The scandal of OxyContin, the painkiller that caused untold pain

Last week I was staying in a cool hotel in the middle of San Francisco. When I walked out to find coffee in the morning, I came across a man with his trousers lowered as he injected himself in the groin. An older fellow nearby used the street as a toilet, adding to the human excrement on the pavement. A woman lay crashed out, hair matted over her face in the heat. Returning later in the day, passing the clusters of tents and people chasing dragons from foil, I was asked: ‘Do you want anything?’

These disturbing scenes of human despair were beside a smart shopping mall in the city with the most billionaires per capita on the planet. San Francisco saw almost three times as many people killed last year by fentanyl — the ultra-potent opioid many times stronger than heroin — than who died from Covid. And this superb exposé points the finger of blame squarely at one family: the Sacklers, who became unbelievably rich while hiding behind the facade of their private firm and seeking to launder their name with donations to art galleries, museums and universities.

The saga of America’s opioid epidemic is familiar now — even if many folk still fail to understand the full horrifying extent of the devastation, let alone how this tragic whirlwind was sparked by doctors doling out medication. There have been almost a million overdose fatalities since Purdue Pharma launched OxyContin, its supposedly safe pain relief drug, in 1996 — and the number surges each year. Yet the strength of Patrick Radden Keefe’s forensic dissection, based on dozens of interviews and the mountain of documents from court cases, is to turn a harsh spotlight on that secretive family who fostered the use of potent opioids for minor ailments, made a fortune and fuelled the addiction catastrophe.

The author’s style is recognisable after his previous book, the deservedly prize-winning Say Nothing, used a traumatised family to explore the Troubles in Northern Ireland.