This is not a book about America's opioid epidemic. I think it's important to make that clear: the opioid epidemic is a complex phenomenon, with a lot of moving parts, and the mainstream media hasn't done an especially great job helping the public understand it. This book isn't fixing that. In some ways, it probably contributes to some of the more damaging misrepresentations of the issue.* The real focus of this book is the Sackler family, and, basically, what craven, awful people they are. Truly. You get the sense that Keefe really tried to be neutral, but gradually became so appalled by Sacklers that he just couldn't be, anymore. Simply detailing the facts already paints a pretty devastating portrait, but actually expressing to readers what some of the implications of these facts, it becomes impossible not to sound like you're attacking them. The effect is exacerbated if you listen to the audiobook, read by the author — there's no way he could have kept it out of his voice.
I read the book mainly because I loved Keefe's previous book, Say Nothing, so much (if you haven't read it, get yourself a copy asap; it's phenomenal). And it must be admitted that this one really isn't as good. It's somewhat sloppy, with lots of minor repetitions (where he tells you something damning, with a kind of DUN-DUN-DUN air, and then awhile later, tells you the same thing again). The timeline is mostly straightforwardly chronological, but once you get into the third generation, it gets a little fuzzier, and it also gets much harder to keep the various people straight (especially because the family recycles first names). And the unwavering focus on greed and ambition — while laudable in some ways! — leaves little room for a more detailed character exploration. In particular, I wanted to know more about the family's interests in fine art. Keefe somewhat suggests that it's motivated by a desire for prestige and respect, but I wanted to know more. Of course, the material for such a profile might not have been readily available. Still, at times, I wanted less of a chronicle of what they were doing, and more insight into who these people were, or are. But honestly, despite these flaws, the material is so juicy and salacious that the book is a gripping read anyhow.
The thing I ultimately found most fascinating was the role that artists, and performance art-style protests, had in the family's decline. Nan Goldin becomes a minor hero by the end of the book, and seems to have been the most formidable force in ending the cozy relationship the Sacklers had with many museums. This is a super interesting insight into the complex relationship between art itself and the high-powered, extremely wealthy, art world. You *can* buy some measure of success and acceptance in the art world! But only up to a point. It turns out that museums care more about their reputation than their donors.
Ultimately, this is really a kind of pleasurable hate-read. You gain some insight into the crisis, sure — and you definitely get some insight into politics and the power of corporations (horrifying) — but mostly, this is about channeling your vitriolic hatred in a worthy direction.
* A lot of the narrative about the epidemic has been about the individual people struggling because of their drug use, or about the potency of the drugs they're taking, or maybe about the evils of Purdue pharma, and very little of it has been about the way our society treats drug users, and how criminalization of drugs invariably leads to a lot more injury and death. Keefe acknowledges this, a little, at the end of the book, where he not only says that the book doesn't get into the intricacies of the epidemic, but also notes that he does not weigh in on controversies over how chronic pain should be managed. He makes two points which are both important and valid — first, that there is a genuine stigma attached to long-term opioid use, and that it means that people who struggle with chronic pain also struggle to receive proper care. Second, the Sackler clan has callously exploited this fact to sell more oxycontin and make more money, and we shouldn't give them a pass on that. The book very clearly demonstrates the latter, but only glancingly mentions the former. It would be easy to walk away from it with a sense that the major problem is the potency of the drugs, and increased access to them.
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