he describes his reporting process in depth, opens up about intimidation tactics that he says the Sacklers employed against him, and goes into further details of their constant denials even in the face of wildly obvious evidence. He also explains that a large portion of the depositions, law enforcement files, and internal Purdue records he used to report the story arrived in his mailbox via an anonymous thumb drive (he was in the process of a Freedom of Information Act suit against the FDA at the time). The envelope arrived with a note that quoted The Great Gatsby, capturing the exact Eat the Rich sentiment that feels like it's bubbling underneath the surface of every page of Empire of Pain. "They were careless people," the anonymous whistleblower wrote, quoting Fitzgerald. "They smashed up things and creatures and then retreated back into their money or their vast carelessness or whatever it was that kept them together, and let other people clean up the mess." B+

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