Journalist Investigates 'Crime Story' Of The Sackler Family And The Opioid Crisis

Apr 14, 2021
Originally published on April 14, 2021 5:23 pm

The Sackler family has spent decades making a name for itself in philanthropic circles, with sizable donations to the Metropolitan Museum of Art, the Louvre, the British Museum, Harvard University and Yale University, among other institutions.

But as the public began to scrutinize the source of the family's money, many museum wings and buildings that once displayed the Sackler name have removed it.

That's because members of the Sackler family own Purdue Pharma, which made billions of dollars selling OxyContin, an opioid painkiller stronger than morphine. Introduced in 1996, OxyContin has been largely blamed for the opioid addiction crisis that followed. The Sacklers and the company now face a combined total of more than 2,500 related lawsuits.

"As the opioid crisis has intensified, with roughly a half a million Americans having died in recent decades, you've started to see some of these institutions [that have received Sackler money] back away," New Yorker writer Patrick Radden Keefe says.

Keefe investigates the Sackler family and Purdue Pharma's role in the opioid crisis in his new book, Empire of Pain. He says that the widespread use of OxyContin created a community of people who developed a dependency on opioids — including many who later turned to heroin and fentanyl when OxyContin became harder to come by.

"You had a market that was cultivated by Purdue and grew and grew of people who were abusing prescription pharmaceuticals," Keefe says. "And then, at a certain point, a lot of them transition or graduate to illicit opioids, like heroin, and fentanyl, which, as we know, are incredibly deadly."

Though Keefe reached out to the family while researching the book, he says it declined to participate. Instead, he says, some members of the Sackler family have "thrown a lot of energy" into trying to thwart his reporting.

"They've told me that they may very well sue. They've told me I should preserve everything because it's going to be evidence in the eventual lawsuit," Keefe says. "One of the stories I tell in the book is about how Barry Meier, a New York Times reporter who was really one of the first to break the story about how OxyContin was not as great as the company had cracked it up to be, he dealt with these same types of threats 20 years ago. And so there's a continuity in their tactics, this tendency to throw their weight around and try and control the narrative."


Interview Highlights

On the belief within Purdue Pharma that there was "no ceiling" on OxyContin doses

There's actually a moment that I discovered where a legal secretary at Purdue Pharma learns that they're going to be introducing this 160-milligram pill and says, and this was the quote, says to the general counsel at the time, "They're killing themselves with the 80s. Why would we come out with a 160?" - Patrick Radden Keefe

Part of what was innovative about OxyContin was that you could have these huge doses, and there were some people at the company ... who believed that there was "no ceiling," was what they would call it, on the dose that somebody could take. And so you had not just 10 milligrams and 20 milligrams and 40 and 80.

Eventually the company introduced a 160-milligram OxyContin pill. They did end up taking that off the market after concern was expressed by some people in the government that if a kid took one 160-milligram OxyContin pill, the kid could die. And there's actually a moment that I discovered where a legal secretary at Purdue Pharma learns that they're going to be introducing this 160-milligram pill and says, and this was the quote, says to the general counsel at the time, "They're killing themselves with the 80s. Why would we come out with a 160?"

On when the Sacklers claim they realized OxyContin was addictive and lethal

Empire of Pain: The Secret History of the Sackler Dynasty, by Patrick Radden Keefe
Doubleday

There has long been a story told by Purdue Pharma and the Sacklers that they introduced this revolutionary painkiller in 1996 and that it helped lots and lots and lots of people — and I should say, that's true. It did actually bring relief to a lot of people who had been suffering from terrible pain. But the story that the family and the company always told is that it wasn't until the spring of the year 2000 — so really four years later — that they first started getting an indication that there might be a big problem with this drug, that lots of people might be abusing it and, indeed, overdosing and dying and becoming addicted to the drug.

There were two different very senior company officials who testified under oath before Congress that they didn't learn a thing until early 2000. Richard Sackler himself, one of the really key family members who was involved in the company and involved in the development of OxyContin, he said, in a sworn deposition, "We didn't really know there was a big problem until early 2000." And there was a claim that they learned about it from press reports. And that seemed just intuitively a little weird to me as a journalist. ... What's weird is the idea that the company would learn about it from the journalists, because one thing that any modern pharmaceutical company does is it tracks very carefully where the pills are being prescribed and sold. They keep very close track of which doctors are prescribing and in what way. And they do that for marketing reasons, because they want to know which doctors to target.

One of the oddities with OxyContin, we know now, is that there were, from pretty early on, some doctors who were prescribing way more than it would make sense for them to be prescribing — some regions where tons and tons of pills were going and Purdue would have known this.

On a Purdue Pharma legal secretary researching how people were abusing the drug

This is in 1999 — this is a year before the company claims that they learned about any of these problems. She went into these newsgroups and started doing research into ways in which people are abusing the drug. And it turned out there were lots and lots of people online talking about that Contin coating and that if you crush the Contin coating, if you crush the pill, then you can release the full dose of oxycodone all at once. And the people were doing that. In some cases, they're abusing the pills just by not swallowing them whole, but by just chewing them and swallowing them. Sometimes they would crush them up and snort them. Sometimes they would cook the powder in a spoon and inject them intravenously.

On Purdue Pharma changing the coating of OxyContin in 2010 to make it harder to smash and abuse

It did make it harder to abuse the drug. One of the former Purdue executives who I interviewed said that it was like when you tried to crush it, it would turn into a gummy bear. So it was hard to snort. You couldn't dissolve it. And interestingly ... one of the things I discovered is that the company learned right away that it was working — that this new formulation was harder to abuse — and the way they learned it is that their sales went down.

So sales of what, at the time, was the strongest version of the drug, the 80-milligram pill, actually dropped 25% nationwide after the introduction of this reformulation. One way of looking at that, you say: Isn't that great? Look at their commitment to doing the right thing and making this drug harder to abuse. The other way of looking at it is: Whoa, so 25% of sales of that strongest pill were going to the black market, effectively, before the reformulation.

On the 2,500-plus lawsuits against Purdue Pharma and the Sackler family and the Sackler legal strategy of having Purdue declare bankruptcy

OxyContin has been a fantastically profitable drug. It's generated some $35 billion in revenue since its introduction in the 1990s. And what's happened is just in the last few years, you've had this gathering storm of lawsuits seeking to hold, initially just the company, Purdue Pharma, but then eventually the family as well, responsible. Purdue and the Sacklers did this really interesting thing where the Sacklers at a certain point put the company into bankruptcy, because they had been taking so much money out of the company for so many years and it was now facing all these lawsuits. And so the company ends up with something like a billion dollars in cash and assets, and the Sacklers put it into bankruptcy. They don't declare bankruptcy themselves. And, in fact, we know from their own records they've taken more than $10 billion out of the company really over the course of just a decade or so. So it's this strange situation in which the company is bankrupt — the family financially is doing just fine.

On the company's rush for help in the final days of the Trump administration

The Sacklers agreed to pay a fine of over $200 million to settle civil charges, but they wouldn't agree to admit any wrongdoing. And no executives from the company were charged or even named. So you end up in this weird situation where the company pleads guilty, but there's no human individual who could be said to have done anything wrong. ... It's like the company is a driverless car." - Patrick Radden Keefe

You have to remember that this is a crime story. So Purdue Pharma, this company that they own and have profited from so handsomely, pled guilty to federal charges in 2007 that they had fraudulently marketed OxyContin. And the story was always that, after 2007, they cleaned up their act. They got on the straight and narrow, that they never did anything like that again. But the truth was that actually they expanded their sales force after 2007 and continued to do a lot of the same stuff that had gotten them in trouble in the first place. And in the last couple of years, there have been multiple different federal criminal investigations of the company.

What I learned in my reporting was that you had these different investigations and what the family and the company wanted to do was make a deal, and that at the Justice Department, you had some career prosecutors who thought that they really needed to crack down hard on Purdue and on the Sacklers because they had done this pretty bad conduct. It was quite recent. And they're kind of recidivist, if you think about it. They already got busted once and then continued to do some of the bad stuff that they had done in the past.

But what ended up happening is that there was a rush in the final days of the Trump administration to get this case sorted out. The way it was explained to me was somebody said, "They want to wind this thing up and with a soft touch." And so you ended up in a situation in which there was a deal where Purdue pled guilty to a new set of federal criminal charges and the Sacklers agreed to pay a fine of over $200 million to settle civil charges, but they wouldn't agree to admit any wrongdoing. And no executives from the company were charged or even named. So you end up in this weird situation where the company pleads guilty, but there's no human individual who could be said to have done anything wrong. ... It's like the company is a driverless car.

Copyright 2021 Fresh Air. To see more, visit Fresh Air.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross. The one entity that has received the most blame for the opioid epidemic is Purdue Pharma, the company that makes and sells OxyContin. It's now facing over 2,500 lawsuits. Purdue Pharma and the Sackler family that owns and runs it is the subject of the new book "Empire Of Pain" by my guest, Patrick Radden Keefe. The Sacklers have been a secretive family. They never put their name on the company, but many wings of museums, universities, medical institutions and other organizations were named after the Sacklers after the Sacklers contributed huge sums of money. This connected the Sackler name with great acts of philanthropy. Keefe has investigated those philanthropic donations and the motivations behind them. The Sackler name has been removed from some of those institutions after the name was sullied by the opioid epidemic.

Keefe describes his book as a family saga about how the Sacklers became a dynasty which changed the world, a story about ambition, philanthropy, crime and impunity, the corruption of institutions, power and greed. The book is based on hundreds of interviews, as well as documents that were leaked to him. He has evidence that the Sacklers knew more than they ever admitted about how addictive OxyContin is and how it was being abused as a street drug. Keefe first wrote about the Sacklers in The New Yorker. His previous book, "Say Nothing: A True Story Of Murder And Memory In Northern Ireland," won a National Book Critics Circle Award for Nonfiction.

Patrick Radden Keefe, welcome to FRESH AIR. Let's start with the origin story of OxyContin. Before there was OxyContin, there was something called MS Contin, and this was a drug developed by Knapp Laboratories in 1966. The Sackler brothers had acquired this company, and in the late '70s, Knapp produced this new product, MS Contin. That was very innovative. It was a morphine pill. Why was this a game changer in terms of morphine and patients who needed morphine?

PATRICK RADDEN KEEFE: So morphine was a painkiller that had been around for a long time. It wasn't the morphine that was new. What was novel about MS Contin was the coating on the pill. And so up to that point, if you administered morphine, it would often be in the form of a shot or a drip. And so people were in a situation in which they were having to go to the hospital and actually be administered to by doctors in order to deal with their pain - any kind of pain that they were suffering, which at the time was often cancer pain, end of life pain. It was quite severe pain. What MS Contin did was took the old drug, morphine, and then introduced this coating, which they called Contin. That's where the Contin comes from. And what that did was regulate the distribution of the drug into your bloodstream over a period of hours. And so what happened is that the seal meant that once you swallow the pill, slowly, slowly, that morphine will be released into your body, which meant that people who were pain patients didn't have to go in and be treated in the hospital. They could go home. It also meant that there was less of a stigma associated with taking the morphine because a pill is just more approachable. And so that was a very innovative drug for the Sacklers. It was introduced in the 1980s.

GROSS: The company that produced it, Knapp, the company that the Sacklers had acquired, was a British company. So it was marketed in England, but the Sacklers wanted to market it in the U.S., but they had to go through the FDA in order to do that. So they tried to get around the FDA so they could rush it onto the market. You learned things about how they managed to get it marketed in the U.S. and basically bypass a lot of the FDA requirements. What did they do to make that happen?

KEEFE: Well, normally, if you're going to introduce a new drug in this country, you need to go through a process, which is the new drug application process, and get approval from the FDA to sell the drug, to market the drug. And what happened was when the Sacklers and Purdue Pharma were going to release this drug that they'd already released in the U.K., MS Contin, they decided, you know, instead of doing the new drug application, what we'll do is we will claim that actually this is just morphine, right? Morphine is an old drug. We wouldn't need approval, new approval, to sell morphine. And so we're just going to market it. We're just going to put it out there in the world and start selling it and behave as though we don't need to get that approval from the FDA.

So they did this, and the drug had been on sale for several months when they get a letter from the FDA saying, wait a second, you know, you can't just do that. You have to go through the whole process here. And so then there was a back-and-forth between the company and the agency where at that point there were already a lot of pain patients who had come to rely on this drug. So it was tricky for the FDA. They didn't want to just pull the drug from the shelves. And so what they did basically was they kind of grandfathered it in. They said you can now retroactively apply for a new drug application for this drug that you rather cavalierly already went ahead and sold and marketed without asking us.

GROSS: OK, so that's a bit of the story of MS Contin. MS Contin was morphine, but oxycodone was developed, and that's a chemical cousin of morphine. And oxycodone is the basic ingredient of OxyContin. So make the connection for us between MS Contin, the morphine drug, and oxycodone, which is the basis of OxyContin.

KEEFE: So these are two different drugs. They're both opioids, which is to say they're both derived from the opium poppy. And in fact, oxycodone has been around for a long time and is significantly stronger than morphine. It's about twice as strong as morphine, but it was not as well known in the United States. And so what happened was, for any pharmaceutical company, the real profits to be made are generally made only in a limited period of time, because what happens is that you innovate a new drug, and you get a patent on the drug, and the patent allows you to sell it exclusively, which means that you can charge really high prices. But it only lasts a certain amount of time, and eventually, the patent expires, at which point generic companies can come in and sell the same drug and charge less.

And so Purdue, which at the time was called Purdue Frederick, had had great success with this drug, MS Contin, but at a certain point, they realized that the patent is expiring. And when it does, other companies are going to be able to make this same drug, and their profits are going to really steeply decline. People talk about this in the industry. They call it the patent cliff because that's what your profits look like. It's like you've gone off a cliff at the point where generics start coming in and making the same drug. So the Sacklers and senior executives at their company start talking about, well, what can we do? What - you know, what's our next thing? And they still have this Contin-ous (ph) system; remember that coating on the pills? And they figured, well, we could probably find another drug to use with that same seal that would slowly come out into the bloodstream.

And they settle on oxycodone, which is a stronger opioid, twice as strong as morphine. And they realized that you can essentially do the same trick. You take just pure oxycodone. You have this coating on it. And because it enters the bloodstream slowly, you can actually introduce a huge dose that will, over the course of 12 hours, filter into the bloodstream. And so the decision is made to release this drug, which becomes known as OxyContin. And there's a few things about this that are interesting. One is that, at the time, this was a very, very powerful opioid, more powerful than - certainly than morphine.

But what the company realized when they started doing focus groups with doctors was that a lot of American physicians didn't realize that oxycodone was more powerful than morphine. They actually thought it was weaker. So there was a kind of a mistaken impression among American doctors. And there are these incredible emails in the early years with OxyContin, where senior executives at the company talk about this. And they say, you know, it's the strangest thing. Doctors don't seem to understand that this drug is actually much stronger than morphine, not weaker. They think it's weaker. Let's not do anything to correct that misimpression.

GROSS: This is especially important because Purdue is marketing this drug directly to doctors. And marketing directly to doctors is an innovation that Arthur Sackler, one of the three main Sackler brothers who create Purdue. This is an innovation of Arthur Sackler back when he was in the pharmacy advertising business. And one of his main clients was Pfizer and another client was Roche. And he had a market, Librium and Valium. And he thought, let's go directly to the doctors. So what are some of the innovations that he created when he was marketing Librium and Valium that he started using for OxyContin?

KEEFE: Well, this was a big part of what appealed to me about this story is that it's not just an OxyContin story, is that you have this prehistory that dates back really to the 1950s. So Arthur Sackler, the oldest of these three brothers, was a physician. All three brothers were physicians. But he started in medical school, when he was in medical school, working as a copywriter on the side for advertising companies and getting into pharmaceutical advertising. And one of his big innovations was that he realized that at a time when it was tricky to market often directly to consumers, what you could do instead was market directly to physicians. And the physicians are the ones writing these prescriptions. And so they're the ones that you want to appeal to.

And he did that in a whole bunch of different ways. I mean, he did that with direct mail campaigns. He did that by getting his client, Roche, to hire an army of sales representatives who were these young, polished advocates for a product. And they would go out and hit the road and meet with doctors and pharmacists and nurses and make the case for each new drug. And he sometimes did this in ways that were quite dishonest. There were many, many instances in which the side effects of a drug or the potential downsides were underplayed and the benefits of the drug were significantly overplayed in terms of all the promises that were made.

GROSS: Another marketing thing that Purdue came up with for OxyContin, they developed a card program issuing coupons for a 30-day trial. Now, it's one thing if you do that, say, for a headache pill. It's another thing if you're doing it for a highly addictive painkiller. This is like a way to get people. I'm not saying it was intentionally a way to do that, but it turns out to be a way to get people addicted to this pill and they have to keep buying it.

KEEFE: You're exactly right. And it's funny, you know, I came to this project from a slightly strange angle. I had written for years about the illicit drug trade, about the drug cartels in Mexico. And one of the things that you find when you look at the business model of illegal drug organizations is that the - you know, the first hit is often free, is that that's a tried-and-true approach taken by drug syndicates in order to cultivate new customers.

So it was pretty astonishing for me to look at the history of this same practice in the pharmaceutical industry when it comes to products that are potentially quite addictive. And this was not just true with OxyContin. In fact, in an earlier era, the same thing happened with Valium, another drug that many people become addicted to. There were many, many, many free samples and, in fact, coupons for free prescriptions that were given out. And this was one way in which the market was built.

GROSS: Let's take a break here and then we'll talk some more. If you're just joining us, my guest is Patrick Radden Keefe. His new book is called "Empire Of Pain: The Secret History Of The Sackler Dynasty." We'll be right back. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Patrick Radden Keefe, author of the new book "Empire Of Pain: The Secret History of The Sackler Dynasty." The Sackler family owns Purdue Pharma, which manufactures OxyContin, the pill that has been blamed for much of the opioid crisis.

One of the things that Purdue did with OxyContin was to increase the dose by a lot. I mean, it wasn't a mandatory dose. You could get Oxy in several doses. But somebody in the company objected to raising the dose to this much higher dose. What was the objection?

KEEFE: Part of what was innovative about OxyContin was that you could have these huge doses. And there were some people at the company - and, in fact, in the Sackler family who believed that there was there was no ceiling, was what they would call it, on the dose that somebody could take. And so you had not just 10 milligrams and 20 milligrams and 40 and 80.

Eventually, the company introduced 160 milligram OxyContin pill. And they did end up taking that off the market after concern was expressed by some people in the government that if a kid took 160 milligram OxyContin pill, that kid could die. And there's actually a moment that I discovered where a legal secretary at Purdue Pharma learns that they're going to be introducing this 160-milligram pill and says - and this was the quote - says to the general counsel at the time, "they're killing themselves with the 80s. Why would we come out with a 160?"

GROSS: And this gets to the fact that the Sacklers knew a lot more than they admitted about how addictive Oxy was and how it was being abused as a street drug. What are some of the things that you learned about how much they knew that they didn't admit?

KEEFE: There has long been a story told by Purdue Pharma and the Sacklers, that they introduced this revolutionary painkiller in 1996 and that it helped lots and lots and lots of people. And I should say, that's true. It did actually bring relief to a lot of people who had been suffering from terrible pain. But the story that the family and the company always told is that it wasn't until the spring of the year 2000 - so really, four years later - that they first started getting an indication that there might be a big problem with this drug, that lots of people might be abusing it and, indeed, overdosing and dying and becoming addicted to the drug. And there were two different very senior company officials who testified under oath before Congress that they didn't learn a thing until early 2000. Richard Sackler himself, one of the really key family members who was involved in the company and involved in the development of OxyContin, he said in a sworn deposition, you know, we didn't really know there was a big problem until early 2000.

And they always claimed that they learned about it from press reports. And that seemed just intuitively a little weird to me as a journalist because if you think about it, of course, it does make sense that if you have people abusing the drug and black-marketing the drug and people overdosing and becoming hooked that journalists would eventually figure this out. What's weird is the idea that the company would learn about it from the journalists, because one thing that any modern pharmaceutical company does is it tracks very carefully where the pills are being prescribed and sold. They keep very close track of which doctors are prescribing and in what way. And they do that for marketing reasons, because they want to know which doctors to target. And one of the oddities with OxyContin we know now is that there were, from pretty early on, some doctors who were prescribing way more than it would make sense for them to be prescribing, some regions where tons and tons of pills were going. And Purdue would have known this. And intuitively, that was always my sense. But I didn't really have any evidence until I started digging into it. And what I discovered in the course of researching the book is this paper trail.

GROSS: One of the things that you discovered was that one of the people in Purdue, one of the executives, asked his legal secretary, one of the legal secretaries, to investigate how Oxy was being used outside of how it's supposed to be used. And she found out some interesting things by basically going undercover into newsgroups and seeing what people were saying. What did she find out?

KEEFE: So this was in 1999. This is a year before the company claims that they learned about any of these problems. And she went into these newsgroups and started doing research into ways in which people were abusing the drug. And it turned out there were lots and lots of people online talking about that Contin coating and that if you crush the pill, then you can release the full dose of oxycodone all at once. And the people were doing that. You know, in some cases, they were abusing the pills just by not swallowing them whole but by just chewing them and swallowing them. Sometimes they would crush them up and snort them. Sometimes they would cook the powder in a spoon and inject them intravenously.

GROSS: And so it was being abused as a street drug?

KEEFE: Yes. I mean, I think there's a couple of different things going on. And it's important to make these distinctions because this is - has always been an element of the company and the family's defense. It was being abused as a street drug. It was also, though, being abused by people who were prescribed the drug in a doctor's care. So Purdue's defense when these problems started to arise was to say, look; there's two kinds of people. There's people who are legitimate pain patients who are prescribed the drug by a doctor. They take it to take care of their pain. And those people don't get addicted. That was what the company said. They said, in those instances, addiction, you know, it happens less than 1% of the time. And then, on the other hand, there are drug abusers. And these are just reckless, irresponsible people who will abuse, really, any drug. And so they've kind of - they've opportunistically taken our drug, taken this gift that we've given to the world and turned it on us and abused it.

GROSS: So this legal secretary who investigated how Oxy was being abused, she ends up being in chronic - I think it was back pain. And her boss at Purdue says, oh, you should take OxyContin. It'll really help you. She ended up getting addicted to Oxy. And then she was fired by the company.

KEEFE: Yeah, after 20 years.

GROSS: What do you make of that?

KEEFE: I think you see both sides of the coin in that story. I think that the willingness of the boss to recommend it to her shows their kind of faith in the drug - right? - that it was the drug for everyone. There was a sense that anybody with any kind of pain could take OxyContin, and it would be good for them. But then also the denial that you see, where people develop a problem and they immediately assume, well, look; you're the one with the problem. It's not the drug. It couldn't be the drug. It's got to be the person who's abusing it. And so in her case, she found that it wasn't lasting as long as she wanted it to. She had done all that research in the newsgroups, so she knew to crush the pills. And she started doing that. And eventually, it really took hold of her. And at that point, they fired her and showed her the door.

GROSS: Let's take a short break here. And then we'll talk some more. If you're just joining us, my guest is Patrick Radden Keefe, author of the new book "Empire Of Pain: The Secret History Of The Sackler Dynasty." We'll be right back. I'm Terry Gross. And this is FRESH AIR.

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GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Patrick Radden Keefe, author of the new book "Empire Of Pain: The Secret History Of The Sackler Dynasty." The Sackler family owns Purdue Pharma, which manufactures OxyContin, the pill that has been blamed for much of the opioid crisis. Patrick Radden Keefe first wrote about the Sacklers in The New Yorker. His previous book, "Say Nothing: A True Story Of Murder And Memory In Northern Ireland," won a National Book Critics Circle Award for nonfiction.

Purdue developed a different coating for OxyContin in an attempt to prevent people from abusing the drug by getting off the coating and then maximizing the hit of OxyContin. So it wouldn't be time released. It would be like an immediate high. It would be harder to crush and snort it or to cook it and inject it. Was this effective, this new version with the coating that you could not crush?

KEEFE: It was to one way of looking at things. So it did make it harder to abuse the drug. One of the former Purdue executives who I interviewed said that it was like - when you tried to crush it, it would turn into a gummy bear. So it was hard to snort. You couldn't dissolve it. And interestingly, the company - one of the things I discovered is that the company learned right away that it was working in a way, that this new formulation was harder to abuse. And the way they learned it is that their sales went down. So sales of what at the time was the strongest version of the drug, the 80 milligram pill, actually dropped 25% nationwide after the introduction of this reformulation. Which - you know, one way of looking at that, you say, isn't that great? Look at their commitment to doing the right thing and making this drug harder to abuse. The other way of looking at it is, whoa. So 25% of sales of that strongest pill were going to the black market effectively before the reformulation.

And there's another darker irony here, which is that when the reformulation comes in 2010, the original OxyContin had been on sale for nearly 15 years. So you have this huge community of people who have a dependency to opioids and who are counting on that drug. And what ended up happening was that a lot of those people who are no longer abusing OxyContin because it's harder to abuse or because it's gotten harder to access, end up moving on to other drugs. And one of the drugs that they move on to is heroin.

GROSS: And another is fentanyl.

KEEFE: And another is fentanyl, yes. And so you end up in this - it's quite an interesting ethical conundrum. The Sacklers today feel as though they have been really maligned by a lot of the press coverage and the congressional hearings and all of these lawsuits because they say, look, the opioid crisis today is a crisis of heroin and fentanyl, and we don't sell heroin and fentanyl. We never did. All we ever did was sell this FDA-regulated drug. At the same time, there have been studies on this, and there is a connection between OxyContin and heroin and fentanyl - that you had a market that was cultivated by Purdue - and grew and grew - of people who were abusing prescription pharmaceuticals. And then at a certain point, a lot of them transitioned or graduate to illicit opioids like heroin and fentanyl, which, as we know, are incredibly deadly.

GROSS: Paradoxically, for some people, heroin and fentanyl became easier to access and cheaper to buy than OxyContin.

KEEFE: Yes, for a couple of reasons - I mean, in part because I think slowly the American medical establishment and law enforcement began to dial back some of the overprescribing, so it did get harder for some people to get prescriptions. And you also had the reformulation of OxyContin in 2010. But I've interviewed people who've told me about going to see their dealer - their regular dealer - who would sell them black-market OxyContin pills and being told, listen, I don't have any Oxy for you, but I'll sell you a bag of heroin. And it's interesting 'cause when you talk to people who have been in this situation, these are sometimes people who, earlier in their life, they would say, I would never use heroin; I would never stick a needle in my arm. But what they tell you is, when you're in withdrawal from OxyContin, there's nothing you won't do to make that withdrawal go away.

GROSS: The Sackler family created a reputation as great philanthropists. What are some of the institutions that have a Sackler wing, a building or a wing named after the Sackler family because they contributed so much money?

KEEFE: Oh, well, there's the Metropolitan Museum of Art, the Guggenheim, New York University, Tufts University, Harvard University, Yale University, Columbia University, the Louvre in Paris, the British Museum in London, the Sackler Serpentine Gallery - which was actually renamed after them - the Tate Modern in London, Oxford University. I could go on and on.

GROSS: Yeah, which gives you a sense of how much money the Sackler family had or has. So there was a whole, like, secret enclave at the Metropolitan Museum of Art. And you know, the Sackler family - maybe it was more precisely Arthur Sackler - donated a lot of money to the Metropolitan Museum of Art in New York. The Met named a wing after the Sackler family. It was completed in 1978, opened with the famous King Tut exhibit. But Arthur Sackler also had a secret enclave at the Metropolitan Museum of Art. What was this about?

KEEFE: Yeah (laughter), this is a wild story. So Arthur was the first of the brothers to really break out into philanthropy in art collecting in a big way. And he did it in the '60s, and he started cultivating the Met. And the Metropolitan Museum in New York is this interesting institution because, on the one hand, it's very democratic and egalitarian in a way, in the sense that they don't charge admission. They didn't then, and anybody can go. And so the idea is that it's this real public institution. On the other hand, for the super elite, it is this ultimate kind of feather in your cap, the idea that you would you would become a trustee of the Met, that your name would be on a wing of the Met. And so Arthur developed this very close relationship - but a fraught one - with the museum, cultivating different directors of the Met.

And one of the things that he wanted was a space inside the museum that would be his own personal storage space, basically, for his art collection, which he called the Enclave. It was his Enclave inside the Met. They gave it to him. They didn't charge him any rent for it. He had the keys. And he allowed his own personal curators to come and go. A lot of people who worked at the museum didn't even really understand the relationship, didn't know what was happening in that space. And so it was one of these kind of exotic little perks that people like Arthur Sackler come to enjoy.

GROSS: Well, the New York attorney general launched an investigation into the Sackler Enclave. Why?

KEEFE: Well, I think there were questions about a public institution offering that kind of prerogative to a private individual and whether such a thing should be done at all. And if it should be done, should it be done in such secrecy? It's funny. Arthur at the time was not implicated with any wrongdoing, and he claimed that it had all been the Met's idea. I tend not to believe that because something I found in a different set of archives is that he had a similar relationship with the Museum of the American Indian, where he also got his own private enclave. So I think this was a thing he did.

But in the backdrop, what was happening here was this interesting phenomenon when it comes to public institutions and the people who give them money, which is that the Met was going to give Arthur pretty much anything he asked for because they were hoping he would leave his whole collection to them. And you see this phenomenon play out again and again, where you get wealthy donors who give to museums and universities, but they enjoy a range of perks that go well beyond what they actually donate because these institutions are trying to keep them happy in the hopes that they'll donate more in the future. And so that's what happened with Arthur is the museum really wanted to please him and said, OK, you want an Enclave? You got an Enclave. Just leave your collection to us. And the irony is it didn't work out that way.

GROSS: No. I mean, what happened was he made a deal with the Smithsonian.

KEEFE: A museum named after him.

GROSS: Yeah, a museum named after him. And then the Smithsonian took some of the stuff from the Enclave, moved it out of the Met and into the Smithsonian. So not only didn't the Met inherit his collection, the stuff that he stored, some of the art and artifacts that he stored there was moved out.

KEEFE: Not just some of it, but all the best of it. I mean, there's this humiliating scene where...

GROSS: Oh, all of it? (Laughter) OK.

KEEFE: ...Where this team of curators from the Smithsonian, you know, this rival museum, file into the Met into the Enclave where the Met has been storing Arthur's stuff free of charge all these years. And they just pick out all the best stuff and cart it away to Washington.

GROSS: So we should mention here that a lot of the institutions that had the Sackler name on a building or a wing of the building have taken the Sackler name off because of all that we've learned about OxyContin and the opioid crisis and how the Sacklers knew more than they said they did about how addictive it was.

KEEFE: Yeah. You've seen a slow process just in recent years as there's been more scrutiny of the family and their role in running this company and deriving profits from this drug. And obviously, as the opioid crisis has intensified with, you know, roughly a half a million Americans having died in recent decades, you've started to see some of these institutions back away. Initially, they would say, look, we're not going to take any future money from the Sacklers, but we will leave their names from past gifts up.

And then one by one, really, starting with Tufts University, you started to see some institutions actually take the name down. So Tufts did, the Louvre did in Paris quite recently. New York University did - took the Sackler name off of a whole series of institutions. And it's a question now whether, for instance, the Sackler Wing at the Met will continue to be called the Sackler Wing or whether the Metropolitan Museum will reconsider.

GROSS: Well, let's take another break here. If you're just joining us, my guest is Patrick Radden Keefe. His new book is called "Empire Of Pain: The Secret History Of The Sackler Dynasty." We'll be right back. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Patrick Radden Keefe, author of the new book "Empire Of Pain: The Secret History Of The Sackler Dynasty." The Sackler family owns Purdue Pharma, which manufactures OxyContin, the pill that has been blamed for much of the opioid crisis.

Purdue Pharma and the Sackler family are facing over 2,500 lawsuits combined, might be closer to 2,600 by now.

KEEFE: I think so, yeah.

GROSS: And these are cases brought against them by states, cities, towns, hospitals, insurance companies. One of the Sackler legal strategies has been to have Purdue declare bankruptcy. Why has that been a strategy?

KEEFE: So OxyContin is has been a fantastically profitable drug. It's generated some $35 billion in revenues since its introduction in the 1990s. And what's happened is just in the last few years, you've had this gathering storm of lawsuits seeking to hold initially just the company, Purdue Pharma, but then eventually the family as well, responsible. And Purdue and the Sacklers did this really interesting thing where the Sacklers at a certain point put the company into bankruptcy because they had been taking so much money out of the company for so many years, and it was now facing all these lawsuits. And so, you know, the company ends up with something like a billion dollars in cash and assets and, the Sacklers put it into bankruptcy.

They don't declare bankruptcy themselves. And in fact, we know from their own records they've taken more than $10 billion out of the company really over the course of just a decade or so. So it's this strange situation in which the company is bankrupt. The family financially is doing just fine. And really, the reason the company is bankrupt is because they've kind of looted their own corporation. There's this added irony too which is that - because of the bankruptcy, when a business is in bankruptcy, what will happen is the bankruptcy judge will say there may be a lot of lawsuits against this business, but I'm going to freeze all those lawsuits while we sort out the bankruptcy.

So the Sacklers and Purdue said, OK, but can you also protect the family from lawsuits? 'Cause there are a lot of states - for instance, about roughly half of the states are suing the Sackler family themselves, members of the family that served on the board. And they want to keep going with their lawsuits. They say, OK, if we can't sue the company, at least we could sue the family. But the judge in the bankruptcy court said, no, I'm going to protect the family as well, even though the family hadn't declared bankruptcy.

GROSS: And the family has a lot of their money hidden in tax havens and all kinds of tax shelters and LLCs, so - and those are pretty secretive.

KEEFE: Yeah, we don't - the - Letitia James, who is the attorney general of New York, has been trying to get to the bottom of, you know, where is the money? How much of it is there? If they deliberately removed it from the company, knowing that one day they would be facing lawsuits, is that a form of fraud? She's been trying to figure that out. And it's been really hard to get a complete picture of where that money is 'cause a lot of it is offshore, as you say. It's - you know, it's in places like Switzerland and the Channel Islands and various accounts and trusts. It's kind of deliberately been obscured and, I think, will be very difficult for the authorities to track down.

GROSS: So facing all of these lawsuits, one of the things that the Sacklers did is go directly to the Trump administration to try to get their help. Did they get help? And what kind of help was it?

KEEFE: They sure did. I mean, you have to remember that this is a crime story. So Purdue Pharma, this company that they own and have profited from so handsomely, pled guilty to federal charges in 2007 that they had fraudulently marketed OxyContin. And the story was always that after 2007, they cleaned up their act. They got on the straight and narrow, that they never did anything like that again. But the truth was that, actually, they expanded their sales force after 2007 and continued to do a lot of the same stuff that had gotten them in trouble in the first place.

And in the last couple of years, there have been multiple different federal criminal investigations of the company. What I learned in my reporting was that you had these different investigations, and what the family and the company wanted to do was make a deal and that, at the Justice Department, you had some career prosecutors who thought that they really needed to crack down hard on Purdue and on the Sacklers because there had been, you know, this pretty bad conduct. It was quite recent. And they're kind of recidivists, if you think about it, right? They already got busted once and then continued to do some of the bad stuff that they had done in the past.

But what ended up happening is that there was a rush in the final days of the Trump administration to get this case sorted out. The way it was explained to me was somebody said, you know, they want to wind this thing up and with a soft touch. And so you ended up in a situation in which there was a deal where Purdue pled guilty to a new set of federal criminal charges, and the Sacklers agreed to pay a fine of over $200 million to settle civil charges. But they wouldn't agree to admit any wrongdoing, and no executives from the company were charged or even named. So you end up in this weird situation where the company pleads guilty, but there's no human individual who could be said to have done anything wrong. I say in the book, it's like the company's a driverless car.

GROSS: Let me introduce you here. If you're just joining us, my guest is Patrick Radden Keefe. His new book is called "Empire Of Pain: The Secret History Of The Sackler Dynasty." We'll be right back. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Patrick Radden Keefe, author of the new book "Empire Of Pain: The Secret History Of The Sackler Dynasty." The Sackler family owns Purdue Pharma, which manufactures OxyContin, the pill that has been blamed for much of the opioid crisis.

Where do things stand now in all the lawsuits against the cyclers?

KEEFE: So the end game is really going to play out in the next couple of months. You have 2,500 lawsuits against the company and the family, and there's a bankruptcy which has frozen all those lawsuits. And what the Sacklers and Purdue are hoping is that the bankruptcy will kind of resolve everything all at once, that the different states that are suing the family and the company can be persuaded or, actually, forced by this bankruptcy judge to set aside their cases, that the Sacklers would make a contribution of about $4.25 billion, that that money would be used to address the opioid crisis.

And then you get into this really strange thing, which is that what they want to do is turn Purdue Pharma into a public company, basically a public benefit company, a trust, which will continue to sell OxyContin and use the profits from the sale of OxyContin to address the opioid crisis, this epidemic that OxyContin helped to start. And about half of the states that are suing are OK with that deal. They like that deal. And another half really don't, and they think it's not enough. They think that while the Sacklers might be willing to pay $4 billion, they'll be walking away with much more and that it's not enough, that they should have to give more. And they want to be able to continue with their lawsuits.

There's one really interesting kind of curveball that's come in just in recent weeks, which is that Carolyn Maloney, who's a congresswoman from New York has introduced a piece of legislation in the House of Representatives called the Sackler Act. And what it would do if it passed is say that the judge in the bankruptcy court is not able to protect the Sackler family themselves from future lawsuits, that he can protect the company because the company has declared bankruptcy. But the family hasn't declared bankruptcy. And so what it would say is he's not in a position to say - to basically give the Sacklers a permanent get-out-of-jail-free card. And if that legislation gets any traction, it could really change the game. It could mean real accountability for the Sacklers and not a situation in which, at some point in the coming months, that bankruptcy deal is approved and that they walk away, basically, you know, with a great fortune and a protection from future lawsuits and a family name that's in tatters.

GROSS: One of the things you write about in your book about Purdue and the Sackler family is how the Sacklers have tried to stop investigative reporting that would reflect negatively on them. Did the Sackler family try to stop you from publishing your book?

KEEFE: Yeah. They've really thrown a lot of energy into trying to thwart this project from its very inception. They hired a lawyer, who's been sending me legal threats since before I started writing, actually. I've gotten a lot of letters. They've, you know, told me that they may very well sue. They've told me I shouldn't destroy any documents because everything - I should preserve everything because it's going to be evidence in the eventual lawsuit. I had a moment last summer where my house was being staked out by a private investigator. You know, I can't say for sure that the Sacklers sent him. But I can tell you I wasn't working on any other projects at the time and that when I asked them, actually, in a request for comment whether they were responsible for this, they declined to comment. They didn't respond one way or the other. And part of what I find so intriguing about this is these are tactics they've used for years. I - one of the stories I tell in the book is about how Barry Meier, a New York Times reporter who was really one of the first to break the story about how OxyContin was not as great as the company had cracked it up to be, he dealt with these same types of threats 20 years ago. And so there's a continuity in their tactics, this tendency to throw their weight around and try and control the narrative.

GROSS: Now that your book is published and it's getting terrific reviews, are you continuing to hear from Purdue Pharma?

KEEFE: Not from Purdue, but from the Sacklers, yes. Their lawyers...

GROSS: Oh, directly from the Sacklers. Oh, OK.

KEEFE: Yeah. I mean, well, not directly from them, but from their lawyers, certainly.

GROSS: From their lawyers, from Sackler lawyers. Yeah.

KEEFE: Yes. They continue to - I mean, I think about a week ago was the last time we got a letter. They've been very consistent. I mean, they're very unhappy with the book. But they - you know, none of the Sacklers would give me interviews. And when I sent all of my pretty precise fact-checking queries about the stuff that's in the book, they basically boycotted the process. They refused to confirm or deny or comment on the many, many queries that I had. So yeah, (laughter) they're pretty persistent.

GROSS: Patrick Radden Keefe, thank you so much for talking with us.

KEEFE: Oh, thank you. It's been a pleasure.

GROSS: Patrick Radden Keefe is the author of the new book "Empire Of Pain: The Secret History Of The Sackler Dynasty." Tomorrow on FRESH AIR, we'll talk with the host of the podcast "Resistance," Saidu Tejan-Thomas Jr. Last summer, when the George Floyd protests started, he thought of himself as a former protester who despaired it wasn't much use fighting anymore. He had a close friend from college who was killed by an officer. Instead of marching last summer, he started reporting on people leading protests and how their lives were being changed. And that's what most episodes of "Resistance" are about. Tejan-Thomas Jr. grew up in Sierra Leone during the civil war and came to the U.S. when he was 8. I hope you'll join us.

FRESH AIR's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Ann Marie Baldonado, Thea Chaloner, Seth Kelley and Kayla Lattimore. Our associate producer of digital media is Molly Seavey-Nesper. Roberta Shorrock directs the show. I'm Terry Gross.

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